Yoko Yoshikawa

Laparoscopic radical nephrectomy for renal cell carcinoma: the standard of care already?

Purpose of review Laparoscopic radical nephrectomy has been developed and applied for patients with renal cell carcinoma since 1992. The number of patients undergoing laparoscopic radical nephrectomy has increased explosively worldwide in recent years, and laparoscopy is now extended to patients with advanced disease. It is very important to clarify the present status of laparoscopic radical nephrectomy among the treatment modalities for patients with renal cell carcinoma. Recent findings Laparoscopic radical nephrectomy has a minimally invasive nature as well as comparable long-term cancer control in patients with pT1-3a renal cell carcinoma to open surgery. It is technically applicable for N1-2 disease and T3b disease if the tumor thrombus is within the renal vein. Also, it is feasible as a cytoreductive surgery for patients with M1 disease. Summary Laparoscopic radical nephrectomy is a standard treatment modality for T1-3a renal cell carcinoma patients. It is also available for treating patients with N1-2 disease, and for patients with M1 disease as a cytoreductive surgery.

Urodynamic Study of Storage and Evacuation of Urine in Patients with a Urethral Kock Pouch

PURPOSE The urodynamics of pouch-urethra function were investigated in patients with a urethral Kock pouch to understand mechanisms involved in the storage and evacuation of urine, and elucidate any problems of long-term outcome. MATERIALS AND METHODS Urodynamic evaluation was performed in 18 male patients who underwent bladder replacement with a urethral Kock pouch following radical cystectomy. RESULTS Good urinary continence was achieved with normal frequency of voiding. On urodynamics pressure within the pouch remained low during the storage phase (mean 33.2 cm. water) but markedly increased during the evacuation of urine (mean 77.3 cm. water). In 8 patients (44%) extremely high pressure within the pouch (80 to 150 cm. water) was noted at voiding. Clean intermittent self-catheterization was initiated in a patient with high pressure within the pouch at voiding in whom pouch-ureter reflux developed 7 months postoperatively. The external urethral sphincter was impaired to some extent postoperatively but it contracted in response to filling of the pouch with a marked increase in urethral pressure from a mean of 31.6 to 66.3 cm. water. CONCLUSIONS Urodynamic and radiological studies will be necessary periodically since high pressure within the pouch at voiding might jeopardize the antireflux mechanism, leading to reflux and renal impairment.

Impact of urinary incontinence on the psychological burden of family caregivers

The present study was conducted to assess the impact of urinary incontinence on the psychological burden of family caregivers providing care to disabled family members with urinary incontinence.

Prognostic value of pressure-flow study in surgical treatment of benign prostatic obstruction.

Abstract The prognostic value of pressure-flow study (P-FS) in the surgical treatment of bladder outlet obstruction (BOO) was retrospectively studied in patients with benign prostatic hyperplasia. In 74 patients who underwent surgical treatment for BOO, P-FS and free uroflowmetry were performed pre- and postoperatively. On P-FS, obstruction and detrusor contractility were analyzed according to the Schäfer nomogram. The patients were classified into the following 3 groups according to their preoperative P-FS: group A consisted of 39 patients with normal detrusors and obstruction (obstruction grade 3–6); group B consisted of 13 patients with weak detrusors and obstruction; and group C included 22 patients with weak or very weak detrusors combined with minimal obstruction, if any (obstruction grade 0–2). Postoperatively, the detrusor pressure at maximal flow rate and obstruction grades on P-FS improved significantly in groups A and B but not in group C. The rate of improvement was most prominent in group A, followed by groups B and C. On free uroflowmetry, however, a significant improvement occurred in all three groups with respect to maximal flow rate, average flow rate, and postvoid residue. Moreover, the rate did not differ among the three groups except for the maximal flow rate as determined between groups A and C. Although good detrusor contractility and evident obstruction on analysis of P-FS will guarantee the best surgical outcome, subjects with weak detrusors and minimal obstruction will also have a good outcome by the relief of BOO. In the weak detrusor, P-FS may be limited in diagnosing obstruction and have a low prognostic value, and such patients should not necessarily be excluded from surgical indications.

Pathophysiology and subjective symptoms in women with impaired bladder emptying

Aims: To assess the pathophysiology and subjective symptoms in female patients with impaired bladder emptying.

Early experience of laparoscopic radical nephrectomy for T3b renal cell carcinoma

Abstract We report our experience with laparoscopic radical nephrectomy for a 79‐year‐old man who had renal cell carcinoma (RCC) with a renal vein thrombus. For the transaction of the renal vein with the thrombus, we used an endoscopic gastrointestinal anastomosis stapler. The operating time was 4 h and blood loss was 400 mL. The patient could walk and drink on the first postoperative day. He recovered normal activity 30 days postoperatively. There were no intraoperative and postoperative complications. The present report demonstrates the feasibility of laparoscopic radical nephrectomy in patients with T3b RCC who suffer from tumor thrombus in the renal vein.

Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function

Objectives:  To assess the impact of laparoscopic radical prostatectomy on vesicourethral function and compare it to that of open radical prostatectomy.

Positive bladder cooling reflex in patients with bladder outlet obstruction due to benign prostatic hyperplasia

Abstract The bladder cooling reflex was evaluated in patients with bladder outlet obstruction to study the effect of obstruction on the afferent neural function of the bladder, especially on the C-afferents. The bladder cooling test was performed by infusion of 0 °C saline into the bladder with simultaneous detrusor pressure measurement in 104 patients with bladder outlet obstruction due to benign prostatic hyperplasia. In 49 patients (47%) a positive cooling reflex was observed. This was defined as a rise in the detrusor pressure following cold saline instillation exceeding 15 cmH2O (range 15–130 cmH2O, mean 60.6 cmH2O; positive group). In the remainder of cases the pressure rise ranged from 0 to 12 cmH2O (mean 6.1 cmH2O; negative group). Bladder outlet obstruction may cause some alteration in the afferent neural function of the bladder, in particular of the C-afferent fibers.

Urodynamic Evaluation of Results of Endopyelotomy for Ureteropelvic Junction Obstruction

We treated 13 patients with unilateral ureteropelvic junction obstruction by percutaneous endopyelotomy, and they were urodynamically evaluated by the Whitaker test and diuresis renography, in addition to excretory urography (IVP). Surgery was uncomplicated in all patients except 1 who required repeat incision 4 weeks later. Obstruction was diagnosed preoperatively by the Whitaker test and diuresis renography in 10 cases, and by IVP in 13. Postoperatively, all 10 patients (100%) with a positive Whitaker test were free of obstruction with a significant reduction in the relative renal pelvic pressure from 35.0 to 8.1 cm. water (p < 0.01). Diuresis renography revealed no obstruction in 8 patients (80%) and persistent obstruction in 2. IVP demonstrated reduced hydronephrosis in 8 of 13 patients (62%) 12 weeks after surgery and in 11 of 13 patients (85%) 19 months later. However, a marked reduction in renal pelvic size was noted in only 3 patients (23%). Flank pain disappeared in 10 of 11 patients (91%) postoperatively. Overall, surgery was successful in 11 of the 13 patients (85%). Percutaneous endopyelotomy was effective in relieving obstruction at the ureteropelvic junction with minor morbidity. The Whitaker test was more sensitive for evaluating the results of surgery than diuresis renography and IVP, although diuresis renography appears to be useful in followup evaluation of hydronephrosis.

A new treatment for retroperitoneal fibrosis: initial experiences of using Seprafilm® to wrap the ureter

To confirm the efficacy of using Seprafilm® (Genzyme Corp., Cambridge, MA, USA) for wrapping the ureter to treat the ureteric stenosis caused by retroperitoneal fibrosis (RPF).