Hideaki Izumi

Urinary straining contributes to inguinal hernia after radical retropubic prostatectomy

To verify whether abdominal pressure during urination represents an important factor in the postoperative development of inguinal hernia after radical retropubic prostatectomy.

Phosphodiesterase type 5 inhibitor administered immediately after radical prostatectomy temporarily increases the need for incontinence pads, but improves final continence status

Purpose To evaluate the effects of phosphodiesterase type 5 inhibitor (PDE5i) on urinary continence recovery after bilateral nerve-sparing radical prostatectomy (BNSRP). Materials and Methods Between 2002 and 2012, 137 of 154 consecutive patients who underwent BNSRP in our institution retrospectively divided into 3 groups that included patients taking PDE5i immediately after surgery (immediate PDE5i group, n=41), patients starting PDE5i at an outpatient clinic after discharge (PDE5i group, n=56), and patients taking no medication (non-PDE5i group, n=40). Using self-administered questionnaires, the proportion of patients who did not require incontinence pads (pad-free patients) was calculated preoperatively and at 1, 3, 6, 12, 18, and 24 months after BNSRP. Severity of incontinence was determined based on the pad numbers and then compared among the 3 groups. Results Proportions of pad-free patients and severity of incontinence initially deteriorated in all of the groups to the lowest values soon after undergoing BNSRP, with gradual improvement noted thereafter. The deterioration was most prominent in the immediate PDE5i group. As compared to the non-PDE5i group, both the PDE5i and immediate PDE5i groups exhibited a better final continence status. Conclusions PDE5i improves final continence status. However, administration of PDE5i immediately after surgery causes a distinct temporary deterioration in urinary incontinence.

Infliximab-Induced Tubulointerstitial Nephritis with Image Findings of Striated Nephrogram in Crohn’s Disease

Tubulointerstitial nephritis is primary injury to renal tubules and interstititum which could be resulting in decreased renal function. The acute and chronic forms are most often due to allergic drug reactions or to infections. Tubulointerstitial nephritis in Crohns disease has rarely been reported. Imaging findings of a striated nephrogram on enhanced computed tomography (CT) could represent the clinical state of tubulointerstitial nephritis. This is the first report of tubulointerstitial nephritis caused by infliximab, monoclonal antibody against human tumor necrosis factor-α, showing striated nephrograms in Crohns disease. The case of a 28-year-old man treated with infliximab for Crohns disease is described. Infliximab was added to his maintenance therapy, and bowel symptoms were stable. The patient presented with a 2-month history of fever and an elevated C-reactive protein after infliximab administration for 4.5 years. Contrast-enhanced CT showed striated nephrograms in both kidneys. Urinalysis showed no abnormal findings. The pathological diagnosis on CT-guided percutaneous renal needle biopsy was drug-induced tubulointerstitial nephritis because of eosinophilic infiltration with neutrophils mainly in the tubulointerstitial areas. The imaging findings of striated nephrogram are important for the diagnosis of tubulointerstitial nephritis. Tubulointerstitial nephritis could be caused by drug-induced inflammation or direct extension of Crohns disease as an extra-interstitial manifestation. The treatment strategies for these two diseases are contradictory to each other and inappropriate treatment could worsen the renal function. Needle biopsy is therefore indispensable for differential diagnosis.

High luteinizing hormone weakens urinary continence mechanisms in association with prostaglandin E2 elevation in a postmenopausal rat model

To explore the role of luteinizing hormone (LH) in the urinary continence mechanism, urethral function was investigated using a postmenopausal rat model with high serum LH concentrations and the postmenopausal rat model given a gonadotropin releasing hormone (GnRH) antagonist to lower LH concentrations.

MP37-19 SHORT-TERM IMPACT ON HEALTH-RELATED QUALITY OF LIFE OF LAPAROSCOPIC ADRENALECTOMY FOR PRIMARY ALDOSTERONISM IN JAPANESE PATIENTS

INTRODUCTION AND OBJECTIVES: Primary aldosteronism (PA) is one of the typical forms of secondary hypertension (HTN). Our previous study showed that the antihypertensive effect of laparoscopic adrenalectomy (LA) was not a little for elderly PA patients suffering from HTN for many years. However, the impact of LA on health-related quality of life (QOL) in those patients has not been evaluated. METHODS: According to Japanese diagnostic criteria for PA, a total of 178 PA patients who underwent LA between July 2012 and December 2015 were eligible for this study. Demographic data, perioperative outcomes and QOL were examined. QOL was assessed using the Short Form 36-Item Health Survey questionnaire before and at 6, 12, 18 and 24 months after LA. RESULTS: Responses were analyzed for 96 of 136 patients (70.6%) who responded to the questionnaire. Median age was 55 years (range, 25-77 years) andmedianduration ofHTNwas9 years (range, 1-43 years). Median follow-up was 12months (range, 6-24months) after LA. To evaluate the influence of the duration of HTN on health-related QOL, we compared differences in Norm-based Scoring in Japanese between patients with HTN for <10 years (median age, 51 years) and patients with HTN >10 years (median age, 60 years). In the former group, scores improved in all 8 health-related QOL domains from the baseline at the 6month survey after LA (Figure A). In the latter group, scores of 4 domains did not improve in terms of Physical functioning, Bodily pain, Social functioning or Mental health. However, scores for another 4 domains improved from the baseline (Figure B). Furthermore no significant differences between groups were evident 6 months after LA in any domains scores. CONCLUSIONS: To the best of our knowledge, normalizing aldosterone levels by LA contributes not only to antihypertensive effect, but also to protective effects against cardiovascular diseases. In our study, LA for PA patients with short-term HTN leads to much greater improvements in prognosis and QOL. However, improvements of QOL by LA was found among PA patients despite long-term use of HTN. The negative impact of LA for PA patients with long-term HTN on Social functioning and Mental health remains to be elucidated. More time is needed to evaluate the influence of LA on long-term QOL among PA patients with long-term HTN to achieve better outcomes from LA.

MP80-02 INCREASING AGE OF PATIENTS WITH TESTICULAR CANCER: 1980-2016 SINGLE-CENTER EXPERIENCE

INTRODUCTION AND OBJECTIVES: Local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and-29%. Intra-operative Frozen Section (FS) is a useful tool to ensure safe microscopic margins in organ sparing procedures in penile cancer. In this series, we evaluated the impact of intra-operative surgical margin assessment by FS examination during penile-cancer preserving surgery on the local recurrence rate. METHODS: We analysed all those patients in which intraoperative FS was employed during penile preserving surgery in a single tertiary referral centre (catchment of 6.5 million) from 2007-2014. The tissue analysed for margins was the Urethral “donut”, corporal and/or glandular tissue proximal to the resection margin. We looked to see if this technique altered the surgical technique and what affect it had on recurrence rates. Median follow-up was 28 (1-114) months. RESULTS: Of the total number of 93 patients, 39 (41.9%) had a total glansectomy, 44 (47.3%) a partial penectomy, 7 (7.5%) a wide local excision, 2 (2.2%) a total penectomy and one (1%) a circumcision. Intra-operative histological FS examination of the surgical margin was positive in 16 (17.2%) cases mandating further resection under the same anaesthetic. Final paraffin histological examination confirmed cancer-free margins in 100%. At follow-up, none of the 16 patients with initial positive FS had local recurrence. Only 1 (1%) patient with negative intra-operative FS developed local recurrence at 23 months. This patient’s histology was initially G3pT4. CONCLUSIONS: The use of intra-operative frozen section analysis during organ preserving surgery for penile cancer facilitates conservative surgery, reduces the need, distress and expense of further surgery and in this series contributed to a very low rate (1%) of local recurrence.

Updated recommendation on molecular-targeted therapy for metastatic renal cell cancer

Molecular-targeted therapy was recommended for the systemic therapy of renal cell cancer (RCC) in the RCC guidelines, but these guidelines do not address the order of administration of the multiple presently available agents. There are several aspects that remain unknown regarding the optimal administration order and combination of molecular-targeted drugs. Until the optimal treatment sequence is determined by clinical trials, treatment individualization is required for each patient based on patient and disease characteristics. We herein investigate 12 cases of RCC patients who received axitinib. Axitinib was used as the first-line drug in 4 cases, second-line in 5 cases, third-line in 1 case and as a fourth-line drug in 2 cases. Partial response (PR) was observed in 4 cases (30%) and stable disease in 4 cases (30%) during axitinib treatment, with an overall response rate of 60%. The duration of PR ranged from 6 to 19 months. Based on our cases, axitinib exhibited reasonable therapeutic efficacy as first- as well as second-line treatment. However, more cases are required to draw firm conclusions.

MP86-07 IMPACT OF TISSUE SEALING SHEET ON ERECTILE DYSFUNCTION IN A RAT MODEL OF NERVE-SPARING RADICAL PROSTATECTOMY

INTRODUCTION AND OBJECTIVES: We investigated combined therapeutic efficacy of human adipose-derived stem cells (h-ADSCs) application on injured cavernous nerve and low-energy shockwave therapy (SWT) on the corpus cavernosum in a rat model of post-prostatectomy erectile dysfunction. METHODS: Rats were randomly divided into five groups: Control, BCNI (bilateral cavernous nerve injury), ADSC (BCNI group with h-ADSCs on the cavernous nerve), SWT (BCNI group with lowenergy SWT on the corpus cavernosum), and ADSC/SWT (BCNI group with a combination of h-ADSCs and low-energy SWT). After four weeks, erectile function was assessed using intracavernosal pressure (ICP). The cavernous nerves and penile tissue were evaluated through immunostaining, western blotting and a cyclic guanosine monophosphate (cGMP) assay. RESULTS: ADSC/SWT significantly improved ICP compared to the other experimental group. ADSC had significantly increased s-III tubulin expression of cavernous nerve, and SWT had markedly enhanced vascular endothelial growth factor (VEGF) expression in corpus cavernosum. The ADSC/SWT group had a significantly increased in alpha smooth muscle content (P <.05), neural nitric oxide synthase (nNOS) of the dorsal penile nerve (P <.05), endothelial nitric oxide synthase (eNOS) protein expression (P <.05), and cGMP level (P <.05) compared to ADSC or SWT alone group. In addition, ADSC/SWT reduces the apoptotic index in corpus cavernosum. CONCLUSIONS: In this study, h-ADSCs showed effect on recovery of injured cavernous nerve and low-energy SWT improved angiogenesis in the corpus cavernosum. The h-ADSCs combined with low energy SWT showed beneficial effect on the recovery of erectile function in a rat model of post-prostatectomy erectile dysfunction.

Impact of Tissue Sealing Sheet on Erectile Dysfunction in a Rat Model of Nerve-Sparing Radical Prostatectomy

INTRODUCTION The tissue sealing sheet has recently been used to prevent intraoperative bleeding from the neurovascular bundles in radical prostatectomy. Surgical stress or inflammatory changes likely play a role in erectile dysfunction after cavernous nerve injury. However, the efficacy of a tissue sealing sheet for preventing erectile function after nerve-sparing radical prostatectomy remains unclear. AIM To evaluate the effect of a tissue sealing sheet on erectile dysfunction after cavernous nerve dissection. METHODS Male Sprague-Dawley rats were randomly divided into three groups and subjected to sham operation or bilateral cavernous nerve dissection with (sheet group) or without (non-sheet group) a tissue sealing sheet. In the sheet group, cavernous nerves were sealed with a tissue sealing sheet immediately after cavernous nerve dissection. MAIN OUTCOME MEASURES Erectile function was assessed by measuring intracavernous pressure and arterial pressure during pelvic nerve electrostimulation at 4 weeks after surgery. Expressions of interleukin-6, tumor growth factor-β1, and heme-oxygenase-1 in the major pelvic ganglion were examined by real-time polymerase chain reaction. RESULTS Mean intracavernous pressure along with mean arterial pressure in the sheet group were similar to those in the sham group and showed a significant positive response compared with the non-sheet group (P < .05). Furthermore, expressions of interleukin-6, tumor growth factor-β1, and heme-oxygenase-1 were significantly lower in the sheet group than in the non-sheet group (P < .05). CONCLUSION Use of a tissue sealing sheet attenuated postoperative inflammatory changes and oxidative stress and improved erectile function after cavernous nerve injury in rats. The tissue sealing sheet might become a useful therapeutic approach to preserve erectile function after nerve-sparing radical prostatectomy.

Trough blood levels of sunitinib for Asian (Japanese) patients with metastatic renal cell carcinoma and therapeutic drug monitoring.

508 Background: The optimal blood concentration of total Sunitinib (SU) (SU + its active metabolite) is reportedly 50-100 ng/ml at trough levels according to the product literature. This is, however, based on models optimally calculated for Caucasians; hence, the desirable blood concentration for Asian patients, including Japanese, is unclear. We examined trough SU levels in Japanese patients with metastatic renal cell carcinomas (mRCC), to determine the preferred concentration of total SU and its doses. We also evaluated the efficacy and dependability of therapeutic drug monitoring (TDM) through the duration of therapy. Methods: Patients with mRCC scheduled for targeted therapy were prospectively recruited between November 2011 and August 2015. TDM of trough levels for patients treated with SU was performed on a regular basis. For this, blood samples were obtained immediately before administering SU on day 8 and day 15 after the initial administration day. Pre-therapeutic characteristics and post-therape...