Shigehiro Soh

Factors influencing morbidity in patients undergoing transurethral resection of the prostate

OBJECTIVESnTransurethral resection of the prostate (TURP) has become the primary method to relieve bladder outlet obstruction for patients with benign prostatic hyperplasia (BPH). Data from 3861 consecutive patients with BPH who underwent TURP from 1971 to 1996 at our hospital were retrospectively analyzed.nnnMETHODSnThe patients were classified into two groups comprising 1930 patients who underwent TURP from 1971 to 1985 (early group) and 1931 patients who underwent TURP from 1985 to 1996 (late group). Risk factors associated with blood transfusions and perioperative complications were analyzed in these patients.nnnRESULTSnMortality, morbidity, and blood transfusions were noted in 5 (0.1 %), 516 (13.4%), and 507 (13.1%) patients, respectively. The blood transfusion and morbidity rates decreased over the 25-year period (P <0.001, chi-square test for trends), which was reflected in a decrease in these rates in the late group (6.1% and 9.5%, respectively) compared with those of the early group (20.2% and 17.2%, respectively). Postoperative bleeding and morbidity were closely related to prostatic gland size and operating time. The most significant differences for the risk of a blood transfusion were related to resection time, the amount of tissue resected, age, and the decade (1970s, 1980s, or 1990s) in which the surgery was performed (P <0.0005), whereas resection time was significantly correlated with morbidity (P <0.0005). As risk factors for each complication, the time of surgical resection, the decade of surgery, and the amount of tissue resected directly correlated with the incidence of extravasation and hemostatic procedures (P < or =0.003), whereas the incidence of postoperative epididymitis positively correlated with a preoperative vasectomy and a closed drainage system (P <0.0005).nnnCONCLUSIONSnSince the 1970s, the rates of blood transfusions and morbidity have decreased for patients undergoing TURP. Advances in techniques, instrumentation, and surgical and perioperative management, including anesthesia, have made TURP a relatively safe procedure, and it remains an effective means for treating patients with BPH.

The human renal lymphatics under normal and pathological conditions

Aims:u2002 The renal lymphatics have not been fully documented in humans. The aim of this study was to clarify the morphology of the human renal lymphatic system under normal and pathological conditions by immunohistochemistry using anti‐D2‐40 antibody.

Limited suppression of prostate-specific antigen after salvage radiotherapy for its isolated elevation after radical prostatectomy

OBJECTIVESnTo investigate the clinical outcome and degree of prostate-specific antigen (PSA) suppression after salvage radiotherapy performed because of isolated PSA elevation after radical prostatectomy.nnnMETHODSnWe examined the outcomes of 32 patients who underwent radiotherapy after radical prostatectomy. Hypersensitive, as well as conventional, PSA assays were used to measure PSA levels after irradiation.nnnRESULTSnOf 125 patients who underwent radical prostatectomy for clinically resectable prostate cancer, 42 (33.6%) developed detectable PSA an average of 13.5 months postoperatively. Thirty-two patients underwent salvage radiotherapy. In 13 patients (40.6%), PSA became undetectable (less than 0.1 ng/mL) at a mean of 1.2 months. Two of these patients later developed detectable PSA within 1 2 months. Of 22 patients who had at least 12 months of follow-up, 8 had a durable PSA response. Of 13 patients who attained an undetectable PSA postoperatively and then showed a delayed progressive increase, 7 exhibited a durable response lasting for more than the 12 months after irradiation. By contrast, only 1 of 9 patients with persistently elevated postoperative PSA showed undetectable levels after irradiation. Frozen sera from the 8 patients with a durable response to irradiation were available to measure levels less than 0.1 ng/mL by hypersensitive assay. The mean value was 0.035 ng/mL at an average of 26.9 months after irradiation. Only 3 patients had levels less than 0.01 ng/mL.nnnCONCLUSIONSnAlthough radiotherapy may be beneficial in a small number of patients, many patients continue to have measurable levels of PSA (more than 0.01 ng/mL) after irradiation. Our results suggest that this treatment in its current form is inadequate to eradicate residual carcinoma.

Laparoscopic pyeloplasty for ureteropelvic junction obstruction: Outcome of initial 12 procedures

Abstractu2003 Background:u2002 Open pyeloplasty has been the gold standard for surgical treatment of ureteropelvic junction (UPJ) obstruction, enjoying a long‐term success rate exceeding 90%. Unfortunately, this procedure requires a muscle incision that entails some degree of morbidity. We have, therefore, investigated the feasibility of laparoscopic pyeloplasty for UPJ obstruction and report here the outcomes of our early cases. The median follow up is 25u2003months (range, 12–42u2003months).

Significance of Lymphatic Invasion and Proliferation on Regional Lymph Node Metastasis in Renal Cell Carcinoma

We studied the associations of lymphatic invasion and lymphatic vessel density around tumors with lymph node (LN) status in renal cell carcinoma (RCC) by immunohistochemical analysis using D2-40 antibody as a lymphatic marker. Surgically removed specimens from 76 cases with RCC, including 16 cases with LN metastasis, were used. Lymphatic vessel density around the tumor increased compared with normal kidneys but was not significant by LN status. Tumor size, tumor cell types, patterns of tumor growth, nuclear grade of tumor cells, venous invasion, lymphatic invasion, and primary tumor stage were predictive factors for LN metastasis. Based on multivariate regression analysis, only lymphatic invasion was an independent risk factor for LN metastasis. The immunohistochemical detection of lymphatics was useful for identifying the lymphatic invasion of RCC, and the presence of lymphatic invasion around RCC was an independent predictive factor for LN metastasis.

Distribution of Lymphatic Vessel Network in Normal Urinary Bladder

OBJECTIVESnThe lymphatic vessel endothelial hyaluronan receptor (LYVE-1) is a novel lymphatic vessel marker that is expressed on lymph vessel endothelial cells. The objective of this study was to determine the LYVE-1 expression patterns in normal urothelium and to compose the geometric topography of the lymphatic network.nnnMETHODSnImmunohistochemical staining for LYVE-1 and von Willebrand factor was performed to assess the differences in the distribution of lymphatic vessels between the components in the urinary bladder. The sizes of the individual lymphatic vessels were categorized as small, medium, and large. To compare the lymphatic density (counts per square millimeter), the number of lymphatic vessels of the five random areas was counted in each specimen.nnnRESULTSnLYVE-1 expression and the lymphatic density of the muscularis propria were significantly greater than those of other layers, including the epithelium, lamina propria, perivesical fat, and serosa (P <0.0001). The size of the lymphatic vessels in the muscularis propria was significantly smaller than that in the other layers (P <0.0001). The greatest distribution of the lymphatic vessels was identified in the border areas consisting of the lamina propria and muscular propria or the muscular propria and adventitia, including the perivesical fat and serosa.nnnCONCLUSIONSnWe have developed a new type of color geometric topography to accurately exhibit the distribution of that complex network. Lymphatic vessels, although small, are predominately distributed in the muscularis propria in the normal urothelium compared with that in the other layers. The LYVE-1 antibody was a useful specific marker for the illustration of the lymphatic vessel in conventional paraffin-embedded specimens of the urinary bladder.

Inadequacy of free prostate-specific antigen parameters in the prediction of pathologic extent of prostate cancer in japanese men

OBJECTIVESnTo evaluate free prostate-specific antigen (PSA) and free to total PSA ratio as predictors of pathologic extent in Japanese patients with prostate cancer.nnnMETHODSnBy TOSOH assay, pretreatment serum serologic markers of free PSA, total PSA, free to total PSA ratio, and PSA density (PSAD) were determined for 108 patients subsequent to radical prostatectomy for resectable prostate cancer. Serum values for these markers were compared with pathologic findings and tumor volume on the basis of pathologic assessment of whole mount section histology.nnnRESULTSnMean total PSA, free PSA, free to total PSA ratio, and PSAD significantly differed for pathologically confined (pT2 or lower) and advanced (pT3 or higher) cancers (P < 0.05). Total PSA, free PSA, and PSAD provided indication of seminal vesicle involvement, surgical margin status, nodal involvement, and total tumor volume (P < 0.05). Free PSA was more closely correlated with total tumor volume than the free to total PSA ratio; this ratio was not correlated with total tumor volume or specimen Gleason score. Free PSA and free to total PSA ratio were not found to be any more useful than total PSA and PSAD for predicting pT3 disease by receiver operating characteristic curve analysis. Multivariate logistic regression analysis and log likelihood ratio test results indicated little additional value of these parameters for predicting pT3 disease.nnnCONCLUSIONSnContrary to previous reports, free PSA and the free to total PSA ratio are of little use subsequent to the diagnosis of prostate cancer.

A PITFALL IN DIAGNOSING A TUMOR THROMBUS BY COMPUTED TOMOGRAPHY

This paper presents a case of right renal cell carcinoma with a false‐positive finding of tumor thrombus in the inferior vena cava. The intraluminal filling defect revealed by computed tomography appeared to be an artifact due to the inflow of non‐opacified blood into the inferior vena cava. The possibility of such an artifact should be borne in mind to avoid as far as possible any unnecessary diagnostic intervention and delay in instituting proper therapy.