Gaku Kawabata

Comparison of surgical stress between laparoscopy and open surgery in the field of urology by measurement of humoral mediators

Background: Recently, laparoscopic procedures have become more common in urological surgery, and are suggested to be less stressful compared with open surgery; however, little data on objective evaluation of surgical stress after laparoscopic surgery are available. The objective of this study was to compare surgical stress between laparoscopic and open surgery in the field of urology by measurement of humoral mediators.

LONG-TERM EXPERIENCE WITH ORTHOTOPIC RECONSTRUCTION OF THE LOWER URINARY TRACT IN WOMEN

PURPOSE We investigated the long-term outcome of orthotopic neobladders in women. MATERIALS AND METHODS At our institutions 8 women have undergone lower urinary tract reconstruction with an orthotopic neobladder and have been followed for more than 4 years. After urethral sparing cystectomy the neobladder was constructed and connected to the native urethra. Late complications were analyzed, and voiding function was evaluated by a pressure flow micturition study and bead-chain cystourethrography. RESULTS No late complications related to the surgery were noted. Of the 8 patients 7 were completely dry day and night. Four patients with ileal neobladder required clean intermittent catheterization, and hypercontinence might have been caused by downward migration of the neobladder and reduced neobladder pressure at voiding. No recurrence in the native urethra was noted, and all patients were satisfied postoperatively. CONCLUSIONS These results of orthotopic neobladder in women are encouraging. Overall patient satisfaction was excellent. An international collaborative study is necessary to achieve the number of patients required to determine the ideal orthotopic neobladder for women.

Feasibility and usefulness of laparoscopic radical prostatectomy: Kobe university experience

Objectives: The objective of this study was to present the clinical outcomes of 26 patients who underwent laparoscopic radical prostatectomy at our institution.

Incidence of Local and Port Site Recurrence of Urologic Cancer After Laparoscopic Surgery

OBJECTIVES To determine the incidence of dissemination and port site metastases in patients undergoing laparoscopic surgery for urologic cancer. METHODS From June 1992 to August 2005, 459 laparoscopic procedures were performed, 304 of which were for cancer. These included 162 radical prostatectomies, 67 radical nephrectomies, 20 partial nephrectomies, 45 nephroureterectomies, 5 retroperitoneal lymph node dissections of testicular cancers after chemotherapy, 3 radical cystectomies, and 2 other procedures. No patients without a histologic diagnosis of cancer were included in this study. RESULTS Of the 304 patients with cancer, 4 (1.3%) developed a local recurrence, including after retroperitoneal lymph node dissection in 2 patients, radical nephrectomy in 1, and radical cystectomy in 1. No port site metastases were observed. The histologic type of both testicular cancers was mixed germ cell tumor, with one occurring in a renal hilar lymph node and the other in a paraaortic lymph node and kidney. The histologic type of the renal cell carcinoma was papillary renal cell carcinoma with sarcomatoid features (Stage pT3aN1), and it occurred in a retrocaval lymph node. The histologic type of the bladder cancer was transitional cell carcinoma, Grade 3, Stage pT4aN0, and it presented as peritoneal carcinomatosis 11 months postoperatively. CONCLUSIONS The incidence of recurrence in our series was closely correlated with the range in previous reports. However, two recurrences were found in 5 patients who had undergone retroperitoneal lymph node dissection for testicular cancer after chemotherapy. Therefore, we should be careful when determining the indications for laparoscopic surgery in such patients.

Extraperitoneal laparoscopic retroperitoneal lymph node dissection in supine position after chemotherapy for advanced testicular carcinoma.

Aim:  To evaluate the feasibility and usefulness of extraperitoneal laparoscopic retroperitoneal lymph node dissection (RPLND) in the supine position after chemotherapy for advanced testicular carcinoma

Automated urinalysis. Evaluation of the Sysmex UF-50.

We assessed the Sysmex UF-50 for reproducibility of results and carryover rate by performing between- and within-run precision analyses on 315 urine samples, evaluated the feasibility of using the UF-50 to measure urinary cellular and noncellular components by comparing results from the UF-50 with results of manual urinalysis using the Kova system, and performed side-by-side comparison of the within-run reproducibility from the UF-50, the UF-100, and the Kova system. Results from the UF-50 and UF-100 were highly reproducible, and the carryover rate was 0.5% or less for the urinary components. In between-run precision assays, the coefficients of variation for UF-50 results for all cellular components were less than 10%. The agreement (gamma statistics) between values from the UF-50 and the Kova system was excellent for RBC, WBC, and bacterial counts. The cell counts from the UF-50 for RBCs, WBCs, epithelial cells, and bacteria were 52%, 63%, 54%, and 110%, respectively, of those measured by manual urinalysis. The UF-50 performed quantitative analysis in 72 seconds, compared with 330 seconds for manual methods. The UF-50 is suitable for the first screening to detect hematuria, pyuria, and bacteriuria.

Assessment of availability of magnetic resonance angiography (MRA) in renal arteriovenous fistula

We report two cases of cirsoid-type renal arteriovenous fistula (RAVF) which were difficult to differentiate from renal pelvic tumor by intravenous pyelogram (IVP) and computed tomography (CT) scan. Two women visited our department complaining of sudden asymptomatic macroscopic hematuria. CT scans showed an irregular mass in the right kidney. Magnetic resonance angiography (MRA) revealed a cirsoid-type RAVF. These patients were treated with transarterial embolization (TAE) using ethanol, geratin sponge, and a coil. It is suggested that MRA is useful for the diagnosis of renal arteriovenous fistula.

Posterior approach for retroperitoneal laparoscopic bilateral nephrectomy in a child.

We report on a unique posterior approach for bilateral nephrectomy by retroperitoneoscopy that was conducted in a 13-year-old boy with end-stage renal disease managed by peritoneal dialysis. A posterior approach for bilateral nephrectomy by retroperitoneal laparoscopy provided adequate visualization and created enough working space for the manipulation. The procedure was performed during a short period, and the patient did not need to be repositioned. Retroperitoneal laparoscopic bilateral nephrectomy is a useful option in school-aged children with poorly functioning kidneys, particularly those children also undergoing peritoneal dialysis.

Oncological outcome of laparoscopic prostatectomy.

Aim:  Oncological outcomes including surgical margin status and biological progression‐free survival (bPFS) were analyzed in patients who underwent laparoscopic prostatectomy (LRP) only.

Usefulness of Ureteropyeloscopy for Diagnosis of Upper Urinary Tract Tumors

BACKGROUND Upper urinary tract tumors have historically been diagnosed using urinary cytology examination and radiography. As the technique and instrumentation of ureteroscopic inspection and biopsy have advanced, ureteroscopic examination has become more routine. We studied the applicability and safety of using ureteropyeloscopy to diagnose upper urinary tract tumors. PATIENTS AND METHODS Between January 1994 and October 1999, 50 patients at Kobe University Hospital underwent ureteropyeloscopy for suspected upper urinary tract tumors. RESULTS The sensitivity values of radiography, urinary cytology, and ureteroscopy were 96%, 60%, and 92%, respectively. The specificity values of the three procedures examination were 12%, 84%, and 88%, respectively. No major complications or dissemination of malignant cells were evident. CONCLUSION Ureteroscopic examination is a safe, sensitive, and specific means of detecting upper urinary tract tumors.