Momokazu Gotoh

THE LONG-TERM OUTCOME OF LAPAROSCOPIC RADICAL NEPHRECTOMY FOR SMALL RENAL CELL CARCINOMA

PURPOSE To evaluate the efficacy of laparoscopic radical nephrectomy in patients with small renal cell carcinoma, we analyzed the long-term results in those treated with laparoscopy and those undergoing open surgery. MATERIALS AND METHODS A total of 149 patients with tumors less than 5 cm. in diameter enrolled in a radical nephrectomy program between January 1992 and March 2000. Of these patients 103 were treated laparoscopically and the remaining 46 underwent open surgery. Patient followup was until June 30, 2000. RESULTS Laparoscopy followup was from 3 to 95 months (median 29). A total of 100 patients survived, 2 died without any recurrent disease in months 34 and 45, respectively, and 1 dropped out in postoperative month 3. Seeding of the port sites did not develop in any of the patients. There were 3 patients who had metastatic disease in months 3, 19 and 61, respectively, and 1 had local recurrence in postoperative month 43. The 5-year disease-free and patient survival rates were 95.1%, and 95.0%, respectively. Except for 2 patients who dropped out in months 10 and 16, respectively, 44 who underwent open surgery were followed from 11 to 101 months (median). Of the 44 patients 41 survived without any recurrent disease, 1 also survived with metastasis and 2 died of metastatic disease in months 7 and 11, respectively. The 5-year disease-free and patient survival rates were 89.7% and 95.6%, respectively. CONCLUSIONS Laparoscopic radical nephrectomy can be an alternative to open nephrectomy in patients with localized small renal cell carcinoma.

Clinical guidelines for overactive bladder

Department of Urology, Fukushima Medical University, Fukushima, Department of Urology, Shinshu University School of Medicine, Matsumoto, Nagano, Department of Urology, University of Yamanashi Interdisciplinary Graduate School of Medicine and Engineering, Chuo, Yamanashi, Department of Urology, University of Fukui Faculty of Medicine, Fukui, Department of Urology, University of Tokyo Faculty of Medicine, Tokyo, Department of Urology, Asahikawa Medical College, Asahikawa, Hokkaido, Department of Urology, Niigata University School of Medicine, Niigata, Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Department of Urology, Graduate School of Medical Science, Kyushu University, Fukuoka, Department of Urology, Graduate School of medical Science, Kumamoto University, Kumamoto, Japan

Randomized, double‐blind, placebo‐ and propiverine‐controlled trial of the once‐daily antimuscarinic agent solifenacin in Japanese patients with overactive bladder

To compare solifenacin succinate (5 and 10 mg once‐daily) to placebo and propiverine hydrochloride (20 mg once‐daily), respectively, in Japanese patients with overactive bladder syndrome (OAB).

Phase III, randomised, double-blind, placebo-controlled study of the β3-adrenoceptor agonist mirabegron, 50 mg once daily, in Japanese patients with overactive bladder.

To evaluate the efficacy and safety of the β3‐adrenoceptor agonist mirabegron, in a Japanese population with overactive bladder (OAB).

Solifenacin as add-on therapy for overactive bladder symptoms in men treated for lower urinary tract symptoms--ASSIST, randomized controlled study.

OBJECTIVES To assess the efficacy and safety of solifenacin add-on therapy to tamsulosin in lower urinary tract symptoms (LUTS) men with residual overactive bladder (OAB) symptoms despite tamsulosin monotherapy. METHODS In this randomized, multicenter, double-blind study, male LUTS patients aged≥50 years with urgency episodes/24 hours≥2 and micturitions/24 hours≥8 were randomized to 3 groups: 12-weeks tamsulosin plus placebo (TAM+PBO), tamsulosin plus solifenacin 2.5 mg (TAM+SOL), and tamsulosin plus solifenacin 5 mg (TAM+SOL). Changes from baseline to end of treatment in the number of urgency episodes/24 hours (primary endpoint), micturitions, nocturia, urgency incontinence episodes, International Prostate Symptom Scores (IPSS), and Overactive Bladder Symptom Score (OABSS) were compared between the TAM+SOL groups and TAM+PBO. Safety was assessed on adverse events, postvoid residual volume, and maximal urinary flow rate (Qmax.). RESULTS Six-hundred thirty-eight men were randomized. Urgency was reduced by 2.2 and 2.4 episodes in the TAM+SOL 2.5 and 5 mg groups, respectively. The TAM+SOL 5 mg group showed significant improvement compared with TAM+PBO (-2.4 vs -1.9, P=.049). The number of micturitions in both TAM+SOL groups were significantly reduced compared with TAM+PBO (both P<.001). IPSS storage symptom score and OABSS significantly improved in both TAM+SOL groups compared with TAM+PBO. Changes in IPSS voiding symptom score and Qmax. were similar in all groups. Four patients (1.9%) in the TAM+SOL 5 mg group had urinary retention, but all recovered after catheterization. CONCLUSIONS In male LUTS patients with residual OAB symptoms despite tamsulosin monotherapy, TAM+SOL showed efficacy on urgency, which represents OAB symptoms and was well tolerated.

Periurethral injection of autologous adipose-derived stem cells for the treatment of stress urinary incontinence in patients undergoing radical prostatectomy: report of two initial cases.

Objectives:  To report a novel cell therapy using autologous adipose tissue‐derived stem cells (ADSC) for stress urinary incontinence caused by urethral sphincteric deficiency and the outcomes in two initial cases undergoing periurethral injection of stem cells for the treatment of urinary incontinence after radical prostatectomy.

Ischemic Renal Damage after Nephron-Sparing Surgery in Patients with Normal Contralateral Kidney

BACKGROUND Although nephron-sparing surgery (NSS) has been reported not to affect total renal function, the functional damage of the operated kidney is masked by the contralateral kidney in elective indications. OBJECTIVE To determine ischemic renal damage after NSS. DESIGN, SETTING, AND PARTICIPANTS From August 2005 to October 2007, 32 consecutive patients with elective indications underwent NSS. The mean tumor diameter was 2.6 cm. INTERVENTION Of our patients, the open surgery was performed in 20 patients, and laparoscopic surgery was performed in 12 patients. NSS was performed by hilar clamping with a warm ischemic time of 24.3 min. MEASUREMENTS We analyzed effective renal plasma flow (ERPF) calculated from (99m)Tc-mercaptoacetyltriglycine ((99m)Tc-MAG-3) renal scintigraphy and renal parenchymal volume (RPV) measured from computed tomography (CT) scan. In addition, we analyzed (99m)Tc-MAG-3 uptake regionally in the surgically non-affected parts. (99m)Tc-MAG-3 and CT scans were performed preoperatively and 1 wk and 6 mo postoperatively. RESULTS AND LIMITATIONS One week after NSS, ERPF of the operated kidney decreased by 28.7% (from 158.9 to 113.3 ml/min per 1.73 m(2), p<0.001), and RPV decreased by 12.6% (from 149.8 to 131.0 cm(3), p<0.001). These changes were stable for 6 mo. Regional (99m)Tc-MAG-3 uptake of the operated kidney with an ischemic time of > or = 25 min decreased to 61.8% after 1 wk and 70.9% after 6 mo. In contrast, with ischemic times within 25 min, regional (99m)Tc-MAG-3 uptake was 87.4% after 1 wk and 94.4% after 6 mo. This is a relatively small study, and the follow-up period is short. A larger sample size and longer follow-up may be required. CONCLUSIONS Although total renal function was almost unaffected before and after NSS, a warm ischemic time of > or = 25 min caused irreversible damage distributed diffusely throughout the operated kidney.

Periurethral injection of autologous adipose‐derived regenerative cells for the treatment of male stress urinary incontinence: Report of three initial cases

Objectives:  To report a novel cell therapy using autologous adipose tissue‐derived regenerative cells for male stress urinary incontinence caused by urethral sphincteric deficiency, and the outcomes in the initial cases undergoing periurethral injection of adipose tissue‐derived regenerative cells.

Comparison of tamsulosin and naftopidil for efficacy and safety in the treatment of benign prostatic hyperplasia : a randomized controlled trial

To compare the efficacy and safety of two α1a/α1d adrenoceptor (AR) antagonists with different affinity for the α1AR subtypes, tamsulosin and naftopidil, in the treatment of benign prostatic hyperplasia (BPH).

Regenerative treatment of male stress urinary incontinence by periurethral injection of autologous adipose-derived regenerative cells: 1-year outcomes in 11 patients.

To assess the efficacy and safety of a novel cell therapy for male stress urinary incontinence consisting of periurethral injection of autologous adipose‐derived regenerative cells, and to determine the 1‐year outcomes.