Teruaki Ao

Factors influencing morbidity in patients undergoing transurethral resection of the prostate

OBJECTIVES Transurethral 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. METHODS The 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. RESULTS Mortality, 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). CONCLUSIONS Since 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.

Infrequent involvement of mutations on neurofibromatosis type 1, H-ras, K-ras and N-ras in urothelial tumors

The neurofibromatosis type 1 (NF1) gene is considered a tumor-suppressor gene whose product acts upstream of ras. The ras gene is an oncogene very commonly detected in human cancers and consists of three families, H-ras, K-ras and N-ras. These genes are converted to active oncogenes by point mutations in codon 12, 13, or 61. Examination was made of the mutations of these genes in 39 urothelial malignant tumors (31 bladder cancer, 6 renal pelvic tumor, and 2 ureter tumors) using polymerase chain reaction single-stranded conformation polymorphism and direct sequencing methods. Three of 39 (7.7%) cases showed mobility shifts in the ras family gene but no point mutations in NF1 and N-ras genes could be detected. Mutations were found in 1 case in H-ras at codon 13 (GGT-GTT/GGT) and K-ras at codon 12 in 2 cases (GGT-GCT/GGT, GGT-GTT/GGT). All 3 cases had progressed far beyond grade 2 and stage pT2. It follows from the above that NF1 and ras gene mutations are infrequent in the pathogenesis of urothelial tumors.

Laparoscopically Assisted Heminephrectomy of a Horseshoe Kidney: A Case Report

Laparoscopic surgery is a minimally invasive alternative to an open While technically demanding, laparoscopic heminephrectomy may be the treatment of choice in certain cases. We report a case of laparoscopically assisted heminephrectomy for nonfunctioning giant hydronephrosis in a horseshoe kidney. CASE REPORT

Prostatic stromal sarcoma with neuroectodermal differentiation

AbstractProstatic stromal sarcoma is a fairly rare tumor that constitutes approximately 0.1–0.2% of all prostatic cancers. Detailed characteristics of the tumor are still unclear due to its rarity.We describe a case of prostatic stromal sarcoma in a 63 year-old man who suffered from urinary obstructive symptoms. Palliative transuterine resection was performed and the preliminary histopathological diagnosis was neuroendocrine carcinoma. After chemotherapy, total pelvic exenteration was performed. Histopathologically, the tumor was composed of monotonously proliferating small to medium-sized round cells, which existed in compact islands with loose or dense fibrovascular networks. Immunohistochemically, the tumor cells were widely positive for vimentin, CD56, CD99 and focally positive for synaptophysin, CD10, progesterone receptor, desmin and CD34, but negative for EMA, cytokeratin, estrogen receptor, S-100 and myoglobin. Most of the previously reported tumors exhibited positive stainability for CD10 and progesterone receptor. In addition to these markers, expressions of CD56, CD99 and synaptophysin were characteristically detected in our case. To the best of our knowledge, we present the first case of prostatic stromal sarcoma with characteristic immunohistochemical staining properties. Although the biological characteristics of this rare tumor have not yet been elucidated, these findings suggest prostatic stromal sarcoma can potentially show neuroectodermal differentiation.Virtual slideThe virtual slide(s) for this article can be found here:http://www.diagnosticpathology.diagnomx.eu/vs/7291874028051262

Visual laser Ablation of the Prostate and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

For the past 50 years, transurethral resection of the prostate (TURP) has been the most common treatment for benign prostatic hyperplasia (BPH). The authors have conducted visual laser ablation of the prostate (VLAP) for BPH as a minimum invasive surgery. The results were compared with those of VLAP, VLAP+transurethral incision of the prostate (TUIP), and TURP as other treatments for BPH. In the VLAP group, 50 of 52 (96.2%), 36 of 40 (90.0%) and 31 of 36 (86.1%) were categorized as having more than a Fair Response (FR) at 3, 6 and 12 months, postoperatively. In the VLAP+TUIP group, 24 of 29 (82.8%), 19 of 22 (86.4%) and 9 of 11 (81.8%) were classed as having more than a FR at 3, 6 and 1 2 months, postoperatively. Forty–one of 42 (97.6%), 1 7 of 1 7 (100.0%) and 6 of 6 (100.0%) patients reaction to TURP was more than FR in overall response at 3, 6 and 12 months, postoperatively. The need for a blood transfusion, perforation of the prostate capsule and transit incontinence persisting for more than 1 month occurred in 1 of 45 (2.2%), 1 (2.2%) and 4 (8.9%) patients in the TURP group. Bladder neck contracture was seen in 4 of 52 (7.7%) in the VLAP group. Average postoperative catheter duration was shorter in the VLAP+TUIP (5.7 ± 8.4 days) than in the VLAP group (10.3 ± 10.4 days). Although TURP remains the standard treatment for BPH, VLAP results in less morbidity compared to TURP. VLAP with TUIP appears to lessen the risk of postoperative urinary retention and provide better results in longer follow–up studies.

[Clinical experiences with TURP at the Oita Urological Hospital: report of 997 cases].

CLINICAL EXPERIENCES WITH TURP AT THE OITA UROLOGICAL HOSPITAL: REPORT OF 997 CASES Masayuki Sawamura, Teruaki Ao, Toyoaki Uchida, Kazuomi Kadowaki, Kiyoshi Shoji and Masahiro Kanzaki Oita Urological Hospital, Oita, Japan (Director: Dr. M. Kanzaki) Between March 1974 and December 1985, 997 patients underwent TUR-P at the Oita Urological Hospital. This paper is to report the clinical statistics of TURP cases with special reference to preoperative risk factors and surgical complications. Of the 997 patients, 958 were preoperatively diagnosed as BPH and the remaining 39 were as malignant. Histopathological examination of surgical specimens revealed 31 latent carcinomas in the 958 patients whose preoperative diagnosis was benign by rectal examinaiton and echosonography. Routine preoperative evaluation demonstrated a variety of risk factors or complications such as cardiovascular disorder (19%), hypoproteinemia (8.8%), renal dysfunction (7.6%), and abnormal glucose tolerance (5.1%). Surgical and postoperative complications were profuse bleeding requiring blood transfusion (5.9%), hyponatoremia (2.7%), fever (2.6%), urethral stricture (1.7%) and urinary incontinence (0.3%). Although majority of these patients were successfully treated by conservative therapy, three patients died of acute heart failure, cerebral bleeding and sepsis. Hypoproteinemia and renal dysfunction were common preoperative complication in these 3 patients. This is strongly suggestive of importance of preoperative check-up of hypoproteinemia and renal dysfunction as dangerous and mortile preoperative risk factors of TURP.