Atsuko Fujihara

Technique for a hybrid system of real-time transrectal ultrasound with preoperative magnetic resonance imaging in the guidance of targeted prostate biopsy.

Diagnostic magnetic resonance imaging (MRI) for prostate has achieved increasingly higher levels of accuracy. Because real‐time MR‐guided targeted biopsy is still a complicated and expensive procedure, there is considerable interest in a technique of MR/transrectal ultrasound (TRUS) hybridized image‐guided biopsy. However, because the 3‐D shapes of the prostate at the time of image‐acquisition at preoperative MRI are likely to be different from the intra‐operative TRUS images, the precise registration of each 3‐D volume data is critical. To reduce the potential errors in registration of TRUS with MRI, we introduce new procedural techniques in a rigid image fusion technique. First, preoperative MR images were obtained with a specifically‐made plastic outer‐frame, with exactly the same shape as the real TRUS probe, placed in the rectum, in order to simulate the deformation of the prostate caused by the absence or presence of a TRUS probe during the acquisition of MR or TRUS images. Second, instead of using a single plane of longitudinal image, we applied biplane TRUS images to be shown in parallel on a multiplanar display with corresponding reconstructed MRI, in order to register both horizontal and longitudinal images of the prostate simultaneously, thereby achieving improved 3‐D anatomical matching.

Naftopidil versus tamsulosin hydrochloride for lower urinary tract symptoms associated with benign prostatic hyperplasia with special reference to the storage symptom: A prospective randomized controlled study

Objectives:  In order to compare the clinical efficacy of naftopidil (Naf) and tamsulosin hydrochloride (Tam), which differ in their selectivity to alpha receptor subtypes, we performed a multi‐center prospective randomized controlled study.

Neuroselective measure of the current perception threshold of A‐delta and C‐fiber afferents in the lower urinary tract

Sensory dysfunction could be involved in various pathogeneses in the lower urinary tract including neurogenic bladder, overactive bladder, painful bladder syndrome and neuropathy as a result of endocrine disorders. The ability to diagnose sensory function more objectively is of increasing interest to clinicians. Afferent innervations of the lower urinary tract involve myelinated (A‐delta) and unmyelinated (C) fibers. The Neurometer (Neurotron, Baltimore, MD, USA) is the only reported commercially available device to evaluate afferent function by selectively depolarizing different subpopulations of afferent nerves, with 250 Hz activating A‐delta fibers and 5 Hz activating C‐fibers, to determine their current perception threshold (CPT) as a quantitative measure. Recently, increased evidence has suggested that measurement of CPT values of A‐delta and C‐fibers in the lower urinary tracts is feasible and shows significant correlation with clinical symptoms and conventional urodynamic variables, as well as the efficacy of various treatments. However, there are still controversial issues in the wider use of this technology in diagnosis and assessment of the therapeutic effectiveness of sensory dysfunction in the lower urinary tracts. In order to resolve the remaining challenges in the CPT test of the lower urinary tract, recent efforts include development of a new balloon‐type electro‐catheter with dual electrodes as an alternative sensory test for the bladder or urethra, which allows simultaneous performance of conventional urodynamic tests and urine collection, and future standardized techniques available for comparison with validated control values.

Laparoendoscopic single-site versus conventional laparoscopic pyeloplasty: a matched pair analysis.

To compare the outcomes of laparoendoscopic single‐site pyeloplasty versus those of conventional laparoscopic pyeloplasty.

Comparison of diameter-axial-polar nephrometry and RENAL nephrometry score for treatment decision-making in patients with small renal mass

IntroductionThe aim of this study was to evaluate our institution’s experience in performing laparoscopic radical nephrectomy (LRN) and partial nephrectomy (PN) in patients with small renal masses.Methods142 patients with cT1aN0M0 lesions were identified. 68 of these subjects were treated with LRN and 74 were treated with laparoscopic PN (LPN). The clinicopathological characteristics of the two groups of patients, including diameter-axial-polar (DAP) nephrometry and RENAL nephrometry score (RENAL-NS), operative results, and outcomes, were retrospectively analyzed.ResultsA multivariate logistic regression analysis for the selection of PN as the treatment showed that tumor size, DAP nephrometry, RENAL-NS and imperative condition were all independent factors. The area under the curve receiver operating characteristics (ROC-AUC) of DAP and RENAL-NS for performing LPN were 0.897 and 0.825, respectively.ConclusionsAlthough LRN was performed in patients with a high nephrometry score in this study, open partial nephrectomy (OPN) should be considered for patients with a high nephrometry score in T1a renal cell carcinoma (RCC) because of better functional and similar oncological outcomes. Based on ROC analysis, when DAP is 6 or less, LPN should be considered and when DAP is 7 or more, OPN should be considered.

Initial experience of combined use of photodynamic diagnosis and narrow band imaging for detection of flat urothelial lesion.

BackgroundThis preliminary study is the first report to compare photodynamic diagnosis (PDD) with narrow band imaging (NBI) in the same patients with flat urothelial lesions suspicious of carcinoma in situ (CIS) of the bladder.MethodsBetween November 26, 2012 and April 1, 2013, 10 patients underwent transurethral resection of bladder tumor using PDD and NBI simultaneously because of suspicion of CIS. The bladder was mapped first under white light (WL), then under NBI, and subsequently under blue light in odd-numbered patients. The bladder was mapped first under WL, then under blue light, and subsequently under NBI in even-numbered patients. Biopsies were carried out from all suspicious areas, noting whether NBI, PDD or both detected lesions. Random cold cup biopsies from healthy mucosa of bladder were performed from lesions negative on PDD and NBI.ResultsThe sensitivity and specificity of PDD for detection of CIS and dysplasia were 0.916 and 0.827, respectively. The sensitivity and specificity of NBI for detection of CIS and dysplasia were 0.625 and 0.879. The area under the curve (AUC) for detection of CIS and dysplasia was 0.872 with PDD and 0.752 with NBI. The AUC with combined use of PDD and NBI was 0.918. There was no cancer or dysplasia identified in 43 lesions that were both PDD- and NBI-negative.ConclusionWhen both PDD and NBI are negative, the possibility of CIS or dysplasia might be very low. The usefulness of the combination of PDD with NBI was suggested in this study.

Laparoendoscopic Single-Site Surgery for Pediatric Urologic Disease.

BACKGROUND Laparoendoscopic single-site surgery (LESS) was performed for 31 cases of pediatric urologic disease in our department. OBJECTIVE A retrospective chart review was performed on pediatric patients who underwent LESS. DESIGN, SETTING, AND PARTICIPANTS Procedures included pyeloplasty (21), nephrectomy (4), varicocele ligation (3), orchiectomy (1), orchiopexy (1), and removal of female genitalia (1). In all 31 cases, an incision of 15 to 20 mm was made in the umbilical region, and a port for LESS was put in place. A 5-mm flexible scope and 5-mm forceps with a bending tip and regular laparoscopic forceps (3, 5 mm) were used. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Intraoperative and postoperative outcomes were evaluated. RESULTS AND LIMITATIONS For the 21 patients with pyeloplasty, the mean operation time was 240 minutes. Postoperative renal pelvis dilatation was relieved in all patients. For the 4 patients with nephrectomy, the mean operation time was 128 minutes. Postoperative urinary incontinence disappeared in all patients. The mean operation time of varicocele ligation was 73 minutes. Postoperation, varicocele disappeared and there was no testicular atrophy. The operation times of orchidectomy, bilateral orchidopexy, and removal of female genitalia mutilation were 60, 170, and 189 minutes, respectively. In all cases, there were no intraoperative or postoperative complications. CONCLUSIONS The advantages of LESS include superior aesthetics with a smaller scar and less pain. LESS is considered as a less burdensome surgery for pediatric patients.

Urge Perception Index of Bladder Hypersensitivity

PURPOSE By analyzing bladder diaries with patient self-reported urinary perception grades, we developed the urge perception index, a quantitative measure of bladder hypersensitivity. We evaluated the impact of the urge perception index on the definition of overactive bladder severity. MATERIALS AND METHODS We retrospectively evaluated the records of 69 female patients who visited our outpatient clinic with the complaint of storage symptoms. Patients were asked to complete the overactive bladder symptom score and a 3-day bladder diary with self-reported grading of urinary perception on a range of 1 to 5 per void. Overactive bladder was diagnosed in 43 patients and nonoveractive bladder was diagnosed in 26. The urge perception index was defined as voided volume divided by the urinary perception grade at each void. RESULTS We analyzed 1,578 reported voids. According to the urinary perception grade, urge perception index values for overactive bladder were significantly lower than those for nonoveractive bladder (grades 1 to 4 p <0.001). The average ± SD urge perception index in 3-day bladder diaries was lower in overactive than in nonoveractive bladder cases (55 ± 28 vs 133 ± 73, p <0.0001). The most severe (lowest) single urge perception index value during the 3 days was significantly lower in patients with overactive than with nonoveractive bladder (mean 20 ± 12 vs 62 ± 40, p <0.0001). There were negative linear correlations of the urge perception index with total overactive bladder symptom scores (r = -0.598, p <0.0001) and with an urgency symptom score (r = -0.557, p <0.0001). CONCLUSIONS The urge perception index, an integrated parameter of patient reported bladder perception and voided volume, could be promising to quantify the severity of overactive bladder or bladder hypersensitivity by bladder diary analysis.

CNPY2 promoted the proliferation of renal cell carcinoma cells and increased the expression of TP53

Renal cell carcinoma (RCC) is the most common type of kidney cancer. However, the mechanisms underlying the progression of the disease are not well understood. The data in this report suggest that canopy FGF signaling regulator 2 (CNPY2) is a promoter of RCC progression. We found that CNPY2 significantly promoted growth of RCC cells and upregulated TP53 gene expression. Although TP53 is widely known as a tumor suppressor, in RCC TP53 promoted tumor cell growth. A typical p53 target gene, CDKN1A, was upregulated by both p53 and CNPY2 in RCC cells, suggesting that CNPY2 increased the expression level of TP53. Consistent with these results, CNPY2 and TP53 expression levels were positively correlated in RCC patients. These findings suggested that CNPY2 promoted cancer cell growth in RCC through regulating TP53 gene expression.

Importance of continuous sequential chemotherapy and multimodal treatment for advanced testicular cancer: a high-volume Japanese center experience.

AbstractPatients with “difficult-to-treat” advanced testicular cancer can require multiple therapies. We retrospectively assessed our patients with advanced germ cell tumors (GCTs) and characterized the clinical efficacy, outcomes, and factors affecting overall survival (OS).Two hundred fifty-three patients with advanced GCTs were treated at Kyoto Prefectural University of Medicine, Kyoto, Japan, from June 1998 to September 2013. Of 253 patients, 142 patients had salvage chemotherapy.As first-line therapy, bleomycin, etoposide, and cisplatin, and etoposide and cisplatin therapies were performed in 234 cases (92.5%). As second-line therapy, etoposide, ifosfamide, and cisplatin/vinblastine, ifosfamide, and cisplatin, and paclitaxel, ifosfamide, and cisplatin/paclitaxel, ifosfamide, and nedaplatin therapies were carried out in 44 and 59 cases, respectively. Furthermore, 111, 72, 44, and 28 cases had third, fourth, fifth, and sixth-or-later-line chemotherapy, respectively. Five-year OS rate stratified by chemotherapy line was 95.5% in the first line, 89.4% in the second line, 82.1% in the third line, 45.1% in the fourth line, and 58.9% in the fifth or after line. A statistical significant difference was found when comparing fourth-or-after-line versus first to third-line therapy. Additional procedures were performed, including retroperitoneal lymph node dissection (RPLND) (n = 168), extra-RPLN resection (n = 114), and external beam radiotherapy/stereotactic radiotherapy (n = 78).Multivariate analysis showed that factors predicting better outcomes were in serum tumor marker (STM) normalization, RPLND, and extra-RPLN resection.Good outcomes were obtained in patients who completed chemotherapy up to third line. After fourth-line chemotherapy, approximately 50% of “difficult-to-treat” patients could be cured with normalization of STM levels and residual mass resection. Continuous or sequential chemotherapy with multimodality therapy is important for patients with “difficult-to-treat” advanced GCTs. Effective chemotherapy after third line should be developed.