Tomonori Komatsu

Efficacy of Silodosin for Relieving Benign Prostatic Obstruction: Prospective Pressure Flow Study

PURPOSE We investigated the effect of the new sympathetic alpha1A-adrenoceptor antagonist silodosin for relieving benign prostatic obstruction by pressure flow study. MATERIALS AND METHODS In this open, nonblinded, prospective study we administered 8 mg silodosin daily for 4 weeks in 60 patients with lower urinary tract symptoms associated with benign prostatic enlargement. As a primary outcome measure, we assessed changes in bladder function and benign prostatic obstruction using pressure flow study. As secondary outcome measures, changes in subjective symptoms and quality of life were assessed by the International Prostate Symptom Score. Objective changes in urination status were also assessed by free uroflowmetry in terms of maximum flow rate and post-void residual urine volume. RESULTS A total of 57 patients were enrolled for analysis. In the storage phase of the pressure flow study bladder capacity at first desire to void increased significantly with no significant change in maximum cystometric capacity. Of 24 patients 14 (58.3%) with uninhibited detrusor contractions before administration showed apparent improvement in detrusor overactivity after administration, including 6 in whom uninhibited contractions disappeared. In the voiding phase mean detrusor pressure at maximum flow significantly decreased from 72.5 to 51.4 cm H(2)O. The mean bladder outlet obstruction index decreased significantly from 60.6 to 33.8. Obstruction grade assessed by the Schaefer nomogram improved in all except 1 patient. Total symptom and quality of life scores, maximum flow rate and post-void residual urine volume on free uroflowmetry significantly improved. CONCLUSIONS Silodosin improved lower urinary tract symptoms by improving bladder storage function and relieving benign prostatic obstruction.

De novo detrusor underactivity after laparoscopic radical prostatectomy

Objective:  The aim of this study was to investigate bladder function following laparoscopic radical prostatectomy, with a focus on de novo detrusor underactivity.

Direct Visualization of Renal Hemodynamics Affected by Carbon Dioxide-induced Pneumoperitoneum

OBJECTIVES To examine the direct renal hemodynamics during carbon dioxide pneumoperitoneum in both human and porcine models. Laparoscopic living donor nephrectomy has become widespread because of its minimally invasive nature. However, it has been clear that the renal hemodynamics and function are affected during carbon dioxide pneumoperitoneum. METHODS The erythrocyte velocity in the cortical peritubular capillary (CPC) was monitored and measured during laparoscopic nephrectomy on human donors and laparoscopic partial nephrectomy on humans with renal cell carcinoma during carbon dioxide pneumoperitoneum (pressure of 8, 12, 15, 18, and 20 mm Hg). We used a direct imaging system of renal microcirculation by magnifying endoscopy, as previously described. We maintained the same pressure for 5 minutes. In the porcine model (6 pigs), we measured the erythrocyte velocity in the CPC using the same method during carbon dioxide pneumoperitoneum (pressure of 0, 5, 10, 15, 20, and 25 mm Hg). RESULTS The erythrocyte velocity in the renal artery did not change during increased carbon dioxide pneumoperitoneum. When the pneumoperitoneal pressure was 25 mm Hg, we found that >90% of the erythrocyte velocity in the CPC was nonflowing. In the human model, the erythrocyte velocity in the CPC decreased when the carbon dioxide pneumoperitoneum pressure was 12 mm Hg. CONCLUSIONS The erythrocyte velocity in the CPC decreased during carbon dioxide pneumoperitoneum in all kidneys in both the human and the porcine models. However, erythrocyte velocity in the renal artery did not change during carbon dioxide pneumoperitoneum. After stopping the pneumoperitoneum, the erythrocyte velocity in the CPC recovered immediately. The findings of our study have shown that the suitable carbon dioxide pneumoperitoneal pressure for renal microcirculation is <8 mm Hg for laparoscopic surgery.

Long-term outcome of pediatric renal transplantation: a single center study in Japan.

Little is known about the risk factors for long‐term poor outcome in pediatric renal transplantation. Between 1973 and 2010, 111 renal transplants (92 living donations) were performed in 104 children (56 males, mean age, 12.5 yr) at the Social Insurance Chukyo Hospital, and followed‐up for a mean period of 13.6 yr. The patient survival at 1, 5, 10, 15, 20 (living‐ and deceased‐donor transplants), and 30 yr (living‐donor transplants only) was 98.1%, 92.8%, 87.8%, 84.9%, 82.6%, and 79.3%. The graft survival at 1, 5, 10, 15, 20, and 30 yr was 92.0%, 77.3%, 58.4%, 50.8%, 38.5%, and 33.3%. The most common cause of graft loss was CAI, AR, death with functioning, recurrent primary disease, ATN, and malignancy. Donor gender, ATN, malignancy/cardiovascular events, and eras affected patient survival. AR and CAI were the risk factors for graft loss. The evolved immunosuppression protocols improved the outcome by reducing AR episodes and ATN but not CAI, suggesting CAI as the major risk factor for graft loss. CAI was correlated with AR episodes, CMV infection, and post‐transplant hypertension. Strategies for preventing the risk factors for malignancy/cardiovascular events and CAI, including hypertension/infection, are crucial for better outcomes.

Efficacy of Propiverine in Improving Symptoms and Quality of Life in Female Patients with Wet Overactive Bladder

Objectives: The present prospective study was conducted to assess the effects of propiverine hydrochloride in improving symptoms and quality of life (QoL) in female patients with wet OAB.

Solitary fibrous tumor of the seminal vesicle

A 56-year-old man presented to our hospital with a pelvic mass. The tumor was diagnosed to occur from right seminal vesicle and to be a benign solitary fibrous tumor by transrectal tumor biopsy. The tumor enlarged during follow up, and he under-went resection of the tumor.

Factors Having Effect on Graft Survival in Cadaveric Renal Transplantation

BACKGROUND One of the problems of cadaveric renal transplantation is that its graft survival rate is less than that for living renal transplantation. We aim to study relationships between the graft survival of cadaveric renal transplantation patients and various factors. MATERIALS AND METHODS We retrospectively analyzed 350 cadaveric renal transplantation patients from our institutions from 1983 to 2011. Kaplan-Meier analysis was performed to evaluate graft survival ratios. Using a multivariable Cox regression model, we evaluated the relationship between graft survival and the factors such as age and gender of donor and recipient, body mass index of recipient, duration of hemodialysis, warm ischemic time, and acute rejection (AR), etc. RESULTS Among 235 males and 115 females, the overall mean age was 41 years. Median follow-up was 15 years (2 to 28 years). The graft survival ratio was 97% at 1 year, 85% at 5 years, and 71% at 10 years. Using the Cox regression model, graft survival was affected by donor age (younger than 60 years; hazard ratio [HR] 1.5; 95% confidence interval (CI) 1.0-2.0; P = .027) and early acute rejection (within 3 months; HR 2.1; CI 1.6-2.8; P < .001). CONCLUSIONS The graft survival of cadaveric renal transplantation patients is affected by factors of donor age and early AR.

Identification of the narrow lumen of the ureter using a Fogarty catheter during laparoscopic pyeloplasty

It is difficult to identify the narrow sites of the ureter from the outside while carrying out laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. We developed and named a new method, the Fogarty test, to identify the narrow sites of the ureter using a Fogarty catheter. A 4‐ to 5‐Fr Fogarty catheter was inserted through an incision in the pelvis to the proximal ureter, inflated with air and withdrawn gently to determine resistance. The narrow lumen of the ureter was identified under direct vision and spatulated by laparoscopic scissors. This procedure was carried out repeatedly until the ureter was fully spatulated. By using the Fogarty test, we can visualize the narrow position and length of the ureter under direct vision, and confirm whether it is fully spatulated or not. This technique is very simple and easy to carry out. We believe it is useful for sufficient spatulation of intrinsic ureteral stricture, especially in patients where multiple narrow sites exist.

A COMPARISON OF LYMPH NODE DISSECTION IN LAPAROSCOPIC NEPHROURETERECTOMY AND OPEN NEPHROURETERECTOMY FOR TRANSITIONAL CELL CARCINOMA OF THE RENAL PELVIS AND URETER

INTRODUCTION AND OBJECTIVE: Laparoscopic surgery has widely been applied to nephroureterectomy for transitional cell carcinoma (TCC) of the renal pelvis and ureter. Although the laparoscopic technique to perform nephroureterectomy with a bladder cuff has been well discussed, there are few studies on the clinical significance and oncological outcome of simultaneous lymph node dissection. To clarify this point, we assessed the local recurrence after nephroureterectomy with a bladder cuff and simultaneous lymph node dissection, and compared the results between conventional open surgery (ONU) and laparoscopic nephroureterectomy (LNU). METHODS: We retrospectively reviewed the database of 266 patients undergoing nephroureterectomy with a bladder cuff and lymph node dissection for TCC of the renal pelvis and ureter with clinical stages of T1-3N0M0. Of these patients, 138 underwent LNU via a retroperitoneal approach and 128 underwent ONU between August 1997 and November 2007. Local recurrence except bladder tumor was assessed with mean follow-up periods of 46.3 months in the LNU group and 51.4 months in the ONU group. RESULTS: Patient mean age was 69.4 years in the LNU group and 67.5 years in the ONU group. Lymph node metastasis was pathologically positive in 10 patients (7.2%) in LNU group and 9 (7.0%) in ONU group, with no statistical difference between the 2 groups. Recurrence either at local or distant areas without pathologically positive lymph node metastasis was observed in 17 patients (13.3%) in the LNU group and 16 (13.4%) in the ONU group, which was not statistically different. On the other hand, local recurrence was observed in 11 patients (8.6%) in the LNU group and 6 (5.0%) in the ONU. The local recurrence rate in the LNU group tended to be higher than in the ONU group, although the difference was not statistically significant. CONCLUSIONS: Laparoscopic lymph node dissection in combination with nephroureterectomy with a bladder cuff is a feasible technique for TCC of the renal pelvis and ureter. Further investigation to improve surgical technique and to determine the region of lymph node dissection is necessary.

DIRECT VISUALIZATION OF CORTICAL PERITUBULAR CAPILLARY OF HUMAN TRANSPLANT KIDNEY WITH REPERFUSION INJURY USING A MAGNIFYING ENDOSCOPY

Aims: We developed the direct imaging system of renal microcirculation by a magnifying-endoscopy, which enabled the movement of erythrocyte to be visualized in glumerular and cortical peritubular capillary (CPC). The aim of this study is to clarify the early microhemodynamic condition in CPC of transplanted kidney, which is believed to be crucial in early graft function. Methods: Erythrocyte velocity in CPC was analyzed in 13 recipients of living-related (10) and cadaveric donor (3) renal transplants at 20, 60, 90 and 120 minutes after re-perfusion. In living-related donors, erythrocyte velocity in CPC was also measured before nephrectomy. Microhemodynamic parameters were quantified off-line by the sepatiotemporal analysis using a computer-assisted image original program system. Results: Ischemic time, duration of ATN and lowest S-Cr level after kidney transplantation in 13 recipients are shown in table 1. Although erythrocyte velocity was significantly reduced at 20 and 60 minutes after reperfusion in living-related donor transplants, it recovered to base line values at 120minutes (Table 2). In cadaveric donor transplants erythrocyte velocity in CPC after revasculization was significantly lower than that of living-related donor transplants.