Hiroaki Masuda

Transition Zone Index as a Risk Factor for Acute Urinary Retention in Benign Prostatic Hyperplasia

OBJECTIVES To examine the efficacy of various parameters obtained by transrectal ultrasonography (TRUS) as predictors of the onset of acute urinary retention in patients with benign prostatic hyperplasia (BPH). METHODS From April 1993 to March 1997, 331 men aged 51 to 84 years with symptoms of BPH were enrolled in this study. Among them, 64 patients presented to our clinic because of acute urinary retention. TRUS was used to calculate the transition zone (TZ) volume, the transition zone index (TZ index = TZ volume/total prostate volume), the total prostate volume, and presumed circle area ratio (PCAR). To compare the usefulness of the various indices, the area under the receiver-operator characteristic (ROC) curve was calculated for each index. RESULTS There were significant differences in the American Urological Association (AUA) symptom score, total prostate volume, TZ volume, TZ index, and PCAR between patients with and without acute urinary retention, but no significant differences in age and quality of life score. In patients with acute urinary retention, the area under the ROC curve was 0.924 for the TZ index, 0.834 for the TZ volume, 0.753 for the PCAR, 0.684 for the total prostate volume, and 0.628 for the AUA symptom score. CONCLUSIONS The TZ index is an accurate predictor of acute urinary retention in patients with BPH and may be a useful method for deciding between surgical intervention and antiandrogen treatment.

Significant Prognostic Factors for 5‐Year Survival after Curative Resection of Renal Cell Carcinoma

Background: Renal cell carcinoma (RCC) patients occasionally die of RCC even after curative resection. In this study, we investigated prognostic factors between survivors for more than 5 years and patients who died within 5 years after curative resection.

Role of Doppler ultrasound and resistive index in benign prostatic hypertrophy

Background: The aim of the present study was to assess the resistive index in patients with benign prostatic hypertrophy (BPH) and the role of power Doppler ultrasonography.

Prognostic Factors for Renal Cell Carcinoma: A Multivariate Analysis of 320 Cases

Background We performed a multivariate analysis of clinical variables in 320 patients with renal cell carcinoma to identify important prognostic factors for long‐term survival.

Gasless Laparoscopy-Assisted Nephrectomy without Tissue Morcellation for Renal Carcinoma

PURPOSE The efficacy of gasless laparoscopy-assisted nephrectomy for renal tumors is determined. MATERIALS AND METHODS Seven patients with renal tumors underwent gasless laparoscopy-assisted nephrectomy. The results were compared to those of patients undergoing open nephrectomy. RESULTS Although a long operating time was required, convalescence was significantly more rapid. En bloc removal of the kidney and complete pathological examination were possible in all patients. CONCLUSIONS This procedure may be useful for the treatment of noninvasive renal carcinoma, especially in patients with cardiovascular and/or ventilatory complications. However, long-term followup is necessary to confirm the efficacy in preventing recurrence.

Transition Zone Volume-Adjusted Prostate-Specific Antigen Value Predicts Extracapsular Carcinoma of the Prostate in Patients with Intermediate Prostate-Specific Antigen Levels

Objective: The aim of the present study was to examine the efficacy of the volume-adjusted prostate-specific antigen (PSA) density as a predictor of pathological stage. Among patients who underwent radical prostatectomy for clinically organ-confined prostate cancer, we selected patients with PSA levels of 4–10 ng/ml. In these patients with borderline PSA value extent of disease is most difficult to predict. Using the transition zone (TZ) volume instead of the total prostate volume, we compared the ability of PSA to predict the tumor extent. Methods: From April 1992 to November 1996, we examined 61 consecutive patients who underwent radical prostatectomy. Their age ranged from 52 to 78 years. The PSA densities for the total prostate volume (PSAD) and for the TZ volume (PSAT) were calculated by transrectal ultrasound examinations. To compare the usefulness of PSA, PSAD, and PSAT, the area under the receiver-operator characteristic (ROC) curve was calculated for each parameter. Results: The final pathological stage was pT2N₀M₀ in 34 patients, pT3N₀M₀ in 20 patients, and pT3N1M₀ in 7 patients. Accordingly, 34 patients (55.7%) had organ-confined prostate cancer. In patients with capsular perforation, the areas under the ROC curve were 0.686 for PSA, 0.665 for PSAD, and 0.860 for PSAT, while in those with seminal vesicle invasion the respective values were 0.712, 0.703, and 0.882. Thus, PSAT was superior to PSA and PSAD in differentiating extracapsular disease. Conclusion: PSAT provides superior preoperative prediction of extracapsular tumor invasion, which appears to be useful in treatment selection (e.g. total prostatectomy).

Laparoscopy-assisted radical nephrectomy without pneumoperitoneum.

A small renal cell carcinoma of the right kidney was completely removed from a 59-year-old women by laparoscopic radical nephrectomy without requiring a pneumoperitoneum. A 5-cm midline laparotomy incision was made and 3 small retractors were used for suspending the abdominal wall. Under laparoscopic observation, we safely positioned three trocars. The kidney was then removed en bloc together with the adrenal gland, perinephric fat and Gerotas fascia. The resected mass was enclosed in an entrapment sac and removed via the 5-cm abdominal incision without morcellation of the tissues. Three trocars could be positioned safely under direct observation and there were no adverse hemodynamic or ventilatory effects because the operation was performed without intraperitoneal carbon dioxide insufflation. There were no significant operative or postoperative complications. This procedure appears to be advantageous for the treatment of small renal cell carcinomas.

Can symptoms predict the prognosis of renal cell carcinoma? A multivariate analysis of 320 patients

BackgroundThe well-known, classical symptoms of renal cell carcinoma (RCC) are abdominal or flank pain, a palpable mass, and hematuria. However, the number of patients with this classical triad has been decreasing recently. This is especially true in Japan where health screening programs detect many incidental renal cell carcinomas. This study reevaluated the presenting symptoms of RCC as prognostic factors. It also showed that patients found to have RCC by health screening had a significantly low hazard ratio and a good prognosis.Patients and MethodsTo evaluate the presenting symptoms as prognostic factors for survival, we retrospectively studied 320 patients with renal cell carcinoma between 1978 and 1995. The following symptoms were evaluated as prognostic factors: large amount of hematuria, any hematuria (including microscopic and macroscopic), flank and/or abdominal pain, a palpable mass, malaise, weight loss, pyrexia, and the reason for examining the kidneys. Survival curves were calculated by the Kaplan-Meier method, and univariate analysis was performed using the log-rank test and Coxs proportional hazard model. Significant factors were then chosen for Coxs multivariate proportional hazard test to evaluate their relative prognostic value.ResultsThe median follow-up period was 29 months. The overall survival rate at 1, 5, and 10 years was 90.0%, 77.6%, and 69.9%, respectively. The chi-square test revealed a close relationship between flank and/or abdominal pain and local tumor extent; pyrexia and lymph node and distant metastasis; and incidental detection by health screening with no local invasion or distant metastasis.ConclusionOf the 8 prognostic factors evaluated, univariate and multivariate analysis showed that flank and/or abdominal pain and pyrexia were poor prognostic factors, while patients with tumors found by routine health screening or during workup of other diseases showed a good outcome.

Prognostic factors after curative surgery for renal cell carcinoma: Multivariate analysis of 260 patients

BackgroundIn patients with renal cell carcinoma, curative surgery may offer a chance of survival, but a fatal outcome is not infrequent. In this study, we investigated the prognostic factors influencing survival by using both univariate and multivariate analyses.MethodsTo identify the important prognostic factors for long-term survival, we retrospectively studied 260 patients who received curative surgery for renal cell carcinoma between 1978 and 1995. Survival curves were calculated by the Kaplan-Meier method and statistical differences were determined by the log-rank test. Survival correlations were tested using 20 prognostic factors. Significant factors were evaluated using Coxs multivariate proportional hazard test to determine the prognostic value.ResultsThe median follow-up period was 39 months. The overall survival rate at 1, 5, and 10 years was 98.9%, 89.8%, and 83.3%, respectively. Of the 20 prognostic factors evaluated, the log-rank test showed significant differences in patient age, body temperature, hemoglobin, ESR, α2-globulin, CRP, fibrinogen, pathological stage, Robsons stage, T classification, N classification, pathological grade, cell type, and pattern of tumor infiltration. However, several variables (body temperature, ESR, α2-globulin, and fibrinogen) were excluded from the multivariate analysis because more then 10% of the data were missing. Pathological stage was selected as a representative variable for stage indices (pathological stage, Robsons stage, T classification, and N classification). Using the remaining 7 variables (age, hemoglobin, CRP, pathological stage, pathological grade, cell type, and pattern of tumor infiltration), Coxs multivariate proportional hazard analysis showed that tumor stage (P=0.0496) was the most important independent prognostic factor for patient survival.ConclusionsFrom this analysis, the pathological tumor stage was found to be the most important factor predicting long-term survival in patients who received curative surgery for renal cell carcinoma.

Close Correlation of Tumor Size and Volume with TNM Stage in Renal Cell Carcinoma

BackgroundTumor size is important when distinguishing T1 renal cell carcinoma (RCC) from T2 disease. However, further details of the relationship between tumor size and TNM classifications have not been reported. In this study, we evaluated the correlation between the size and TNM stage of RCC and compared it with correlations for tumor volume.MethodsWe retrospectively studied 241 patients with RCC and obtained data on size and TNM stage from surgical records. To assess the correlation of these variables with involvement of the renal capsule, lymph node metastasis, and distant metastasis, the area under the corresponding receiver-operator characteristic (ROC) curve was calculated. The statistical significance of differences between these ROC curves was also studied.ResultsWith respect to involvement of the renal capsule, the areas under the ROC curves for tumor size and volume were 0.796 and 0.800, respectively. There was no significant difference between tumor size and tumor volume. With lymph node metastasis, the areas for tumor size and volume were 0.751 and 0.757, respectively. With distant metastasis they were 0.693 and 0.722, respectively. The areas for tumor volume were larger than those for tumor size, but there were no significant differences between these 2 variables. By using a cutoff value of 5 cm for tumor size and 65 mL for tumor volume, we obtained a high sensitivity and specificity in detecting renal capsular invasion.ConclusionTumor size and volume are both sensitive and specific indices of renal capsular invasion. These variables, obtained before surgery by imaging modalities, could be useful for preoperative staging of RCC, especially for T staging.