Yasumasa Shichiri

QUALITY OF LIFE SURVEY OF URINARY DIVERSION PATIENTS : COMPARISON OF CONTINENT URINARY DIVERSION VERSUS ILEAL CONDUIT

Background Continent urinary reservoirs (CUR) have become one of the major options for patients requiring urinary diversion to improve their quality of life (QOL). To assess whether CUR enhanced postoperative QOL, we surveyed patients with CUR and ileal conduit (IC) using a questionnaire sent by mail.

Laparoscopic ureterolysis for idiopathic retroperitoneal fibrosis.

Ureterolysis and subsequent intraperitonealization were performed laparoscopically in 2 patients with unilateral idiopathic retroperitoneal fibrosis. The operative procedure was easily accomplished, and the outcome was excellent in the patient who had a ureteral stricture of 2 cm in length, whereas the operation was technically more complicated with a prolonged operation time in the other patient who had a stricture more than 5 cm in length. The convalescence period after the operation was short in both cases. Laparoscopic ureterolysis is a less invasive alternative to conventional open surgery, particularly in patients with involvement of a unilateral ureter of short length.

Management of Late Complications of Continent Urinary Diversion Using the Kock Pouch and the Indiana Pouch Procedures

Background: Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long‐term follow‐up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods.

Eosinophilic Sclerosing Lipogranuloma of the Male Genitalia Not Caused by Exogenous Lipids

A type of sclerosing lipogranuloma of the male genitalia that is different from cases caused by injection or application of foreign bodies is reported in 4 patients. The characteristics of the disease are a symmetrical Y-shape of the granuloma, spontaneous regression, severe infiltration of eosinophils in the granuloma, eosinophilia of the peripheral blood and absence of any exogenous lipids by chemical analyses of the granuloma tissue. Ultrastructural study showed intracytoplasmic fat vacuoles of varied size in histiocytes and multinuclear giant cells. This is a new type of sclerosing lipogranuloma of the male genitalia and the pathogenesis of the disease is still unknown.

Complications and the learning curve for a laparoscopic nephrectomy at a single institution.

Background:  We assessed our experiences in performing a laparoscopic nephrectomy, with regard to complications and the learning curve, during a 4‐year period.

Evaluation of Intravesical Prostatic Protrusion as a Predictor of Dutasteride-Resistant Lower Urinary Tract Symptoms/Benign Prostatic Enlargement With a High Likelihood of Surgical Intervention.

OBJECTIVE To investigate factors predicting that combination therapy would be insufficient in terms of efficacy, necessitating conversion to surgical intervention, in patients with lower urinary tract symptoms and/or benign prostatic enlargement. MATERIALS AND METHODS In total, 218 patients given combination therapy for 6 months or more were enrolled in our study. Candidate factors for surgical intervention before dutasteride administration were statistically analyzed. We also examined the proportion of stromal components in resected specimens of the intravesical prostatic protrusion (IPP) portion using the point-counting technique according to IPP grades. RESULTS Combination therapy was effective and was thus continued in 172 patients, whereas 46 required surgical intervention. The comparison between these two groups, by multivariate analysis, revealed significant differences in IPP and total International Prostate Symptom Score (IPSS). IPP (odds ratio 1.133, P <.001) was the strongest independent factor predicting conversion to surgical intervention. Receiver operating characteristic analysis identified the optimal cutoff value of IPP to be 8 mm (area under the curve: 0.9). This value yielded a sensitivity of 91% and a specificity of 72%. In addition, the mean proportion of stromal components in resected specimens of IPP according to IPP grades was grade I: 96.7%, grade II: 57.8%, and grade III: 21.4% (P <.001 for all), respectively. CONCLUSION Our results suggest that in lower urinary tract symptoms and/or benign prostatic enlargement associated with severe IPP, combination therapy might have insufficient efficacy due to a low proportion of stromal components, necessitating conversion to surgical intervention.

Vitamin B12 Deficiency in Patients with Urinary Intestinal Diversion

Background Because vitamin B12 is absorbed exclusively by the terminal ileum, we investigated vitamin B12 deficiency as a potential metabolic complication after urinary intestinal diversion.

MINI-LAPAROTOMY STAGING PELVIC LYMPH NODE DISSECTION FOR LOCALIZED PROSTATE CANCER

We report our early experience with mini‐laparotomy staging pelvic lymph node dissection (PLND) for clinically localized prostate cancer. We have used virtually the same original technique described by Steiner and Marshall. A 5 cm lower midline abdominal incision provides excellent exposure, allowing complete PLND under direct visualization. If radical retropubic prostatectomy is indicated by the state of the pelvic lymph nodes, this can be performed only by extending the same incision. Nine patients with histologically proven prostate cancer underwent mini‐laparotomy staging PLND. The average intraoperative time for mini‐laparotomy PLND was 33 minutes (range, 25–50 minutes). The intraoperative blood loss was 44 ml (range, 20–90 ml). The mean number of pelvic lymph nodes removed was 6.9 (range, 5–10 nodes) on the right and 10.8 (range, 8–21 nodes) on the left. Eight patients underwent immediate radical retropubic prostatectomy and one had radiation therapy. There were no complications directly related to the mini‐laparotomy staging PLND. Mini‐laparotomy staging PLND is an attractive alternative to laparoscopic PLND, especially for patients at low risk of lymph node metastasis.

EVOLVING EXPERIENCE WITH CONTINENT URINARY DIVERSION USING THE INDIANA POUCH

The Indiana continent urinary reservoir procedure for urinary diversion was performed in 46 patients. After the first 8 cases several modifications were made to the Indiana pouch. These modifications include complete detubularization of the colonic segment, construction of the pouch augmented with a U‐shaped patch of ileum and, more recently, the use of stapled plication. The mean postoperative follow‐up period was 46 mo (range 4.5‐74.1 mo). There was 1 perioperative death and this case was excluded from the follow‐up study. Late complications related to the urinary reservoir occurred in 12 (26.7%) of the 45 patients. Stone formation was observed in 5 patients. Out of 45 patients, 42 achieved complete urinary continence while 2 suffered mild nocturnal incontinence and 1 had significant leakage. Three had unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy demonstrated no reflux into the upper urinary tract in all of the follow‐up cases. Loopography of the efferent limb showed that a staple‐plicated ileum functions better than a suture‐plicated one in terms of reliability of the continence mechanism and ease of catheterization. The Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because it is technically easy to perform and it has a low revision and high continence rate.

Urinary undiversion for pelvic actinomycosis: a long-term follow up.

Background: A 43‐year‐old woman who had been using intrauterine contraceptive devices for the past 10 years underwent an emergency operation for bowel and urinary obstruction.