Yoh Matsuoka

Reactive oxygen species mediate detrusor overactivity via sensitization of afferent pathway in the bladder of anaesthetized rats.

To investigate the effects of reactive oxygen species (ROS) on the micturition reflex in vivo, especially in bladder afferent signalling in rats, as several pathophysiological conditions in the urinary bladder (e.g. ischaemia/reperfusion and inflammation) are characterized by the formation of ROS.

High Diagnostic Ability of Multiparametric Magnetic Resonance Imaging to Detect Anterior Prostate Cancer Missed by Transrectal 12-Core Biopsy

PURPOSE We clarified the diagnostic ability of multiparametric magnetic resonance imaging to reveal anterior cancer missed by transrectal 12-core prostate biopsy based on the results of 3-dimensional 26-core prostate biopsy, which is a combination of transrectal 12-core and transperineal 14-core biopsies. MATERIALS AND METHODS The study population consisted of 324 patients who prospectively underwent prebiopsy multiparametric magnetic resonance imaging and then 3-dimensional 26-core prostate biopsy at a single institution. We defined transrectal 12-core negative cancer as cancer detected by transperineal 14-core but not transrectal 12-core prostate biopsy. We focused on cancer in the anterior region. Any findings suspicious for malignancy in the region anterior to the urethra on multiparametric magnetic resonance imaging were defined as an anterior lesion on imaging. Significant cancer was defined as a biopsy Gleason score of 4 + 3 or greater, a greater than 20% positive core and/or a maximum cancer length of 5 mm or greater. Associations between an anterior lesion on imaging and transrectal 12-core negative cancer were investigated. RESULTS The overall cancer detection rate on 3-dimensional 26-core prostate biopsy was 39% (128 of 324 cases), of which 28% (36 of 128) were transrectal 12-core negative cancers. An anterior lesion on prebiopsy multiparametric magnetic resonance imaging was identified in 20% of men overall (65 of 324). Of men with and without an anterior lesion on imaging 40% (26 of 65) and 3.8% (10 of 259), respectively, had transrectal 12-core negative cancer. Significant transrectal 12-core negative cancer was observed in 0.4% (1 of 259 men) without an anterior lesion on imaging. Prebiopsy multiparametric magnetic resonance imaging revealed an anterior lesion in 92% of cases (11 of 12) of significant transrectal 12-core negative cancer. CONCLUSIONS Prebiopsy multiparametric magnetic resonance imaging has the potential to efficiently select men who could advantageously undergo anterior samplings, in addition to transrectal 12-core prostate biopsy.

Usefulness of Pre-biopsy Multiparametric Magnetic Resonance Imaging and Clinical Variables to Reduce Initial Prostate Biopsy in Men with Suspected Clinically Localized Prostate Cancer

PURPOSE We evaluated the usefulness of pre-biopsy multiparametric magnetic resonance imaging and clinical variables to decrease initial prostate biopsies. MATERIALS AND METHODS We prospectively evaluated 351 consecutive men with prostate specific antigen between 2.5 and 20 ng/ml, and/or digital rectal examination suspicious for clinically localized disease. All men underwent pre-biopsy multiparametric magnetic resonance imaging and initial 14 to 29-core biopsy, including anterior sampling. Three definitions of significant cancer were defined based on Gleason score and cancer volume (percent positive core and/or maximum cancer length). The overall cohort was divided into men at low risk-prostate specific antigen less than 10 ng/ml and normal digital rectal examination, and high risk-prostate specific antigen 10 ng/ml or greater and/or abnormal digital rectal examination. We evaluated the frequency of significant cancer according to magnetic resonance imaging and risk categories. Clinical variables as significant cancer predictors were analyzed using logistic regression. The sensitivity, specificity, and positive and negative predictive values of magnetic resonance imaging were calculated with or without clinical variables for significant cancer. RESULTS The frequency of significant cancer in men with negative vs positive magnetic resonance imaging was 9% to 13% vs 43% to 50% in the low risk group and 47% to 51% vs 68% to 71% in the high risk group. In men at low risk with negative magnetic resonance imaging prostate volume was the only significant predictor of significant cancer. In the low risk group the negative predictive value for significant cancer of a combination of positive magnetic resonance imaging and lower prostate volume (less than 33 ml) was 93.7% to 97.5%. CONCLUSIONS Pre-biopsy multiparametric magnetic resonance imaging along with prostate volume decreases the number of initial prostate biopsies by discriminating between significant cancer and other cancer in men with prostate specific antigen less than 10 ng/ml and normal digital rectal examination.

New three-dimensional head-mounted display system, TMDU-S-3D system, for minimally invasive surgery application: Procedures for gasless single-port radical nephrectomy

We present an application of a new three‐dimensional head‐mounted display system that combines a high‐definition three‐dimensional organic electroluminescent head‐mounted display with a high‐definition three‐dimensional endoscope to minimally invasive surgery, using gasless single‐port radical nephrectomy procedures as a model. This system presents the surgeon with a higher quality of magnified three‐dimensional imagery in front of the eyes regardless of head position, and simultaneously allows direct vision by moving the angle of sight downward. It is also significantly less expensive than the current robotic surgery system. While carrying out gasless single‐port radical nephrectomy, the system provided the surgeon with excellent three‐dimensional imagery of the operative field, direct vision of the outside and inside of the patient, and depth perception and tactile feedback through the devices. All four nephrectomies were safely completed within the operative time, blood loss was within usual limits and there were no complications. The display was light enough to comfortably be worn for a long operative time. Our experiences show that the three‐dimensional head‐mounted display system might facilitate maneuverability and safety in minimally invasive procedures, without prohibitive cost, and thus might mitigate the drawbacks of other three‐dimensional vision systems. Because of the potential benefits that this system offers, it deserves further refinements of its role in various minimally invasive surgeries.

Combination of Diffusion-weighted Magnetic Resonance Imaging and Extended Prostate Biopsy Predicts Lobes Without Significant Cancer: Application in Patient Selection for Hemiablative Focal Therapy

BACKGROUND Significant cancer in contralateral sides of the prostate that was missed on prostate biopsy (PBx) is a concern in hemiablative focal therapy (FT) of prostate cancer (PCa). However, extended PBx, a common diagnostic procedure, has a limited predictive ability for lobes without significant cancer. OBJECTIVE To identify prostate lobes without significant cancer using extended PBx combined with diffusion-weighted imaging (DWI), which has the potential to provide pathophysiologic information on pretreatment assessment. DESIGN, SETTING, AND PARTICIPANTS We conducted a prebiopsy DWI study between 2007 and 2012 that included 270 prostate lobes in 135 patients who underwent radical prostatectomy (RP) for clinically localized PCa. INTERVENTION Participants underwent DWI and 14-core PBx; those with PBx-proven PCa and who were treated with RP were analyzed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Imaging and pathology were assessed in each side. Based on RP pathology, lobes were classified into lobes with no cancer (LNC), lobes with indolent cancer (LIC), and lobes with significant cancer (LSC). Predictive performance of DWI, PBx, and their combination in identifying lobes without significant cancer was examined. RESULTS AND LIMITATIONS LNC, LIC, and LSC were identified in 23 (8.5%), 64 (23.7%), and 183 sides (67.8%), respectively. The negative predictive values (NPV) of DWI, PBx, and their combination were 22.1%, 27.8%, and 43.5%, respectively, for lobes with any cancer (ie, either LIC or LSC), and 68.4%, 72.2%, and 95.7%, respectively, for LSC. The NPV of PBx for LSC was improved by the addition of DWI findings (p=0.001), with no adverse influence on the positive predictive value. Limitations included a possible selection bias under which the decision to perform PBx might be affected by DWI findings. CONCLUSIONS The combination of DWI and extended PBx efficiently predicts lobes without significant cancer. This procedure is applicable to patient selection for hemiablative FT.

Phase-II trial of combination treatment of interferon-α, cimetidine, cyclooxygenase-2 inhibitor and renin-angiotensin-system inhibitor (I-CCA therapy) for advanced renal cell carcinoma.

We have recently reported favorable responses to a combination treatment comprising cimetidine, a cyclooxygenase‐2 inhibitor and a renin‐angiotensin‐system inhibitor in metastatic renal cell carcinoma (RCC). In view of the potential synergistic effects of these three agents and interferon‐α (I‐CCA therapy), we conducted a phase‐II trial to examine the efficacy and toxicity of I‐CCA as first‐line treatment. Fifty‐one patients with advanced RCC received natural interferon‐α (3–6 million U thrice/week) and cimetidine (800 mg), cyclooxygenase‐2 inhibitor meloxicam (10 mg), and renin‐angiotensin‐system inhibitor candesartan (4 mg) or perindopril (4 mg) orally daily. Memorial Sloan–Kettering Cancer Center prognostic categories were favorable, intermediate and poor in 10 (20%), 31 (61%) and 10 (20%) patients, respectively. The primary end‐point was the objective response rate (ORR) and the secondary end‐points included clinical benefit, progression‐free survival (PFS), overall survival (OS) and safety. Median follow‐up was 19 months. Complete response (CR) was observed in four patients (8%) and partial response in seven (14%), yielding an ORR of 22%. None of the four patients who achieved CR relapsed during the 16‐ to 81‐month follow up. The ORR were 17% in the favorable‐ or intermediate‐risk group and 40% in the poor‐risk group. The other 24 patients (45%) had stable disease for at least 6 months, resulting in a clinical benefit rate of 67%. The median PFS and OS were 12 and 30 months, respectively. Grade 3/4 toxicities were never observed. The I‐CCA therapy, providing favorable responses and low toxicity profiles, is worthy of further consideration as a first‐line therapy for metastatic RCC. (Cancer Sci 2011; 102: 137–143)

Simple prophylactic procedure of inguinal hernia after radical retropubic prostatectomy: isolation of the spermatic cord.

Abstract:  To reduce the incidence of inguinal hernia (IH) after radical retropubic prostatectomy (RRP), a simple prophylactic procedure was carried out during RRP. A consecutive 82 patients who had undergone RRP for clinically localized prostate cancer between July 2002 and October 2006 at Toride Kyodo General Hospital were enrolled. From July 2002 to November 2003, 20 patients underwent conventional RRP. Thereafter, 62 patients underwent conventional RRP with blunt dissection of the peritoneum at the internal inguinal ring and isolation of the spermatic cord from the peritoneum as a prophylactic procedure for IH. There was no significant difference in patient characteristics between the two groups. In the conventional RRP group, IH occurred in 10 patients during a median range follow‐up period of 41 (1 to 73) months. In contrast, in the RRP plus prophylactic procedure group, IH occurred in one patient (1.6%) during a median range follow‐up period of 41 (25 to 59) months. The incidence of IH after RRP plus the prophylactic procedure was significantly lower than that after conventional RRP, indicating the efficacy of the presented procedure.

Gasless laparoendoscopic single-port clampless sutureless partial nephrectomy for peripheral renal tumors: perioperative outcomes.

To describe the technical aspects of gasless laparoendoscopic single‐port clampless sutureless partial nephrectomy for peripheral renal tumors, and to evaluate its outcomes, including surgical, pathological, and short‐term oncological and functional outcomes.

Risk stratification for bladder recurrence of upper urinary tract urothelial carcinoma after radical nephroureterectomy

To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU).

Xanthogranulomatous pyelonephritis with a renocolic fistula caused by a parapelvic cyst

Abstract  Fistula formation between the upper urinary tract and bowel is an uncommon complication in urogenital diseases. We present a rare case of focal xanthogranulomatous pyelonephritis with a renocolic fistula. This is the first case where a parapelvic cyst obstructs the caliceal outflow and leads to the formation of a renocolic fistula in renal inflammatory disease. It is difficult to make a preoperative diagnosis of focal xanthogranulomatous pyelonephritis with widespread involvement that is caused by non‐calculous urinary tract obstruction.