Masataka Aizawa

Prospective Randomized Phase II Trial of a Single Early Intravesical Instillation of Pirarubicin (THP) in the Prevention of Bladder Recurrence After Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma: The THP Monotherapy Study Group Trial

PURPOSE We evaluated the efficacy of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). PATIENTS AND METHODS From December 2005 to November 2008, 77 patients clinically diagnosed with UUT-UC from 11 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were preoperatively enrolled in this study. Patients were randomly assigned to receive or not receive a single instillation of THP (30 mg in 30 mL of saline) into the bladder within 48 hours after nephroureterectomy. Cystoscopy and urinary cytology were repeated every 3 months for 2 years or until the occurrence of first bladder recurrence. RESULTS Seventy-two patients were evaluable for efficacy analysis, 21 of whom had a subsequent bladder recurrence. Significantly fewer patients who received THP had a recurrence compared with the control group (16.9% at 1 year and 16.9% at 2 years in the THP group v 31.8% at 1 year and 42.2% at 2 years in the control group; log-rank P = .025). No remarkable adverse events were observed in the THP-treated group. Based on multivariate analysis, THP instillation (hazard rate [HR], 0.26; 95% CI, 0.07 to 0.91; P = .035) and open surgery (HR, 0.28; 95% CI, 0.09 to 0.84; P = .024) were independently predictive of a reduced incidence of bladder recurrence. CONCLUSION In this prospective randomized phase II study, a single intravesical instillation of THP seemed to reduce bladder recurrence after nephroureterectomy. A phase III, large-scale, multicenter study is needed to confirm these observations.

Somatosensory evoked magnetic fields elicited by dorsal penile, posterior tibial and median nerve stimulation

The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRI-linked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latency of the first cortical components were 63.8 +/- 9.2 ms for DPN, 39.8 +/- 3.0 ms for PTN and 20.7 +/- 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 +/- 10.8 fT for DPN, 160.2 +/- 50.1 fT for PTN and 335.2 +/- 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.

Morphological subtyping of papillary renal cell carcinoma: Clinicopathological characteristics and prognosis

Aim:  The aim of the study was to evaluate the clinicopathological and prognostic significance of morphological subtyping of papillary renal cell carcinoma (PRCC).

Surveillance study for clinical stage I testicular seminomas and nonseminomatous germ cell tumors.

Background: Optimal therapy for stage I testicular tumors is still controversial. This study evaluated the efficacy of a surveillance policy for patients with testicular stage I seminomas and nonseminomatous germ cell tumors (NSGCT).

Clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma

To characterize the site and clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma.

Bulbocavernosus reflex during the micturition cycle in normal male subjects

Abstract Background:  To investigate normal changes in the bulbocavernosus reflex (BCR) during the micturition cycle, we examined the change in BCR during the micturition cycle using an evoked potential reaction of the BCR (BCR‐EP).

Extracorporeal shock wave lithotripsy for a ureteral stone in crossed fused renal ectopia

Abstract Background: A 63‐year‐old woman presented with right flank pain and macroscopic hematuria.

Midline extraperitoneal approach to upper urinary tract surgery: anatomical basis of surgical technique.

Abstract  To overcome the disadvantages inherent in the standard surgical approach to the kidney, we introduced a novel surgical technique via a midline extraperitoneal approach. The surgical technique is not substantially different from that of the standard midline transperitoneal approach, except no entry is made into the peritoneal cavity. Although the peritoneum itself is extremely thin and fragile, the peritoneum together with underlying subperitoneal fascia can be dissected readily as a substantial layer, if the proper plane is dissected. Further medial mobilization of the peritoneal sac en bloc by pursuing the fusion fascia plane allows full exposure of the kidney, ureter and great vessels. This approach was adopted for consecutive 51 patients during a 10‐month period in 2003. All operations, including 33 radical nephrectomies and 11 nephroureterectomies were completed successfully without significant technical difficulties and differences in operation time and estimated blood loss compared to the transperitoneal approach. No intra‐ or perioperative complication occurred. All patients did seem to have a much more comfortable postoperative period with minor pain and few abdominal complaint, and the clinical impression was that they resumed the physical activity and oral intake earlier than those after the transperitoneal approach (P = 0.056). There are no operation‐related problems such as intra‐abdominal adhesion or abdominal muscle weakness resulting in some deformity at 2‐year or more follow up. This approach combines the advantages of the transperitoneal midline and extraperitoneal flank approach. Its use will undoubtedly reduce the complications inherent in the transperitoneal approach or the flank approach.

Serum G-CSF May Be a More Valuable Biomarker than Image Evaluation in G-CSF-Producing Urothelial Carcinoma: A Case Report

Granulocyte colony-stimulating factor (G-CSF)-producing urothelial carcinomas (UCs) are rare and have a poor prognosis. According to the literature, treatment for G-CSF-producing UCs is very difficult. We experienced 2 cases of UC presenting with leukocytosis. In these cases, serum G-CSF levels were higher than the reference value with leukocytosis at diagnosis, and the resected specimens were positive for anti-G-CSF immunostaining. One case had a good prognosis and the other case died after 9 months from diagnosis. A change in serum G-CSF levels was reportedly an effective tumor marker in several reports. In the present cases, evaluation of serum G-CSF levels was found to be more sensitive than computerized tomography. The treatment and outcomes of UC-producing G-CSFs and the efficacy of serum G-CSF as a tumor marker are discussed based on our cases and a review of the literature.

MP78-04 EFFICACY OF EARLY URETERAL LIGATION ON PREVENTION OF INTRAVESICAL RECURRENCE AFTER RADICAL NEPHROURETERECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA: A PROSPECTIVE SINGLE-ARM MULTICENTER CLINICAL TRIAL

Shinichi Yamashita*, Akihiro Ito, Koji Mitsuzuka, Masataka Aizawa, Naomasa Ioritani, Sendai, Japan; Shigeto Ishidoya, Sendai, Japan; Yoshihiro Ikeda, Osaki, Japan; Kenji Numahata, Yamagata, Japan; Kazuhiko Orikasa, Kesennuma, Japan; Tatsuo Tochigi, Natori, Japan; Fumihiko Soma, Hachinohe, Japan; Takashige Namima, Hideo Saito, Sendai, Japan; Makoto Sato, Rifu, Japan; Shinnosuke Katoh, Yuzawa, Japan; Shozo Ota, Sendai, Japan; Atsushi Kyan, Shirakawa, Japan; Atsushi Takeda, Ichinoseki, Japan; Yasuhiro Kaiho, Yoichi Arai, Sendai, Japan