Masaaki Fujimura

Incidence of inguinal hernia after prostate surgery: Open radical retropubic prostatectomy versus open simple prostatectomy versus transurethral resection of the prostate

Our objective was to determine the incidence of inguinal hernia (IH) after surgery for prostatic diseases. Medical records of 395 patients who underwent radical retropubic prostatectomy (RRP; n = 155), open simple prostatectomy (OP; n = 35), or transurethral resection of the prostate (TURP; n = 205) at the Chibaken Saiseikai Narashino Hospital from April 2000 to March 2007 were retrospectively evaluated. The incidence of IH was 23.9% in the RRP group, 18.9% in the OP group, and 2% in the TURP group. Overall, 91.9% in the RRP and 83.3% in the OP group developed an IH within 2 years postoperatively. The laterality of IH after open surgery was mainly on the right side. Subclinical IH were seen in 25% of RRP cases. The existence of subclinical IH was the only significant risk factor for postoperative IH in this analysis. Furthermore, OP and RRP procedures significantly increased the risk of postoperative IH compared with TURP. The hernia‐free ratios were significantly lower after RRP and OP than after TURP (vs RRP: P < 0.001; vs OP: P < 0.001). Our findings confirm that a lower abdominal incision itself is associated with postoperative IH in patients undergoing prostate surgery. Attention must be paid to pre‐existing subclinical IH through careful preoperative assessment. Patients should be followed for more than 2 years due to the high incidence of postoperative IH.

A novel role of the C-terminus of b0,+AT in the ER–Golgi trafficking of the rBAT–b0,+AT heterodimeric amino acid transporter

The heterodimeric complex composed of rBAT (related to b(0,+) amino acid transporter), a single-membrane-spanning glycosylated heavy chain, and b(0,+)AT, a putative 12-membrane-spanning non-glycosylated light chain, is an amino acid transporter that mediates the activity of system b(0,+), a major apical transport system for cystine and dibasic amino acids in renal proximal tubule and small intestine. The C-terminus of b(0,+)AT has been proposed to play an important role in the functional expression of the heterodimeric transporters. In the present study, to reveal the roles of the C-terminus, we analysed b(0,+)AT mutants whose C-termini were sequentially deleted or replaced by site-directed mutagenesis in polarized MDCKII (Madin-Darby canine kidney II), non-polarized HEK-293 (human embryonic kidney-293) and HeLa cells. Although the deletion of C-terminus of b(0,+)AT did not affect the formation of a heterodimer with rBAT, it resulted in the loss of apparent transport function, owing to the failure of the plasma-membrane targeting of rBAT-b(0,+)AT heterodimeric complex associated with incomplete glycosylation of rBAT. A motif-like sequence Val(480)-Pro(481)-Pro(482) was identified in the C-terminus of b(0,+)AT to be responsible for the C-terminus action in promoting the trafficking of rBAT-b(0,+)AT heterodimeric complex from the ER (endoplasmic reticulum) to Golgi apparatus. This is, to our knowledge, the first demonstration of the active contribution of the C-terminus of a light-chain subunit to the intracellular trafficking of heterodimeric transporters. Because the motif-like sequence Val(480)-Pro(481)-Pro(482) is well conserved among the C-termini of light-chain subunits, common regulatory mechanisms could be proposed among heterodimeric amino acid transporters.

External validation and comparison of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology in two patient populations: a retrospective cohort study

The aim of this study is to validate and compare the predictive accuracy of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology among representative patients with prostate cancer. We previously developed a nomogram, as did Chun et al. In this validation study, patients originated from two centers: Toho University Sakura Medical Center (n = 214) and Chibaken Saiseikai Narashino Hospital (n = 216). We assessed predictive accuracy using area under the curve values and constructed calibration plots to grasp the tendency for each institution. Both nomograms showed a high predictive accuracy in each institution, although the constructed calibration plots of the two nomograms underestimated the actual probability in Toho University Sakura Medical Center. Clinicians need to use calibration plots for each institution to correctly understand the tendency of each nomogram for their patients, even if each nomogram has a good predictive accuracy.

Visceral fat accumulation is a risk factor for urinary stone

kinase inhibitor that has a different action mechanism from cytocidal anticancer drugs, which results in milder adverse effects. Few cancer patients have the physical stamina and nutritional conditioning to tolerate treatments with cytotoxic agents, especially after surgical resection of a large abdominal mass as in the present case. From the perspective of adverse events, pazopanib might be better tolerated by patients with these conditions. The present patient experienced only mild hypertension and fatigue (grade 2) as adverse events with pazopanib. Furthermore, treatment with pazopanib showed a dramatic reduction of the locally recurrent lesion, which could suggest the usefulness of pazopanib as neoadjuvant treatment for primary retroperitoneal EES. However, it is unclear whether pazopanib provided the patient a longer survival period. To our knowledge, the present case is the first report of EES treated with pazopanib. In order to develop therapeutic strategies against retroperitoneal EES with poor performance status, more accumulation of evidence is definitely required.

PD03-03 GENOTYPE CLASSIFICATION BASED ON THE MULTIPLE CYSTINE RELATED TRANSPORTERS IN JAPANESE CYSTINURIA PATIENTS

interface was dissected and analyzed via electron dispersion spectroscopy(EDS) and scanning electron microscopy(SEM). RESULTS: Intrarenal stones were identified in 20 kidneys (Fig 1). The kidney with the largest stone came from a deceased 15 year-old Bermese male cat without history of renal insufficiency. The stone was 9x4.5 mm and was attached to the papilla (Fig 2). Stone micro CT demonstrated calcium oxalate overgrowing a region of apatite closest to the papilla. Microstructure of the apatite showed lumens consistent with calcified renal tubules pathognomonic for RP (Fig 3). Mineral composition was confirmed with EDS. Micro-CT of the tissue beneath the stone showed calcium deposition along tubules extending deep within the tissue. CONCLUSIONS: Spontaneous stone formation in cats can occur via a RP mechanism indistinguishable from humans. This is the first description of naturally occurring, spontaneous RP stone overgrowth in a non-human subject and supports further investigation of cats as a model to study stone formation.

MP24-08 IDENTIFICATION OF A NOVEL GENOMIC MUTATIONS THROUGH A NEXT-GENERATION SEQUENCE AMONG JAPANESE CYSTINURIA PATIENTS

INTRODUCTION AND OBJECTIVES: We recently revealed that mitochondrial collapse due to oxidative stress and subsequent renal tubular cell injury occurs in the early stages of kidney stone formation. In addition, using cyclophilin D (CypD)-deficient mice, we previously reported that mitochondrial collapse is caused by mitochondrial permeability transition (MPT), which is controlled by CypD. Meanwhile, oxidative stress and inflammation have been reported to be associated with MPT. Therefore, here, we examined the correlation between inflammation, oxidative stress, and CypD-dependent MPT using CypDdeficient mice. METHODS: We administered 80 mg/kg glyoxylic acid, a precursor of oxalic acid, intraperitoneally for 6 consecutive days to 8-weekold male CypD-deficient mice (CypD-/-, n 1⁄4 6) and wild-type mice (CypD+/+, n 1⁄4 6). We removed the kidneys of the mice in each group 6 days after glyoxylic acid administration. Stone formation and morphology were evaluated using polarization microscopy and Pizzolato staining, and the stone formation ratio was estimated using an image analysis software. For the evaluation of oxidative stress, superoxide dismutase (SOD) activity and malondialdehyde (MDA) level were determined using immunohistochemical staining. For the evaluation of inflammation, monocyte chemoattractant protein (MCP)-1, interleukin (IL)-6, and tumor necrosis factor (TNF)-a levels were assessed using quantitative polymerase chain reaction (PCR). RESULTS: There were no significant differences between CypD+/+ and CypD-/mice in the expressions of MCP-1, IL-6, and TNFa (p 1⁄4 0.604, 0.356, and 0.549, respectively). The stone formation ratio of CypD-/mice (0.05%) was significantly lower than that of CypD+/+ mice (0.22%). Oxidative stress of CypD-/mice was significantly lower than that of CypD+/+ mice. CONCLUSIONS: Our results indicate that inflammation occurring in the renal tissue is not affected by CypD. In the renal tissue, oxidative stress induced by glyoxylic acid administration and inflammation occurred, and subsequently CypD-dependent MPT promoted mitochondrial collapse, mitochondria-induced oxidative stress, and kidney stone formation.

Development and external validation of a nomogram to predict high-grade papillary bladder cancer before first-time transurethral resection of the bladder tumor

BackgroundThe aim of this study was to identify the clinical predictors related to the risk of high-grade papillary bladder cancer before first-time transurethral resection of a bladder tumor (TUR-Bt), and to develop and validate a nomogram predicting the risk of high-grade papillary bladder cancer.MethodsA retrospective clinical study of consecutive patients who underwent first-time TUR-Bt for papillary bladder cancer was performed. Medical records were reviewed uniformly, and the following data were collected: age, sex, episodes of urinary symptoms, tumor size, number of tumors, location of the largest tumor (lateral walls, base, posterior wall, dome, and anterior wall), tumor appearance (papillary or non-papillary, pedunculated or sessile), and urinary cytology. Data from 254 patients (Group A) were used for the development of a nomogram, while data from 170 patients (Group B) were used for its external validation.ResultsHigh-grade papillary bladder cancer was pathologically diagnosed in 51.6 and 74.6% of Group A and Group B patients, respectively. Based on univariable analyses in Group A, macrohematuria, tumor size, multiple tumors, appearance, and positive urinary cytology were selected as variables to incorporate into a nomogram. The AUC value was 0.81 for the internal validation (Group A), and 0.78 for the external validation (Group B). This novel nomogram can predict high-grade papillary bladder cancer accurately.ConclusionsThe present nomogram can help clinicians calculate the probability in patients with bladder cancer before TUR-Bt and decide on earlier intervention and priorities for the treatment of patients diagnosed with bladder cancer.

Bilateral Ureteral Obstruction and Acute Renal Failure in Spite of Prior Ureteral Catheterization in Radical Hysterectomy

We present an extremely rare case of acute renal failure following radical hysterectomy although we inserted ureteral catheter bilaterally. A 76-year old female received bilateral ureteral catheterization prior to operation. Just after operation oliguria was admitted and serum creatinine level increased to 3.6 mg/dL. An abdominal computed tomography (CT) revealed bilateral hydronephrosis. From soon after exchange to double J catheter large amount of urine was collected and the level of creatinine normalized 2 days later. The shape of J catheter may be more effective than open-end catheter because it has multiple side hole and can ensure urinary drainage.