Toru Sugihara

Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score

Study Type – Therapy (symptom prevalence)

Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases

Study Type – Prognosis (outcome)

Expression of androgen and estrogen signaling components and stem cell markers to predict cancer progression and cancer-specific survival in patients with metastatic prostate cancer

Purpose: Genes of androgen and estrogen signaling cells and stem cell–like cells play crucial roles in prostate cancer. This study aimed to predict clinical failure by identifying these prostate cancer-related genes. Experimental Design: We developed models to predict clinical failure using biopsy samples from a training set of 46 and an independent validation set of 30 patients with treatment-naïve prostate cancer with bone metastasis. Cancerous and stromal tissues were separately collected by laser-captured microdissection. We analyzed the association between clinical failure and mRNA expression of the following genes androgen receptor (AR) and its related genes (APP, FOX family, TRIM 36, Oct1, and ACSL 3), stem cell–like molecules (Klf4, c-Myc, Oct 3/4, and Sox2), estrogen receptor (ER), Her2, PSA, and CRP. Results: Logistic analyses to predict prostate-specific antigen (PSA) recurrence showed an area under the curve (AUC) of 1.0 in both sets for Sox2, Her2, and CRP expression in cancer cells, AR and ERα expression in stromal cells, and clinical parameters. We identified 10 prognostic factors for cancer-specific survival (CSS): Oct1, TRIM36, Sox2, and c-Myc expression in cancer cells; AR, Klf4, and ERα expression in stromal cells; and PSA, Gleason score, and extent of disease. On the basis of these factors, patients were divided into favorable-, intermediate-, and poor-risk groups according to the number of factors present. Five-year CSS rates for the 3 groups were 90%, 32%, and 12% in the training set and 75%, 48%, and 0% in the validation set, respectively. Conclusions: Expression levels of androgen- and estrogen signaling components and stem cell markers are powerful prognostic tools. Clin Cancer Res; 20(17); 4625–35. ©2014 AACR.

Impact of hospital volume and laser use on postoperative complications and in-hospital mortality in cases of benign prostate hyperplasia.

PURPOSE We analyzed the impact of hospital volume and laser use on postoperative complications and in-hospital mortality in transurethral prostatic surgery. MATERIALS AND METHODS We evaluated data from 18,578 patients in 686 hospitals who underwent transurethral prostatic surgery between July and December, 2006 to 2008, using the Diagnosis Procedure Combination database in Japan. Cases were divided into low (14 or less per year), medium (14 to 29 per year) or high (30 or more per year) hospital volume groups. Logistic regression analyses were conducted to determine the concurrent effects of hospital volume, laser use and other factors on postoperative complications, transfusion and in-hospital mortality. Laser devices included neodymium:yttrium aluminum garnet and holmium:yttrium aluminum garnet lasers. RESULTS The overall in-hospital mortality was 0.05% (10 of 18,578 patients) and was not significantly different among groups. The transfusion rates of the low, medium and high volume groups were 8.3%, 7.0% and 5.5%, respectively (low vs high volume adjusted odds ratio 1.55, p <0.01), and postoperative complication rates were 3.7%, 3.2% and 2.6% (low vs high volume OR 1.425, p = 0.016), respectively. An absence of laser use was also a significant risk factor on both measures (OR 1.46 and 2.02, both p <0.01). Teaching hospitals were associated with a higher transfusion rate (OR 1.75), and comorbidities of chronic lung disease, chronic renal failure and malignancy were related to complication rates (OR 1.89, 2.32 and 1.50, respectively). CONCLUSIONS The mortality rate of transurethral prostatic surgery is extremely low and is not affected by hospital volume. However, higher surgical volumes and laser use were significantly associated with lower rates of complications and transfusions.

Admissions related to interstitial cystitis in Japan: an estimation based on the Japanese diagnosis procedure combination database.

We estimated the incidence of admissions related to interstitial cystitis in Japan using a national administrative claims database, the Diagnosis Procedure Combination database, which included information for 53.6% of urological training hospitals certified by the Japanese Urological Association. “Admissions related to interstitial cystitis” was defined as those cases whose ICD‐10 code for the main reason for admission was N301 (interstitial cystitis) between 2007 and 2009. Among 8.42 million inpatient cases, 784 female and 212 male patients with interstitial cystitis were identified. The ratio of females to males was 3.69 and the median age was 67 years (range 5–92 years). The admission incidence (per 100 000 person‐years) in females and males was estimated to be 1.35 (95% confidence interval 1.25–1.46) and 0.37 (0.31–0.42), respectively. This incidence is low compared with other reports. Possible reasons for this finding include racial difference, clinical examination methods, lack of outpatient data and poor health‐care coverage of interstitial cystitis.

A nomogram predicting severe adverse events after ureteroscopic lithotripsy: 12 372 patients in a Japanese national series

Ureteroscopic lithotripsy sometimes causes severe complications, e.g. septic shock, and the relationship between long operative duration and complication rate has been empirically recognised. But due to the rarity, evidence is limited. We analysed 12372 cases and showed that the complication rate increased according to operative duration, especially for operations taking >90 min. Also, we found that high‐volume centres had lower complication rates.

Renal haemorrhage risk after extracorporeal shockwave lithotripsy: results from the Japanese Diagnosis Procedure Combination Database.

Study Type – Therapy (case series)

Longer operative time is associated with higher risk of severe complications after percutaneous nephrolithotomy: Analysis of 1511 cases from a Japanese nationwide database

To evaluate risk factors of severe adverse events after percutaneous nephrolithotomy with an emphasis on operation time, and to develop a nomogram for predicting them.

Comparisons of perioperative outcomes and costs between open and laparoscopic radical prostatectomy : A propensity-score matching analysis based on the Japanese Diagnosis Procedure Combination database

We compared perioperative outcomes and costs between open and laparoscopic radical prostatectomy for prostate cancer. The Japanese Diagnosis Procedure Combination database, including cases from 2007 to 2010, was used by one‐to‐one propensity‐score matching. The following items were compared: complication rate; homologous and autologous transfusion rate; first cystography day and cystography repeat rate; anesthesia time; postoperative length of stay; and costs. Multivariate analyses were carried out by including age, Charlson Comorbidity Index, T stage, hospital volume and hospital academic status as variables. As a result, among 15 616 open and 1997 laparoscopic radical prostatectomies, 1627 propensity‐score matched pairs were generated. The laparoscopic approach showed a better overall complication rate (3.4% vs 5.0%), homologous transfusion rate (3.3% vs 9.2%), autologous transfusion rate (44.9% vs 79.3%), first cystography day (mean 6th vs 7th day), mean postoperative length of stay (mean 11 vs 13 days), and cost without surgery and anesthesia (mean

Nocturia in men is a chaotic condition dominated by nocturnal polyuria.

7965 vs