MDPIActa Medica Okayama2072-669415242023The Diagnosis and Treatment Approach for Oligo-Recurrent and Oligo-Progressive Renal Cell Carcinoma5873ENKensukeBekkuDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTatsushiKawadaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakanoriSekitoDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKasumiYoshinagaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYukiMaruyamaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTomoakiYamanoiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYusukeTominagaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakuyaSadahiraDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversitySatoshiKatayamaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTakehiroIwataDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityShingoNishimuraDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityKoheiEdamuraDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityTomokoKobayashiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYasuyukiKobayashiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityMotooArakiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYuzuruNiibeDepartment of Public Health, School of Medicine, Kurume UniversityOne-third of renal cell carcinomas (RCCs) without metastases develop metastatic disease after extirpative surgery for the primary tumors. The majority of metastatic RCC cases, along with treated primary lesions, involve limited lesions termed goligo-recurrenth disease. The role of metastasis-directed therapy (MDT), including stereotactic body radiation therapy (SBRT) and metastasectomy, in the treatment of oligo-recurrent RCC has evolved. Although the surgical resection of all lesions alone can have a curative intent, SBRT is a valuable treatment option, especially for patients concurrently receiving systemic therapy. Contemporary immune checkpoint inhibitor (ICI) combination therapies remain central to the management of metastatic RCC. However, one objective of MDT is to delay the initiation of systemic therapies, thereby sparing patients from potentially unnecessary burdens. Undertaking MDT for cases showing progression under systemic therapies, known as goligo-progressionh, can be complex in considering the treatment approach. Its efficacy may be diminished compared to patients with stable disease. SBRT combined with ICI can be a promising treatment for these cases because radiation therapy has been shown to affect the tumor microenvironment and areas beyond the irradiated sites. This may enhance the efficacy of ICIs, although their efficacy has only been demonstrated in clinical trials.No potential conflict of interest relevant to this article was reported.SpringerActa Medica Okayama2730-60111412023Geriatric nutritional risk index as a prognostic marker of first-line immune checkpoint inhibitor combination therapy in patients with renal cell carcinoma: a retrospective multi-center study204ENShogoWatariDepartment of Urology, National Hospital Organization Okayama Medical CenterSatoshiKatayamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiromasaShiraishiDepartment of Urology, National Hospital Organization Okayama Medical CenterMotoTokunagaDepartment of Urology, National Hospital Organization Okayama Medical CenterRisaKubotaDepartment of Urology, National Hospital Organization Okayama Medical CenterNorihiroKusumiDepartment of Urology, National Hospital Organization Okayama Medical CenterTakaharuIchikawaDepartment of Urology, National Hospital Organization Okayama Medical CenterTomoyasuTsushimaDepartment of Urology, National Hospital Organization Okayama Medical CenterYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKensukeBekkuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesPurpose This study aimed to investigate the effectiveness of the Geriatric Nutritional Risk Index (GNRI) in predicting the efficacy of first-line immune checkpoint inhibitor (ICI) combination therapy for metastatic or unresectable renal cell carcinoma (RCC) and associated patient prognosis.<br>
Methods A retrospective study was conducted using data from 19 institutions. The GNRI was calculated using body mass index and serum albumin level, and patients were classified into two groups using the GNRI values, with 98 set as the cutoff point.<br>
Results In all, 119 patients with clear cell RCC who received first-line drug therapy with ICIs were analyzed. Patients with GNRI >= 98 had significantly better overall survival (OS) (p = 0.008) and cancer-specific survival (CSS) (p = 0.001) rates than those with GNRI < 98; however, progression-free survival (PFS) did not differ significantly. Inverse probability of treatment weighting analysis showed that low GNRI scores were significantly associated with poor OS (p = 0.004) and CSS (p = 0.015). Multivariate analysis showed that the Karnofsky performance status (KPS) score was a better predictor of prognosis (OS; HR 5.17, p < 0.001, CSS; HR 4.82, p = 0.003) than GNRI (OS; HR 0.36, p = 0.066, CSS; HR 0.35, p = 0.072). In a subgroup analysis of patients with a good KPS and GNRI >= 98 vs < 98, the 2-year OS rates were 91.4% vs 66.9% (p = 0.068), 2-year CSS rates were 91.4% vs 70.1% (p = 0.073), and PFS rates were 39.7% vs 21.4 (p = 0.27), respectively.<br>
Conclusion The prognostic efficiency of GNRI was inferior to that of the KPS score at the initiation of the first-line ICI combination therapy for clear cell RCC.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0022-522316522023Modified single-patch repair for atrioventricular septal defects results in good functional outcomes in the absence of deep ventricular septal defects411421ENYasuyukiKobayashiDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University HospitalShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University HospitalShunjiSanoPediatric Cardiothoracic Surgery, University of CaliforniaYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences and Okayama University HospitalObjectives<br>
We compared 2-patch repair (TP) with modified single-patch repair (MSP) for complete atrioventricular septal defects and evaluated their effect on the left atrioventricular valve (LAVV) competence. We also identified risk factors for unfavorable functional outcomes.<br>
<br>
Methods<br>
This retrospective study included 118 patients with complete atrioventricular septal defects who underwent intracardiac repair from 1998 to 2020 (MSP: 69; TP: 49). The median follow-up period was 10.4 years. The functional outcome of freedom from moderate or greater LAVV regurgitation (LAVVR) was estimated using the Kaplan–Meier method.<br>
<br>
Results<br>
The hospital mortality was 1.7% (2/118) and late mortality was 0.8% (1/118). Eight patients required LAVV-related reoperation (MSP: 4; TP: 4) and none required left ventricular outflow tract-related reoperation. In the MSP group without LAVV anomaly, the receiver operating characteristic curve analysis revealed that the ventricular septal defect (VSD) depth was strongly associated with moderate or greater postoperative LAVVR, with the best cutoff at 10.9 mm. When stratified according to the combination of intracardiac repair type and VSD depth, the MSP-deep VSD (VSD depth >11 mm) group showed the worst LAVV competence among the 4 groups (P = .002). According to multivariate analysis, weight <4.0 kg, LAVV anomaly, and moderate or greater preoperative LAVVR were independent risk factors for moderate or greater postoperative LAVVR, whereas MSP was not a risk factor.<br>
<br>
Conclusions<br>
Postoperative LAVVR remains an obstacle to improved functional outcomes. MSP provides LAVV competence similar to TP unless deep VSD is present. The surgical approach should be selected on the basis of anatomical variations, specifically VSD depth.No potential conflict of interest relevant to this article was reported.Spandidos PublicationsActa Medica Okayama2049-94501822022Bladder tuberculosis with ureteral strictures after bacillus Calmette‑Guérin therapy for urinary bladder cancer: A case report7ENYusukeTominagaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasanoriFujiiDepartment of Allergy and Respiratory Medicine, Okayama University HospitalTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiKatayamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakehiroIwataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKensukeBekkuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiKiuraDepartment of Allergy and Respiratory Medicine, Okayama University HospitalYoshinobuMaedaDepartment of Allergy and Respiratory Medicine, Okayama University HospitalKoichiroWadaDepartment of Urology, Shimane University Faculty of MedicineMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesIntravesical immunotherapy using bacillus Calmette‑Guérin (BCG) is recommended for patients with intermediate‑ to high‑risk non‑muscle invasive bladder cancer. Bladder tuberculosis (TB) is a rare complication of BCG therapy. The present study describes the case of a 73‑year‑old man who underwent intravesical BCG therapy for urothelial carcinoma in situ of the bladder. Red patches around the resection scar were first detected 1 year and 5 months after BCG treatment; these findings gradually spread to encompass more of the bladder wall. Transurethral biopsy revealed a benign lesion, but the patient developed bilateral hydronephrosis and mild voiding dysfunction. The patient was eventually diagnosed with bladder TB by mycobacterial urine culture and TB‑specific polymerase chain reaction (PCR). The patient was given multidrug therapy (isoniazid, rifampicin and ethambutol) and their bladder TB was completely cured; however, their voiding dysfunction and bilateral hydronephrosis did not fully improve. Bladder TB can occur long after intravesical BCG administration and cystoscopy findings consistent with inflammation can be the key to suspecting this condition. Acid‑fast examination and PCR testing of a urine sample are necessary for early diagnosis.No potential conflict of interest relevant to this article was reported.ElsevierActa Medica Okayama009042951702022Simplified PADUA REnal (SPARE) Nephrometry System can Describe the Surgical Difficulty of Renal Masses With High Accuracy Even Without 3D Renal Models132138ENTomofumiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakanoriSekitoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesObjective: To evaluate whether a 2-dimensional(2D) model describes the surgical difficulty of a renal mass accurately comparable to that obtained using a 3D model with the Simplified PADUA REnal nephrometry system (SPARE).<br>
Methods: A total of 100 patients underwent RAPN in our hospital between October 2018 and May 2021. We excluded patients with CT images inappropriate for evaluation or for construction of 3D models, patients with multiple tumors, and those who underwent preoperative transcatheter arterial embolization. We conducted a retrospective analysis of the remaining patients using SPARE predictions from CT images (2D-SPARE) and SPARE predictions from 3D models (3D-SPARE). We evaluated the difference between the 2 nephrometry scores and compared them by their ability to predict the achievement of the desired surgical outcome: absence of positive margins, absence of ischemia, and absence of significant complications.<br>
Results: A total of 87 patients were included in this study. Total score, and risk categorization using 3D-SPARE was significantly different from those using 2D-SPARE (P <.05), but in their areas under the curve (AUC), the scores and categorizations were not significantly different (score, 0.763 vs 0.742; P = .501; categorization, 0.711 vs 0.701; P = .755).<br>
Conclusion: The SPARE system can describe the surgical difficulty of renal masses with high accuracy even without the use of 3D renal models.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7562021Clinical Efficacy and Safety of Sitafloxacin 200 mg Once Daily for Refractory Genitourinary Tract Infections763766ENTakehiroIwataDepartment of Urology, Okayama University HospitalTakuyaSadahiraDepartment of Urology, Okayama University HospitalYukiMaruyamaDepartment of Urology, Okayama University HospitalTakanoriSekitoDepartment of Urology, Okayama University HospitalKasumiYoshinagaDepartment of Urology, Okayama University HospitalShogoWatariDepartment of Urology, Okayama University HospitalKentaroNagaoDepartment of Urology, Okayama University HospitalTatsushiKawadaDepartment of Urology, Okayama University HospitalYusukeTominagaDepartment of Urology, Okayama University HospitalShingoNishimuraDepartment of Urology, Okayama University HospitalAtsushiTakamotoDepartment of Urology, Okayama University HospitalTomokoSakoDepartment of Urology, Okayama University HospitalKoheiEdamuraDepartment of Urology, Okayama University HospitalYasuyukiKobayashiDepartment of Urology, Okayama University HospitalMotooArakiDepartment of Urology, Okayama University HospitalAyanoIshiiDepartment of Urology, Okayama University HospitalMasamiWatanabeDepartment of Urology, Okayama University HospitalToyohikoWatanabeDepartment of Urology, Okayama University HospitalYasutomoNasuDepartment of Urology, Okayama University HospitalKoichiroWadaDepartment of Urology, Okayama University HospitalClinical Study Protocol10.18926/AMO/62820The aim of this ongoing trial is to evaluate the clinical efficacy and safety of sitafloxacin (STFX) 200 mg once daily (QD) for 7 days in patients with refractory genitourinary tract infections, which include recurrent or complicated cystitis, complicated pyelonephritis, bacterial prostatitis, and epididymitis. The primary endpoint is the microbiological efficacy at 5-9 days after the last administration of STFX. Recruitment began in February 2021, and the target total sample size is 92 participants.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7562021Testosterone Recovery after Neoadjuvant Gonadotropin-Releasing Hormone Antagonist versus Agonist on Permanent Iodine-125 Seed Brachytherapy in Prostate Cancer Patients: A Propensity Score Analysis705711ENTakehiroIwataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTatsushiKawadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiKatayamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoSakoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/62810Optimal neoadjuvant hormone therapy (NHT) for reducing prostate cancer (PC) patientsf prostate volume pre-brachytherapy is controversial. We evaluated the differential impact of neoadjuvant gonadotropin-releasing hormone (GnRH) antagonist versus agonist on post-brachytherapy testosterone recovery in 112 patients treated pre-brachytherapy with NHT (GnRH antagonist, n=32; GnRH agonists, n=80) (Jan. 2007-June 2019). We assessed the effects of patient characteristics and a GnRH analogue on testosterone recovery with logistic regression and a propensity score analysis (PSA). There was no significant difference in the rate of testosterone recovery to normal levels (> 300 ng/dL) between the GnRH antagonist and agonists (p=0.07). The GnRH agonists induced a significantly more rapid testosterone recovery rate at 3 months post-brachytherapy versus the GnRH antagonist (p<0.0001); there was no difference in testosterone recovery at 12 months between the GnRH antagonist/agonists (p=0.8). In the multivariate analysis, no actor was associated with testosterone recovery. In the PSA, older age and higher body mass index (BMI) were significantly associated with longer testosterone recovery. Post-brachytherapy testosterone recovery was quicker with the neoadjuvant GnRH agonists than the antagonist, and the testosterone recovery rate was significantly associated with older age and higher BMI. Long-term follow-ups are needed to determine any differential effects of GnRH analogues on the quality of life of brachytherapy-treated PC patients.No potential conflict of interest relevant to this article was reported.Oxford University Press (OUP)Acta Medica Okayama1569-92933352021Does the size of pulmonary artery impact on recoarctation of the aorta after the Norwood procedure without patch?765772ENYasuyukiKobayashiGraduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama UniversityYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University HospitalTakuyaKawabataDepartment of Cardiovascular Surgery, Okayama University HospitalYosukeKurokoDepartment of Cardiovascular Surgery, Okayama University HospitalShunjiSanoDepartment of Pediatric Cardiothoracic Surgery, University of CaliforniaShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University HospitalOBJECTIVES<br>
This study aimed to evaluate whether recoarctation of the aorta (reCoA) after the Norwood procedure for hypoplastic left heart syndrome correlates with pre- and postoperative anatomic factors.<br>
<br>
METHODS<br>
This retrospective study included 48 patients who underwent Norwood procedure with right ventricle-to-pulmonary artery conduit between 2009 and 2017. Anatomical factors such as preoperative length, diameter of the main pulmonary artery (MPA), and postoperative neoaortic arch angle stratified by arch reconstruction technique were analysed using the receiver operating characteristic analysis.<br>
<br>
RESULTS<br>
Eleven patients needed surgical intervention for reCoA at stage 2. Out of the 30 patients who underwent direct anastomosis during arch reconstruction, 7 developed reCoA. Seven patients received the full patch augmentation (patch augmentation for both lesser and greater curvatures) and were all spared from reCoA. Among the patients who had direct anastomosis, the preoperative MPA length was correlated with the postoperative arch angle (P = 0.021) and was associated with the occurrence of reCoA (P = 0.002) and the best cutoff value for MPA length was 10 mm. The postoperative arch angle was also correlated with the incidence of reCoA (P < 0.001) and was larger in patients who underwent the full patch augmentation than in patients who had direct anastomosis (126 vs 112, P = 0.005) despite comparable MPA length.<br>
<br>
CONCLUSIONS<br>
ReCoA after the Norwood procedure correlates with MPA length when a direct anastomosis was used. Direct anastomosis can be considered in patients with a longer preoperative MPA. In other cases, the full patch augmentation should be considered for obtaining a large and smooth neoaortic arch.No potential conflict of interest relevant to this article was reported.Elsevier BVActa Medica Okayama0041-13455352021ABO Blood Incompatibility Positively Affects Early Graft Function: Single-Center Retrospective Cohort Study14941500ENShogoWatariDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceKasumiYoshinagaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceRisaKubotaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceHidemiTakeuchiDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceKatsuyukiTanabeDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceMasashiKitagawaDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceHiroshiMorinagaDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceShinjiKitamuraDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceHitoshiSugiyamaDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceJunWadaDepartment of Nephrology, Rheumatology, Endocrinology, and Metabolism, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical ScienceBackground<br>
We investigated the association between ABO-incompatible (ABO-I) kidney transplantation and early graft function.<br>
<br>
Methods<br>
We retrospectively analyzed 95 patients who underwent living donor kidney transplantation between May 2009 and July 2019. It included 61 ABO-compatible (ABO-C) and 34 ABO-I transplantations. We extracted data on immunologic profile, sex, age, cold ischemic time, type of immunosuppression, and graft function. Two definitions were used for slow graft function (SGF) as follows: postoperative day (POD) 3 serum creatinine level >3 mg/dL and estimated glomerular filtration rate (eGFR) <20 mL/min/1.73 m2. Logistic regression analysis was performed to analyze the effect of ABO-I on the incidence of SGF.<br>
<br>
Results<br>
The characteristics between the ABO-C and ABO-I were not different. ABO-I received rituximab and plasma exchange. Patients also received tacrolimus and mycophenolate mofetil for 2 weeks and prednisolone for 1 week before transplantation as preconditioning. Of the 95 study patients, 19 (20%) and 21 (22%) were identified with SGF according to POD 3 serum creatinine level or eGFR, respectively. Multivariable analysis revealed that ABO-I significantly reduced the incidence of SGF (odds ratio, 0.15; 95% confidence interval, 0.03-0.7; P = .02), and cold ischemic time >150 min increased the incidence of SGF (odds ratio, 6.5; 95% confidence interval, 1.7-25; P = .006). Similar results were identified in POD 3 eGFR. Inferior graft function in patients with SGF was identified up to 6 months after transplantation.<br>
<br>
Conclusion<br>
ABO-I reduces the incidence of SGF, which is associated with an inferior graft function up to 6 months.No potential conflict of interest relevant to this article was reported.WileyActa Medica Okayama2050-45272021Feasible kidney donation with living marginal donors, including diabetes mellitusENKasumiYoshinagaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityMotooArakiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityKoichiroWadaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityTakanoriSekitoDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityShogoWatariDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityYukiMaruyamaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityYosukeMitsuiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityTakuyaSadahiraDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityRisaKubotaDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityShingoNishimuraDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityKoheiEdamuraDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityYasuyukiKobayashiDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityKatsuyukiTanabeDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityHidemiTakeuchiDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityMasashiKitagawaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityShinjiKitamuraDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityMasamiWatanabeDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityToyohikoWatanabeDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityYasutomoNasuDepartment of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama UniversityObjectives: To compare the donor outcomes of living donor kidney transplantation between standard donors (SDs) and marginal donors (MDs) including diabetic patients (MD + DM). <br>
Methods: MDs were defined according to Japanese guideline criteria: (a) age >70-years, (b) blood pressure <= 130/80 mmHg on hypertension medicine, (c) body mass index >25 to <= 32 kg/m(2), (d) 24-h creatinine clearance >= 70 to <80 ml/min/1.73 m(2), and (e) hemoglobin A1c > 6.2 or <= 6.5 with oral diabetic medicine. Fifty-three of 114 donors were MDs. We compared donor kidney functions until 60 months postoperatively. <br>
Results: No kidney function parameters were different between SDs and MDs. When comparing SD and MD + DM, MD + DM had a lower postoperative eGFR (48 vs. 41 (1 (month), p = .02), 49 vs. 40 (12, p < .01), 48 vs. 42 (24, p = .04), 47 vs. 38 (36, p = .01)) and the percentage of residual eGFR (SD vs. MD + DM: 63 vs. 57 (1 (month), p < .01), 63 vs. 57 (2, p < .01), 64 vs. 56 (12, p < .01), 63 vs. 57 (24, p < .01), 63 vs. 52 (36, p = .02)). However, when MD with a single risk factor of DM was compared to SD, the difference disappeared. Nine out of 12 (75%) MD + DM had >= 2 risk factors. <br>
Conclusions: Although long-term observation of donor kidney function is necessary, careful MD + DM selection had the potential to expand the donor pool.No potential conflict of interest relevant to this article was reported.Oxford University Press (OUP)Acta Medica Okayama1010-79405942020Norwood procedure with right ventricle to pulmonary artery conduit: a single-centre 20-year experience230236ENYasuyukiKobayashiDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University HospitalYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University HospitalYosukeKurokoDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University HospitalTakuyaKawabataDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University HospitalShunjiSanoDepartment of Pediatric Cardiothoracic Surgery, University of CaliforniaShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University HospitalObjectives: The aim of this study was to evaluate the long-term outcomes of the Norwood procedure with right ventricle-pulmonary artery (RV-PA) conduit for hypoplastic left heart complex (HLHC).<br>
Methods: A retrospective observational study was performed in 136 patients with HLHC who underwent a Norwood procedure with RV-PA conduit between 1998 and 2017. The probabilities of survival, reintervention and Fontan completion were analyzed.<br>
Results: Stage 1 survival was 91.9% (125/136). Reintervention for pulmonary artery stenosis was needed for 22% and 30% at stage 2 and 3, respectively, while 15% underwent reintervention for aortic arch recoarctation. Among 106 bidirectional Glenn survivors, 93 (68% of the total number of patients) had a Fontan completion, while four were not considered to be Fontan candidates. Risk factors for overall mortality included weighing <2.5 kg at the time of the Norwood procedure, intact atrium septum, total anomalous pulmonary vein connection, and more than mild atrioventricular regurgitation at the time of the Norwood procedure. Overall survival was 80.9%, 72.3% and 62.8% at 1, 5, and 20 years, respectively.<br>
Conclusions: Probabilities of survival and Fontan completion were acceptable under the current surgical strategy incorporating RV-PA Norwood procedure as the first palliation. Incorporating a strategy to maintain pulmonary artery growth and ventricular function through the staged repair is of prime importance. Further studies are necessary to observe changes in atrioventricular regurgitation as well as in right ventricular function, in patients who require atrioventricular valve interventions during the staged Fontan completion.No potential conflict of interest relevant to this article was reported.The Society of Thoracic SurgeonsActa Medica Okayama000349752021Staged Repair of Tetralogy of Fallot: A Strategy for Optimizing Clinical and Functional OutcomesENYasuyukiKobayashiDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceYasuhiroKotaniDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceYosukeKurokoDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science,TakuyaKawabataDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceShunjiSanoDivision of Pediatric Cardiothoracic Surgery, University of California San FranciscoShingoKasaharaDepartment of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical ScienceBackground<br>
This study evaluated the impact of a staged surgical strategy incorporating a modified Blalock-Taussig shunt (BTS) for tetralogy of Fallot (TOF) on pulmonary valve annulus (PVA) growth, the rate of valve-sparing repair (VSR) at the time of intracardiac repair (ICR), and long-term functional outcomes. <br>
Methods<br>
This retrospective study included 330 patients with TOF who underwent ICR between 1991 and 2019, including 57 patients (17%) who underwent BTS. The mean follow-up period was 15.0}7.3 years. We compared the data of patients who underwent BTS and those who did not undergo BTS before ICR. <br>
Results<br>
The median age and body weight before BTS were 71 (28–199) days and 4.3 (3.3–6.8) kg respectively. There were no in-hospital or interstage deaths after BTS. The PVA Z-scores of patients with BTS revealed significant growth after BTS (from -4.2}1.8 to -3.0}1.7, P<0.001). VSR was eventually performed in 207 (63%) patients, including 26 (46%) patients who underwent staged repair. The overall freedom from pulmonary regurgitation-related reintervention were 99.7%, 99.1%, and 95.8% at 1, 5, and 20 years, respectively. <br>
Conclusions<br>
A staged surgical strategy incorporating BTS as the first palliation for symptomatic patients resulted in no mortality. BTS may have contributed to the avoidance of primary transannular patch repair (TAP) and facilitated PVA growth; therefore, approximately half of the symptomatic neonates and infants were recruited for VSR. Staged repair may have led to functionally-reliable delayed TAP repair, thereby resulting in less surgical reinterventions.No potential conflict of interest relevant to this article was reported.BMCActa Medica Okayama1471-24902112021Photodynamic diagnostic ureteroscopy using the VISERA ELITE video system for diagnosis of upper-urinary tract urothelial carcinoma: a prospective cohort pilot study45ENKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRyutaTanimotoDepartment of Urology, Kagawa Prefectural Central HospitalTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShogoWatariDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHirochikaNakajimaDepartment of Urology, Fukuyama City HospitalHerikAcostaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiKatayamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakehiroIwataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoSakoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesBackground The advantages of photodynamic diagnostic technology using 5-aminolevulinic acid (ALA-PDD) have been established. The aim of this prospective cohort study was to evaluate the usefulness of ALA-PDD to diagnose upper tract urothelial carcinoma (UT-UC) using the Olympus VISERA ELITE video system. Methods We carried out a prospective, interventional, non-randomized, non-contrast and open label cohort pilot study that involved patients who underwent ureterorenoscopy (URS) to detect UT-UC. 5-aminolevulinic acid hydrochloride was orally administered before URS. The observational results and pathological diagnosis with ALA-PDD and traditional white light methods were compared, and the proportion of positive subjects and specimens were calculated. Results A total of 20 patients were enrolled and one patient who had multiple bladder tumors did not undergo URS. Fifteen of 19 patients were pathologically diagnosed with UT-UC and of these 11 (73.3%) were ALA-PDD positive. Fourteen of 19 patients were ALA-PDD positive and of these 11 were pathologically diagnosed with UC. For the 92 biopsy specimens that were malignant or benign, the sensitivity for both traditional white light observation and ALA-PDD was the same at 62.5%, whereas the specificities were 73.1% and 67.3%, respectively. Of the 38 specimens that were randomly biopsied without any abnormality under examination by both white light and ALA-PDD, 11 specimens (28.9%) from 5 patients were diagnosed with high grade UC. In contrast, four specimens from 4 patients, which were negative in traditional white light observation but positive in ALA-PDD, were diagnosed with carcinoma in situ (CIS). Conclusions Our results suggest that ALA-PDD using VISERA ELITE is not sufficiently applicable for UT-UC. Nevertheless, it might be better particularly for CIS than white light and superior results would be obtained using VISERA ELITE II video system. Trial registration: The present clinical study was approved by the Okayama University Institutional Review Board prior to study initiation (Application no.: RIN 1803-002) and was registered with the UMIN Clinical Trials Registry (UMIN-CTR), Japan (Accession no.: UMIN000031205).No potential conflict of interest relevant to this article was reported.Oxford University PressActa Medica Okayama0368-28115112020Long-term ureteroscopic management of upper tract urothelial carcinoma: 28-year single-centre experience130137ENYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceKasumiYoshinagaDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceManojMongaDepartment of Urology, The Cleveland ClinicYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical ScienceHiromiKumonInnovation Center Okayama for Nanobio-Targeted Therapy, Okayama UniversityBackground</br>
Long-term survival outcomes of patients who undergo endoscopic management of non-invasive upper tract urothelial carcinoma remain uncertain. The longest mean follow-up period in previous studies was 6.1 years. This study reports the long-term outcomes of patients with upper tract urothelial carcinoma who underwent ureteroscopic ablation at a single institution over a 28-year period.</br>
Methods</br>
We identified all patients who underwent ureteroscopic management of upper tract urothelial carcinoma as their primary treatment at our institution between January 1991 and April 2011. Survival outcomes, including overall survival, cancer-specific survival, upper-tract recurrence-free survival and renal unit survival, were estimated using Kaplan|Meier methodology.</br>
Results</br>
A total of 15 patients underwent endoscopic management, with a mean age at diagnosis of 66 years. All patients underwent ureteroscopy, and biopsy-confirmed pathology was obtained. Median (range; mean) follow-up was 11.7 (2.3–20.9, 11.9) years. Upper tract recurrence occurred in 87% (n = 13) of patients. Twenty percent (n = 3) of patients proceeded to nephroureterectomy. The estimated cancer-specific survival rate was 93% at 5, 10, 15 and 20 years. Estimated overall survival rates were 86, 80, 54 and 20% at 5, 10, 15 and 20 years. Only one patient experienced cancer-specific mortality. The estimated mean and median overall survival times were 14.5 and 16.6 years, respectively. The estimated mean cancer-specific survival time was not reached.</br>
Conclusions</br>
Although upper tract recurrence is common, endoscopic management of non-invasive upper tract urothelial carcinoma provides a 90% cancer-specific survival rate at 20 years in selected patients.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7452020Combined Laparoscopic and CT Monitoring of the Ice-Ball Margin during Cryoablation for Renal Cell Carcinoma Associated with von Hippel-Lindau Disease: First Case443448ENTakanoriSekitoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakaoHirakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMayuUkaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshiyukiKomakiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYusukeMatsuiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToshihiroIguchiDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSatoshiKatayamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKasumiYoshinagaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShogoWatariDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRisaKubotaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoSakoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesSusumuKanazawaDepartment of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasu Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/60806We report a 47-year-old Japanese female with 10 previous treatments for multiple bilateral renal cell carcinoma (RCC) associated with von Hippel-Lindau disease. The 14-mm right lower pole renal tumor was in contact with the right ureter. Laparoscopic cryoablation was performed to protect the ureter wrapped with gauze. Computed tomography (CT) monitoring was used to confirm the precise ≥ 6 mm ice-ball margin. There was no local progression at 6-months post-surgery. The serum creatinine has been stable. This is apparently the first report of combined laparoscopic and CT monitoring of an ice-ball formation and its margin during cryoablation for RCC.No potential conflict of interest relevant to this article was reported.ElsevierActa Medica Okayama0003497511212020Anatomical Risk Factors for Reintervention after Arterial Switch Operation for Taussig–Bing Anomaly163169ENYasuyukiKobayashiCardiovascular Surgery, Okayama University HospitalYasuhiroKotaniCardiovascular Surgery, Okayama University HospitalYosukeKurokoCardiovascular Surgery, Okayama University HospitalAtsushiTateishiCardiovascular Surgery, Okayama University HospitalShunjiSanoPediatric Cardiothoracic Surgery, University of California, San FranciscoShingoKasaharaCardiovascular Surgery, Okayama University HospitalBackground: This study aimed to determine the factors related to reintervention, especially for pulmonary artery stenosis (PS), in patients with Taussig–Bing anomaly (TBA) after arterial switch operation (ASO).<br>
Methods:This retrospective study included 34 patients with TBA who underwent ASO between 1993 and 2018. Preoperative anatomical and physiological differences and long-term outcomes were determined using a case-matched control with transposition of the great arteries (TGA) with ventricular septal defect (VSD) and TBA with an anterior and rightward aorta. <br>
Results: The median age and body weight at ASO were 43 (16–102) days and 3.6 (2.8–3.8) kg, respectively. Aortic arch obstruction and coronary anomalies were present in 64% and 41% patients, respectively. The hospital mortality rate was 11%, including one cardiac death, and late mortality rate was 2.9%. Furthermore, 41% patients underwent 26 reinterventions for PS. Patients undergoing PS-related reintervention had a significantly larger native pulmonary artery: aortic annulus size ratio than those not receiving reintervention (1.69 vs. 1.41, P = 0.02). This ratio was the only predictor of PS-related reintervention; it was significantly higher in the TBA group than in the TGA/VSD group. PS-related reintervention was required more in the TBA group than in the TGA/VSD group. <br>
Conclusions: Regardless of complex coronary anatomy and associated anomalies, early and late survival were acceptable. Postoperative PS was strongly associated with having a larger native pulmonary valve, suggesting that an optimal surgical reconstruction was required for achieving an appropriate aortopulmonary anatomical relationship during ASO. (243 words)No potential conflict of interest relevant to this article was reported.ElsevierActa Medica Okayama155876732020Sunitinib Versus Sorafenib as Initial Targeted Therapy for mCC-RCC With Favorable/Intermediate Risk: Multicenter Randomized Trial CROSS-J-RCCENYoshihikoTomitaDepartment of Urology, Niigata University Graduate School of Medical and Dental SciencesSeiNaitoDepartment of Urology, Yamagata University Faculty of MedicineNaotoSassaDepartment of Urology, Nagoya University Graduate School of MedicineAtsushiTakahashiDepartment of Urology, Hakodate Goryoukaku HospitalTsunenoriKondoDepartment of Urology, Tokyo Women's Medical University Medical Center EastTakuyaKoieDepartment of Urology, Hirosaki University Graduate School of MedicineWataruObaraDepartment of Urology, Iwate Medical UniversityYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of MedicineJunTeishimaDepartment of Urology, Graduate School of Biomedical Health Science, Hiroshima UniversityMasayukiTakahashi Department of Urology, Tokushima University Graduate School of Biomedical SciencesHideyasuMatsuyamaDepartment of Urology, Yamaguchi University Graduate School of MedicineTakeshiUeda Department of Urology, Chiba Cancer CenterKenyaYamaguchi Department of Urology, Nihon University School of MedicineTakeshiKishidaDepartment of Urology, Kanagawa Cancer CenterRyoichiShirokiDepartment of Urology, Fujita Health University School of MedicineTakashiSaika Department of Urology, Ehime UniversityNobuoShinoharaDepartment of Urology, Hokkaido University Graduate School of MedicineMototsuguOyaDepartment of Urology, Keio University School of MedicineHiro-omiKanayamaDepartment of Urology, Tokushima University Graduate School of Biomedical SciencesPurpose: The present study compared the efficacy of sunitinib and sorafenib as first-line treatment of metastatic clear cell renal cell carcinoma (mCC-RCC) with favorable or intermediate Memorial Sloan Kettering Cancer Center (MSKCC) risk. <br/>
Patients and methods: Treatment-naive patients with mCC-RCC were randomized to receive open-label sunitinib followed by sorafenib (SU/SO) or sorafenib followed by sunitinib (SO/SU). The primary endpoint was first-line progression-free survival (PFS). The secondary endpoints were total PFS and overall survival (OS). <br/>
Results: Of the 124 patients enrolled at 39 institutions from February 2010 to July 2012, 120 were evaluated. The median first-line PFS duration was 8.7 and 7.0 months in the SU/SO and SO/SU groups, respectively (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.42-1.08). The total PFS and OS were not significantly different between the SU/SO and SO/SU groups (27.8 and 22.6 months; HR, 0.73; 95% CI, 0.428-1.246; and 38.4 and 30.9 months; HR, 0.934; 95% CI, 0.588-1.485, respectively). The subgroup analysis revealed that the total PFS with SU/SO was superior to the total PFS with SO/SU in the patients with favorable MSKCC risk and those with < 5 metastatic sites). SO/SU was superior to SU/SO for patients without previous nephrectomy. <br/>
Conclusions: No statistically significant differences were found in first-line PFS, total PFS, or OS between the 2 treatment arms (ClinicalTrials.gov identifier, NCT01481870). No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7412020Robotic Renal Autotransplantation: A Feasibility Study in a Porcine Model5358ENRisaKubotaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKasumiKawamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYukiMaruyamaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuichiAriyoshiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakehiroIwataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTomokoSakoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoheiEdamuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuzukiKanoDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasashiKitagawaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiTanabeDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHitoshiSugiyamaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/57953 We investigated the feasibility of robotic renal autotransplantation (RAT) in a porcine model to reduce invasiveness of RAT. Five pigs underwent robotic RAT using the da Vinci® robotic system. A robotic left nephrectomy was performed in all cases. Robotic RAT was performed on the left side in all but one case. Four ports were used. In 3 cases, the kidney was taken out through the GelPort® and irrigated on ice with Ringerfs solution. In 2 cases, a complete intracorporeal robotic RAT was performed. An end-to-side anastomosis was performed between the renal vein and the external iliac vein and between the renal artery and the external iliac artery. Ureteroneocystostomy was also performed in 2 cases. All cases were performed robotically without open conversion. The median (IQR) console time was 3.1 (0.7) h, and the operative time was 3.8 (1.1) h. The estimated blood loss was 30 (0) ml. The warm ischemia time was 4.0 (0.2) min, and the cold ischemia time was 97 (17) min. Intracorporeal transarterial hypothermic renal perfusion was feasible in the 2 complete intracorporeal robotic RAT cases by using a perfusion catheter through a laparoscopic port. Robotic RAT has the potential to be a new minimally invasive substitute for conventional open surgery.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7142017Robotic Renal Autotransplantation: First Case Outside of North America351355ENMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRisaKubotaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShingoNishimuraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakashiYoshiokaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuichiAriyoshiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKeiFujioDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMoritoSugimotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsumiSasakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinEbaraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHidekiTaninishiDepartment of Anesthesiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroyukiAmanoAmano ClinicMasashiInuiDepartment of Urology, Tokyo Womenfs Medical University Yachiyo Medical CenterMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/55313 A 38-year-old woman with a 2.7-cm left ureteral stenosis requiring chronic ureteral stent exchange elected to undergo robotic renal autotransplantation. Left ureteropelvic junction obstruction (UPJO) was also suspected. Robotic donor nephrectomy contributed to the fine dissection for desmoplastic changes. The kidney was removed through a Gelport and examined on ice. UPJO was not seen. An end-to-side robotic anastomosis was created between the renal and external iliac vessels. The console time was 507 min, and the warm ischemia time was 4 min 5 sec. She became stent-free. Robotic renal autotransplantation is a new, minimally invasive approach to renal preservation.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7132017Diagnostic Ureteroscopy for Cases Clinically Suspected of Carcinoma in Situ of the Upper Urinary Tract227232ENKatsumiSasakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMoritoSugimotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinEbaraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOriginal Article10.18926/AMO/55205@We elucidate the fate of cases clinically suspected of carcinoma in situ (Cis) of the upper tract with serial ureteroscopy. Of 143 patients who underwent ureteroscopy for suspected upper tract urothelial carcinoma (UTUC) between January 2008 and February 2016, 12 cases with consistently positive urine cytology and poorly detectable upper-tract malignancies by imaging were reviewed. In these 12 patients, 19 ureteroscopy procedures (25 renal units) were performed. Vesical random biopsy was performed before the 1st ureteroscopy to exclude malignancy of the bladder in all 12 cases. Median follow-up was 42 (13-67) months. Positive biopsy results at the 1st ureteroscopy were obtained in 3 (25%) patients and all were diagnosed wth Cis of the upper tract. Two (17%) of 9 patients who were negative or inconclusive at the 1st ureteroscopy were finally diagnosed as UTUC, but plural ureteroscopy procedures were needed for the diagnoses in both. Carcinoma of the bladder appeared in 5 (42%) patients during follow-up, despite the earlier ruling out of vesical malignancy. Four (33%) of those 5 patients never developed upper-tract urothelial carcinoma during follow-up. Caution is required before undertaking radical surgery for cases clinically suspected of Cis of the upper tract. In our experience, only 42% of such patients developed UTUC; another 33% eventually developed carcinoma of the bladder without UTUC.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7122017A Combination Therapy of Partial Nephrectomy and Cryoablation Achieved Good Cancer Control and Renal Function in Bilateral Synchronous Renal Cell Carcinoma187190ENAtsushiTakamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMoritoSugimotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsumiSasakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/54989We report the case of a 58-year-old Japanese man with bilateral synchronous renal cell carcinoma (RCC). The diameters of the right and left tumors were 56 and 69 mm, respectively. Both tumors were endophytic. Cryoablation with prophylactic embolization was performed for the left tumor, and 1 month later, a right open partial nephrectomy was performed. No recurrence was observed during a 16-month follow-up, and the serum creatinine level has been stable. The prognosis of bilateral synchronous RCC is better than that of dialysis patients. The novel approach of combining cryoablation and partial nephrectomy can achieve good cancer control and renal function in bilateral RCC.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7122017The Downregulation of the Expression of CD147 by Tumor Suppressor REIC/Dkk-3, and Its Implication in Human Prostate Cancer Cell Growth Inhibition135142ENAkihiroMoriDepartment of Urology, Okayama University, Graduate School of Medicine, Denistry and Pharmacentical SciencesMasamiWatanabeDepartment of Urology, Okayama University, Graduate School of Medicine, Denistry and Pharmacentical SciencesTakuyaSadahiraDepartment of Urology, Okayama University, Graduate School of Medicine, Denistry and Pharmacentical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuichiAriyoshiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHideoUekiDepartment of Urology, Okayama University, Graduate School of Medicine, Denistry and Pharmacentical SciencesKoichiroWadaDepartment of Urology, Okayama University, Graduate School of Medicine, Denistry and Pharmacentical SciencesKazuhikoOchiaiDepartment of Veterinary Nursing and Technology, Nippon Veterinary and Life Science UniversityShun-AiLiCenter for Innovative Clinical Medicine, Okayama University HospitalYasutomoNasuDepartment of Urology, Okayama University, Graduate School of Medicine, Denistry and Pharmacentical SciencesOriginal Article10.18926/AMO/54982The cluster of differentiation 147 (CD147), also known as EMMPRIN, is a key molecule that promotes cancer progression. We previously developed an adenoviral vector encoding a tumor suppressor REIC/Dkk-3 gene (Ad-REIC) for cancer gene therapy. The therapeutic effects are based on suppressing the growth of cancer cells, but, the underlying molecular mechanism has not been fully clarified. To elucidate this mechanism, we investigated the effects of Ad-REIC on the expression of CD147 in LNCaP prostate cancer cells. Western blotting revealed that the expression of CD147 was significantly suppressed by Ad-REIC. Ad-REIC also suppressed the cell growth of LNCaP cells. Since other researchers have demonstrated that phosphorylated mitogen-activated protein kinases (MAPKs) and c-Myc protein positively regulate the expression of CD147, we investigated the correlation between the CD147 level and the activation of MAPK and c-Myc expression. Unexpectedly, no positive correlation was observed between CD147 and its possible regulators, suggesting that another signaling pathway was involved in the downregulation of CD147. This is the first study to show the downregulation of CD147 by Ad-REIC in prostate cancer cells. At least some of the therapeutic effects of Ad-REIC may be due to the downregulation of the cancer-progression factor, CD147.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7042016A Phase II Clinical Trial Evaluating the Preventive Effectiveness of Lactobacillus Vaginal Suppositories in Patients with Recurrent Cystitis299302ENKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesShinyaUeharaDepartment of Urology, Kawasaki Hospital, Kawasaki Medical SchoolAyanoIshiiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakuyaSadahiraDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasumiYamamotoDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRitsukoMitsuhataDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamoto Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasamiWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiHottaCenter for innovative Clinical Medicine, Okayama University HospitalYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesClinical Study Protocols10.18926/AMO/54508Urinary tract infections (UTIs) are the most common bacterial infections in women, and many patients experience frequent recurrence. The aim of this report is to introduce an on-going prospective phase II clinical trial performed to evaluate the preventive effectiveness of Lactobacillus vaginal suppositories for prevention of recurrent cystitis. Patients enrolled in this study are administered vaginal suppositories containing the GAI 98322 strain of Lactobacillus crispatus every 2 days or 3 times a week for one year. The primary endpoint is recurrence of cystitis and the secondary endpoints are adverse events. Recruitment began in December 2013 and target sample size is 20 participants.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7042016The Efficacy of Rituximab in High-risk Renal Transplant Recipients295297ENMotooArakiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichiroWadaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYosukeMitsuiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesRisaKubotaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesTakashiYoshiokaDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYuichiAriyoshiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasashiKitagawaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiTanabeDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroshiSugiyamaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesJunWadaDepartment of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMasamiWatanabeCenter for Innovative Clinical Medicine, Okayama University HospitalToyohikoWatanabeDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsuyukiHottaCenter for Innovative Clinical Medicine, Okayama University HospitalYasutomoNasuDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesClinical Study Protocols10.18926/AMO/54507Although graft survival following renal transplantation (RTx) has improved, outcomes following highrisk RTx are variable. Preexisting antibodies, including donor-specific antibodies (DSA), play an important role in graft dysfunction and survival. We have designed a study to investigate the safety and efficacy of anti-CD20 monoclonal antibodies (rituximab) in high-risk RTx recipients. Major eligibility criteria include: 1) major and minor ABO blood group mismatch, 2) positive DSA. Thirty-five patients will receive 200 mg/body of rituximab. The primary endpoint is the incidence of B cell depletion. This study will clarify whether rituximab is efficacious in improving graft survival in high-risk RTx recipients.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X7032016A Case of Metastatic Urachal Cancer Including a Neuroendocrine Component Treated with Gemcitabine, Cisplatin and Paclitaxel Combination Chemotherapy223227ENShinEbaraDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasuyukiKobayashiDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKatsumiSasakiDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMotooArakiDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesMoritoSugimotoDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKoichirouWadaDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesKeiFujioDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesAtsushiTakamotoDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesToyohikoWatanabeDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesHiroyukiYanaiDepartments of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesYasutomoNasuDepartments of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesCase Report10.18926/AMO/54423The present case report describes a case of recurrent and advanced urachal carcinoma including neuroendocrine features with iliac bone metastasis after partial cystectomy and adjuvant chemotherapy consisting of irinotecan and cisplatin in a 32-year-old man. He received gemcitabine/cisplatin/ paclitaxel (GCP) combination chemotherapy, consisting of gemcitabin (1,000mg/m2) on day 1, 8, cisplatin (70mg/m2) on day 1, and paclitaxel (80mg/m2) on day 1 and 8. After three cycles of chemotherapy, PET-CT showed complete regression of the disease. So the patient underwent total cystourethrectomy, and histological examination showed an almost complete pathological response. External beam radiation therapy was also given to the ileac bone metastasis regions. However, PET-CT taken 17 months after the external beam radiation showed multiple lung metastases. He received GCP chemotherapy again, which resulted in a complete response again after three cycles of chemotherapy. This is the first report on GCP chemotherapy used not only as a salvage chemotherapy but also as a rechallenge regimen for metastatic urachal cancer including a neuroendocrine component.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6922015A Paraganglioma in a Hypertensive Patient with Unilateral Renal Hypoplasia119122ENTomohiroTerasakaHideharuHagiyaKosukeKimuraTakahiroNadaEriNakamuraYoshihisaHanayamaHitoshiSugiyamaYasuyukiKobayashiHiroyukiYanaiFumioOtsukaCase Report10.18926/AMO/53341We report the case of a 46-year-old hypertensive Japanese female with renal insufficiency related to unilateral renal hypoplasia. The patient was found to have developed paraganglioma in the retroperitoneal space over a 5-year period. Catecholamine-producing tumors are not usually recognized as conditions associated with renal hypoplasia. Our long-term observation of the patient eventually led us to the diagnosis of paraganglioma. In hypertensive patients with chronic kidney disease, not only the renin-angiotensin-aldosterone system but also catecholamine activity may be involved, particularly in the patients whose cases are complicated with unilateral renal hypoplasia.No potential conflict of interest relevant to this article was reported.Springer Japan KKActa Medica Okayama1341-96251812013Could salvage surgery after chemotherapy have clinical impact on cancer survival of patients with metastatic urothelial carcinoma?110115ENKensukeBekkuTakashiSaikaYasuyukiKobayashiRyoKioshimotoTaikiKanbaraYasutomoNasuHiromiKumonThe clinical impact of salvage surgery after chemotherapy on cancer survival of patients with metastatic urothelial carcinoma is controversial. We aimed to verify the clinical role of salvage surgery by analyzing the long-term outcome in patients with urothelial carcinoma treated by chemotherapy.
Between 2003 and 2010 at a single institution, 31 of 47 patients (66%) with metastatic urothelial carcinoma showed objective responses (CR in 4, PR in 27) after multiple courses of cisplatin/gemcitabine/paclitaxel-based chemotherapy, and a cohort of patients with partial response (PR) were retrospectively enrolled. Twelve (10 male and 2 female, median age 64.0 years) of 27 patients with PR underwent salvage surgeries after the chemotherapy: metastatectomy of residual lesions (10 retroperitoneal lymph nodes, 2 lung), and 6 radical surgeries for primary lesions as well. Progression-free survival and overall patient survival rates were analyzed retrospectively and compared with those of patients without salvage surgery.
All 12 patients achieved surgical CR. Pathological findings of metastatic lesions showed viable cancer cells in 3 patients. In univariate analysis, sole salvage surgery affected overall survival in 27 patients with PR to the chemotherapy (P = 0.0037). Progression-free survival and overall survival rates in patients with salvage surgery were better than those in 15 PR patients without the surgery (39.8 vs. 0%, and 71.6 vs. 12.1% at 3 years, P = 0.01032 and 0.01048; log-rank test).
Salvage surgery for patients with residual tumor who achieve partial response to chemotherapy could have a possible impact on cancer survival.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6612012Laparoscopic-Assisted Tension-free Vaginal Mesh: An Innovative Approach to Placing Synthetic Mesh Transvaginally for Surgical Correction of Pelvic Organ Prolapse2329ENToyohikoWatanabeMiyabiInoueAyanoIshiiToyokoYamatoMasumiYamamotoKatsumiSasakiYasuyukiKobayashiMotooArakiShinyaUeharaTakashiSaikaHiromiKumonOriginal Article10.18926/AMO/48078Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3}1.3 at baseline to 18.0}1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6522011For Vol. 64, No. 1 pp 27-31 Prognostic Factors Influencing Survival after ephroureterectomy for Transitional Cell Carcinoma of the Upper Urinary Tract143149ENYasuyukiKobayashiTakashiSaikaDaisukeManabeYasutomoNasuHiromiKumonCorrected and Republished Article10.18926/AMO/45274We analyzed the prognostic factors influencing survival after surgeries for upper urinary tract urothelial carcinoma (UUT-UC) with longer follow-up periods than in previous studies. Between January 2000 and December 2004, 386 patients underwent nephroureterectomy for UUT-UC. The data for the 221 patients with UUT-UC were retrospectively reviewed. Nine variables were evaluated for association with the survival outcomes of cause-specific survival. The prognostic significance was tested univariately with the log-rank test. The simultaneous effects of multiple prognostic factors were estimated by multiple regression analysis using the Cox proportional hazards model. The median follow-up was 38.4 months. The 5-year over all survival was 62.3%. Significant prognostic factors for disease-specific survival rate on univariate analysis were pathological stage (p0.0001), tumor grade (p0.0324), and venous invasion (p0.0001). Multivariate analysis revealed that only venous invasion was significant for disease-specific survival rate (p0.0205). Venous invasion was the only independent prognostic factor in pathologically localized UUT-UC.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6162007The Efficacy of Neoadjuvant Androgen Deprivation Therapy as a Prostate Volume Reduction before Brachytherapy for Clinically Localized Prostate Cancer335340ENShinEbaraDaisukeManabeYasuyukiKobayashiRyutaTanimotoTakashiSaikaYasutomoNasuShirouSaitoTakefumiSatohKentaMikiKatsuyoshiHashineHiromiKumonOriginal Article10.18926/AMO/32878<p>From September 2003 to December 2005, 188 patients who visited our hospital and allied institutions for the purpose of prostate brachytherapy were administrated hormonal therapy for volume reductions before brachytherapy. The pretreatment and posttreatment of prostate volume using a transrectal ultrasound volumetric study and the types and duration of hormonal therapy were analyzed. We administered 91 patients with Luteinizing hormone-releasing hormone (LH-RH) agonist, 49 patients with anti-androgen (bicaltamide/flutamide), and 48 patients with maximum androgen blockade (MAB). The duration of the hormonal therapy was 1-3 months for 49 patients, 4-6 months for 59 patients, 7-9 months for 40 patients, 10-12 months for 32 patients, and over 13 months for 8 patients. Before the initiation of hormonal therapy, the mean prostate volume was 35.12 ml (11.04-78.71 ml), and the average of prostate volume before and after hormonal therapy was 36.79 ml and 24.79 ml, respectively (a 32.4% reduction). The prostate volume reduction rate was 32.0% for the LH-RH agonist only, 18.1% for the anti-androgen only and 41.2% for the MAB. No statistically significant difference was observed for the duration of hormonal therapy between 3 groups. A three-month course of the neoadjuvant LH-RH agonist indicated a sufficient volume reduction effectiveness for a large prostate volume.</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6412010Prognostic Factors Influencing Survival after ephroureterectomy for Transitional Cell Carcinoma of the Upper Urinary Tract2731ENYasuyukiKobayashiTakashiSaikaDaisukeManabeYasutomoNasuHiromiKumonOriginal Article10.18926/AMO/32862We analyzed the prognostic factors influencing survival after surgeries for upper urinary tract urothelial carcinoma (UUT-UC) with longer follow-up periods than in previous studies. Between January 2000 and December 2004, 386 patients underwent nephroureterectomy for UUT-UC. The data for the 221 patients with UUT-UC were retrospectively reviewed. Nine variables were evaluated for association with the survival outcomes of cause-specific survival. The prognostic significance was tested univariately with the log-rank test. The simultaneous effects of multiple prognostic factors were estimated by multiple regression analysis using the Cox proportional hazards model. The median follow-up was 38.4 months. The 5-year over all survival was 62.3%. Significant prognostic factors for disease-specific survival rate on univariate analysis were pathological stage (p0.0001), tumor grade (p0.0324), and venous invasion (p0.0001). Multivariate analysis revealed that only venous invasion was significant for disease-specific survival rate (p0.0205). Venous invasion was the only independent prognostic factor in pathologically localized UUT-UC.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6212008Iodine-125 Seed Implantation (Permanent Brachytherapy) for Clinically Localized Prostate Cancer913ENShinEbaraYoshihisaKatayamaRyutaTanimotoKoheiEdamuraHiroyukiNoseDaisukeManabeTomokoKobayashiYasuyukiKobayashiMakotoKobukeMitsuhiroTakemotoTakeshiSaikaYasutomoNasuSusumuKanazawaHiromiKumonOriginal Article10.18926/AMO/30986<p>From January 2004 to March 2007, 308 patients with clinically localized prostate cancer were treated
using iodine-125 (125I) seed implantation (permanent brachytherapy) at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. We evaluated the treatmentfs effi cacy and morbidity in 300 prostate cancer patients who were followed up for more than 1 month after brachytherapy. Based on the National Comprehensive Cancer Network (NCCN) guidelines, patients with a prostate volume of less than 40 ml in transrectal ultrasound imaging were classifi ed as low or intermediate
risk. The median patient age was 67 years (range 50 to 79 years), the median prostate-specific antigen (PSA) value before biopsy was 6.95 ng/ml (range 1.13 to 24.7 ng/ml), and the median prostate volume was 24.33 ml (range 9.3 to 41.76 ml). The median follow-up was 18 months (range 1 to 36 months) and the PSA levels decreased in almost all patients after brachytherapy. Although 194 of 300 patients (64.7%) complained of diffi culty in urination, pollakisuria/urgency, miction pain, and/or urinary incontinence, all of which might be associated with radiation prostatitis during the fi rst month after brachytherapy, these symptoms gradually improved. 125I seed implantation brachytherapy is safe and eff ective for localized prostate cancer within short-term follow up.</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6262008Initial Report of Hybrid Radical Prostatectomy for Prostate Cancer:Reduced Bleeding, Clear Vision, and Secure Surgical Margins379384ENTakashiSaikaYasuyukiKobayashiToyohikoWatanabeDaisukeManabeShinEbaraShinyaUeharaYasutomoNasuHiromiKumonOriginal Article10.18926/AMO/30950<p>To evaluate morbidity in Hybrid Radical Prostatectomy (HRP, hybridized laparoscopic and open retropubic radical prostatectomy). The operative and pathological outcomes obtained in 25 consecutive
patients who underwent HRP were reviewed. The median operating time was 220min, median blood loss was 550ml, and no patient required an allogenic blood transfusion. No severe postoperative complications were observed. The surgical margin was positive in 12% of all patients, and in 1 patient with pT2 or less (4.5%). These results indicate that HRP is safe and may be able to combine the benefits
of both laparoscopic and open procedures.</p>No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6242008The Benefits of Clamping the Renal Artery in Laparoscopic Partial Nephrectomy269273ENYasuyukiKobayashiTakashiSaikaDaisukeManabeYasutomoNasuHiromiKumonOriginal Article10.18926/AMO/30939<p>The purpose of this study is to compare the performance of laparoscopic partial nephrectomy (LPN) with and without clamping of the renal artery and to evaluate the impact of clamping on postoperative renal function. A total of 20 patients underwent LPN, 13 without and 7 with clamping of the renal artery. The 2 groups were compared with respect to complications, blood loss, operative time, mean tumor size, and incidence of positive margins. Renal function was evaluated by pre- and postoperative renal scintigraphy using <sup>99m</sup>Technetium-mercaptoacetyltriglycine (<sup>99m</sup>Tc-MAG3). Intraoperative blood loss was significantly higher in the group without clamping than in the group with clamping (p0.04). In the group with clamping, the median warm ischemic time was 35min (range 25-40min). The serum creatinine values and the renal scintigraphy showed no influence on postoperative renal function with or without clamping. In the group without clamping, 2 cases were showed positive surgical margins. The procedure performed with clamping of the renal artery is superior to the procedure performed without clamping as it provides the advantages of controlling hemorrhaging without injury to renal function and prolonging the surgical time and allowing for more accurate resection of renal tumors.</p>No potential conflict of interest relevant to this article was reported.