Junichi Mochida

Tension‐free vaginal mesh procedure for pelvic organ prolapse: A single‐center experience of 310 cases with 1‐year follow up

Objective:  To prospectively evaluate the efficacy of a tension‐free vaginal mesh (TVM) procedure for pelvic organ prolapse (POP).

Intravesical Recurrence after Surgical Management of Urothelial Carcinoma of the Upper Urinary Tract

Objectives: To elucidate clinicopathological risk factors for intravesical recurrence (IVR) in patients undergoing nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). Methods: We identified a study population of 151 consecutive patients without previous or concurrent bladder cancer who underwent nephroureterectomy for UUT-UC. IVR was assessed in relation to tumor location, size, and multifocality, operation modality and time, stage, grade, lymphovascular invasion, regional lymph node metastasis, preoperative urinary cytology, and perioperative chemotherapy. The median follow-up time was 24 months. Results: Of 151 patients, 51 (34%) developed IVR after nephroureterectomy, and 50 (98%) of the patients presented with IVR within 2 years. Tumor multifocality and site (located in ureter) were determined as risk factors for IVR by univariate analysis. In a multivariate analysis, only tumor multifocality (relative risk: 4.024, p = 0.001) was an independent predictor of IVR. Ten-year cancer-specific survival rates for the patients with and without IVR were 68 and 52%, respectively (p = 0.06). Conclusions: Tumor multifocality is a significant risk factor in developing IVR after surgery for UUT-UC. These results indicate that despite most IVR occurring within 2 years of treatment, it is necessary to follow such patients more closely using cystoscopy. However, IVR is unlikely to indicate a poorer prognosis.

Cytoreductive surgery with liver-involved renal cell carcinoma

The purpose of this study was to demonstrate the benefits of cytoreductive surgery for renal cell carcinomas that also involve the liver. Between 1994 and 1997, four patients with renal cell carcinoma with liver involvement were surgically treated with nephrectomy and hepatectomy. Two of them underwent a simultaneous hepatectomy and nephrectomy (group 1), and the remaining two patients underwent a hepatectomy after a nephrectomy and had a diagnosis of postoperative recurrence (group 2). Two patients, one from each group, died of multiple bone metastasis and lung metastasis 30 months and 12 months after the hepatectomy; the second patient from group 1 died 40 months after the first operation due to gastrointestinal hemorrhaging. The second patient from group 2 displayed no evidence of recurrence 18 months after the second surgical procedure. The survival rates for these patients were 66% and 33% at 1 and 3 years, respectively. Autopsy studies revealed that one patient from group 2 had a local recurrence in the liver while the other two patients from group 1 did not. Our results suggested that a progressive approach may therefore be useful for patients demonstrating renal cell carcinoma where there is liver involvement.

Lower urinary tract symptoms in female patients with pelvic organ prolapse: Efficacy of pelvic floor reconstruction

To evaluate the impact of pelvic floor reconstruction on lower urinary tract symptoms in patients with pelvic organ prolapse.

Prospective study on the relationship between clinical efficacy of secondary hormone therapy with flutamide and neuroendocrine differentiation in patients with relapsed prostate cancer after first line hormone therapy

Abstract Objective. The aim of this study was to prospectively verify the relationship between the clinical efficacies of secondary hormone therapy for castration-resistant prostate cancer (CRPC) following first line hormone therapy and neuroendocrine differentiation (NED). Material and methods. Forty-six consecutive patients with CRPC following first line hormone therapy who were treated with flutamide as secondary hormone therapy were prospectively assessed with a median follow-up of 21 months. Serum chromogranin A (CgA), as a marker of NED, was measured using an immunoradiometric assay. Results. Of the 46 patients, 22 (48%) responded to the secondary hormone therapy as a 50% or more reduction from baseline prostate-specific antigen (PSA) with a median response duration of 9.2 months. The PSA response group was correlated with significantly favorable cancer-specific survival (CSS) (92% vs 59% at 5 years, p = 0.0146) compared with the non-response group. Above-normal CgA levels at study entry were detected in 15 patients (33%), but no association with CSS was identified. Data on CgA kinetics were available in 35 patients. The CgA levels before and at 3 months during the treatment were similar. However, eight patients (23%) with an increase in CgA level of a quarter or more from baseline had a tendency for worse CSS (63% vs 84% at 5 years, p = 0.0507) compared with the remaining patients. Conclusion. Within limitations, in this study secondary hormone therapy with flutamide was effective for CRPC following first line hormone therapy. The above-normal CgA level in the first hormone resistance phase is mostly unrelated to prognosis. However, some patients with a remarkable increase in CgA in a short duration may have an unfavorable prognosis caused by NED as well.

Multivariate analysis of clinicopathologic factors and the efficacy of postoperative IFN-γ adjuvant therapy in 115 patients with renal cell carcinoma

AbstractBackground. In patients with renal cell carcinoma, the relationship between long term survival and clinicopathologic factors is not clear. We performed a retrospective analysis to determine the usefulness of clinicopathological factors as prognostic predictors in these patients and to evaluate the usefulness of interferon-gamma (IFN-γ) adjuvant therapy in their long term survival. Methods. We performed the analysis in 115 patients with renal cell carcinoma who underwent nephrectomy at our institution, between January 1980 and December 1997. Results. The median follow-up period was 40 months. The overall survival rates at 1, 5, and 10 years were 92.9%, 77.1%, and 77.1%, respectively. Four of the eight prognostic factors evaluated, including growth type, tumor size, clinical stage, local invasion (capsular invasion and microvascular invasion), histopathological architecture, and histopathological grade, were significant by the log-rank test. Multivariate analysis indicated that both growth type (P = 0.0005) and clinical stage (P = 0.0345) were significant independent prognostic factors. Among the 51 patients with clinical stage more advanced than Robson II, or with local invasion, the 5-year survival rate in those with IFN-γ treatment (n = 35) was 68.5 %, while the rate in those without 1FN-γ treatment (n = 16) was 48% (P = 0.0326). Conclusion. This analysis showed that tumor growth type and clinical stage were important prognostic factors. As no effective therapies have yet been established for advanced renal cell carcinoma, further investigation is warranted to determine the value of IFN-γ as a basic therapy for advanced renal cell carcinoma and for these carcinomas of the rapid-growth type.

Case of mumps orchitis after vaccination.

We present a case of mumps orchitis after vaccination. A 35‐year‐old man visited the emergency unit of our hospital for fever and right testicular pain on 7 January 2012. Two weeks before the visit, he underwent vaccination for mumps. After 7 days of hospitalization, the patient recovered from fever and testicular pain. Scrotal magnetic resonance imaging suggested right orchitis, and an increased level of serum mumps immunoglobulin M and immunoglobulin G indicated an initial infection of mumps virus. The peak value of immunoglobulin G showed 106 enzyme immunoassay unit 5 weeks after vaccination, which was 10‐fold higher than the ordinary rise of a vaccinated individual. This fact leads to two possibilities. One is this happened as an adverse event of vaccination, and the other is that he actually had a wild‐type infection at the same time as vaccination. There are some reports regarding adverse events of mumps vaccine; however, they might include wild‐type infection.

Allelic loss analysis of tumor suppressor genes regardless of heterozygosity: von Hippel-Lindau gene loss in renal cell carcinoma.

PURPOSE VHL, the von Hippel-Lindau tumor suppressor gene, has no microsatellites, but rather single nucleotide polymorphisms inside the gene. However, their low heterozygosity is unfavorable for loss of heterozygosity analysis. We examined whether our modified single nucleotide polymorphism genotyping method would be useful for allelic loss analysis of the VHL gene in heterozygous and homozygous genotypes of sporadic renal cell carcinoma. MATERIALS AND METHODS Genomic DNA was extracted from tumor and nontumor tissues in 35 cases of sporadic renal cell carcinoma. The single nucleotide polymorphism (rs1642742), G or A containing region of the VHL gene was amplified from sample DNA and subjected to primer extension reaction with fluorescent dideoxynucleotide triphosphate. Template directed incorporation of fluorescent dideoxyguanosine triphosphate or dideoxyadenosine triphosphate was quantitatively analyzed and the A/G (G/A) signal ratio was compared between tumor and nontumor tissues. RESULTS We confirmed quantitative template directed incorporation of dideoxyguanosine triphosphate or dideoxyadenosine triphosphate using model templates with various ratios of DNA from the 2 genotypes AA and GG. In 20 heterozygous cases of renal cell carcinoma the A/G signal ratio was significantly differentiated between tumor and nontumor in 9 loss of heterozygosity positive cases but not in 11 loss of heterozygosity negative cases. A total of 15 homozygous renal cell carcinoma cases were tested by adding homozygous control DNA of a different genotype before analysis. Eight of the 15 cases showed a significantly lower signal ratio in tumor than in nontumor, whereas the other 7 showed no significant difference. CONCLUSIONS Our modified single nucleotide polymorphism genotyping is broadly applicable to allelic loss analysis of tumor suppressor genes in heterozygous and homozygous tumors.

Tension‐free vaginal mesh surgery versus laparoscopic sacrocolpopexy for pelvic organ prolapse: Analysis of perioperative outcomes using a Japanese national inpatient database

To compare nationwide outcomes of tension‐free vaginal mesh surgery and laparoscopic sacrocolpopexy for the treatment of pelvic organ prolapse in Japan.

A CASE OF URETEROUTERINE FISTULA AFTER CAESAREAN SECTION

The reported incidence rate of iatrogenic ureteral injury is 0.5 to 3% among abdominal surgery. We report a case of ureterouterine fistula after caesarean section. A 38-year-old woman visited our department with a complaint of urinary incontinence without dry time after caesarean section. Several examinations revealed right ureterouterine fistula.Ureteroneocystostomy using psoas hitch and hysterectomy was performed. We found a firm adhesion and stitches around right lower ureter over the uterus, which lead to an additional hysterectomy. After surgery, urinary incontinence had improved. Following two years after surgery, we observed no urinary incontinence or renal dysfunction.