Nihon Hinyokika Gakkai zasshi. The japanese journal of urology最新文献

(Introduction) Patients with severe pelvic organ prolapse (POP) are currently being treated with robot-assisted or laparoscopic sacrocolpopexy (LSC). LSC is recognized as being more secure and more effective than transvaginal mesh surgery (TVM). However, favorable postoperative outcomes occur even in patients treated with TVM using ORIHIME^® mesh. We compared the differences in postoperative outcomes and complication rates between patients who underwent either of these two methods using ORIHIME^® mesh. (Material and methods) We retrospectively evaluated 95 patients with POP. In our hospital, 41 patients were treated by LSC, whereas 54 were treated by TVM. We measured the changes in symptoms before and after surgery using the IPSS, OABSS, and ICIQ-SF, and 1-h pad weight testing and complication rates. (Result) Between 3 and 12 months following surgery, both groups' residual urine volume and IPSS plus QOL score significantly decreased. The pad test results revealed a significant decrease 3 months after surgery in the TVM group. From 3 to 12 months after surgery in the TVM group for all patients and patients with POP scored ≤ stage 3, and at 12 months after surgery in the LSC group for all patients, OABSS and ICIQ-SF scores declined significantly. There were no statistically significant differences in the rate of urinary incontinence, mesh exposure after surgery between the two groups. The rate of prolapse recurrence in the TVM group was as low as in the LSC group among patients with stage 2 or 3 POP. (Conclusion) TVM using ORIHIME^® mesh has a favorable postoperative course compared to LSC at 1 year postoperatively. TVM surgery should be preferentially considered for patients scored ≤ stage 3 POP-Q.

(Purpose) To evaluate the safety and efficacy of outpatient procedures using botulinum toxin (BTX) for patients with intractable overactive bladder (OAB) in a Female Urology Clinic. (Methods) Medical charts of female patients who underwent outpatient BTX procedures for intractable OAB were retrospectively reviewed between 2020 and 2022. In addition to uroflowmetry and residual urine measurement, OAB symptoms score (OABSS), international prostate symptom score (IPSS), and patient global impression of improvement (PGI-I) were evaluated preoperatively and postoperatively at 2, 6, 12, and 24 weeks. (Results) Forty-one patients underwent a total of 50 BTX procedures during the above period (1 procedure: 34 patients, 2 procedures: 5 patients, 3 procedures: 2 patients). The average age was 72.4±7.6 (50-86), and 9 (22.0%) and 3 (12.2%) patients had a history of surgeries for pelvic organ prolapse and stress urinary incontinence, respectively. Two patients (4.9%) developed temporal urinary retention which was managed with clean self-intermittent catheterization. Symptomatic urinary tract infection occurred in 3 patients (7.3%). The average maximum flow rate showed a small but significant decrease, and the average residual urine significantly increased from preoperative 41.4 ml to 103.4 ml (week 2), 88.5 ml (week 6), 72.4 ml (week 12), and 60.3 ml (week 24). However, IPSS-voiding symptom score did not show significant differences at week 2-24. OABSS-Q1 (daytime frequency) did not show significant improvement at any point, and OABSS-Q2 (nocturnal frequency) showed significant improvement at week 2 and 6. OABSS-Q3 (urinary urgency), OABSS-Q4 (urgency urinary incontinence), OABSS total score, IPSS-Q4 (urinary urgency), IPSS-storage symptom score, and IPSS-QOL all showed significant improvement at week 2-24. PGI-I showed the highest improvement rates at week 2 (marked improvement 63.4%, improvement 92.7%), and this improvement was sustained at week 12 (marked improvement 43.6%, improvement 84.6%). Most patients did not choose to have additional therapy until 24 weeks to over one year had passed. Furthermore, 12 patients (29.3%) chose to have a second BTX procedure. (Conclusion) In Female Urology Clinics, there are many patients suffering from refractory OAB including those after surgeries for pelvic organ prolapse and stress urinary incontinence. As urinary retention is less frequently caused by BTX and its efficacy is more evident among female patients, BTX procedures could be anticipated as an outpatient treatment option in Female Urology.

The patient in this case is a 67-year-old male. The previous physician examined the patient due to the primary complaint of ulcers on the penis, and the patient was diagnosed with squamous cell carcinoma (cT1N0M0). Our clinic performed a penectomy.Since vascular invasion was negative, a lymphadenectomy was not performed, and the patient was subsequently observed. However, four months after the surgery, we confirmed that the cancer had metastasized to the left inguinal lymph node and the left external iliac lymph node.The patient completed the fourth cycle of the TIP treatment before we performed an inguinal pelvic lymphadenectomy, and the patient succeeded in complete remission.Presently, two years and five months after the lymphadenectomy, no recurrence was found.

A 30-year-old man underwent a right high orchiectomy for a testicular tumor. A computed tomography (CT) scan revealed para-aortic and mediastinal lymph node and lung metastases, consequently he was diagnosed with pTxN3M1aS2 stage III B, mixed germ cell tumor (teratoma, fibrosis). The bleomycin, etoposide, and cisplatin protocol was initiated after the placement of an inferior vena cava filter for common iliac venous thrombus. Human chorionic gonadotropin (HCG) positivity was observed at the end of the fourth course despite the immediate decrease in tumor markers after the treatment's initiation. The HCG levels remained low and positive after three vinblastine sulfate, ifosfamide, and cisplatin protocol and two paclitaxel, ifosfamide, and cisplatin protocol courses. A subsequent CT scan revealed a developing lymph node metastasis; hence, retroperitoneal and mediastinal lymph node dissections were performed biphasically.Residual tumor resection is indicated for patients with non-seminoma having localized retroperitoneal lesions or resectable lesions and high alpha-fetoprotein. However, the lymph node dissection, performed here, stabilized the patient's condition in a non-HCG-negative and HCG stain-negative state, suggesting that elevated HCG may be attributed to abnormal feedback from chemotherapy.

(Objective) It is well known that sperm DNA fragmentation (SDF) affects not only natural conception but also in vitro fertilization (IVF) outcomes, and the importance of sperm quality has received renewed attention. In this study, we investigated the effects of coenzyme Q10 (CoQ10), which is thought to have potent antioxidant properties, on SDF and IVF outcomes. (Materials and methods) Patients whose SDF was measured at our clinic and diagnosed as high (>16%) were given a supplement containing CoQ10 as the main ingredient (MySeed^®) for 3 months, and then SDF, general semen analysis, and semen oxidation-reduction potential (sORP) were reanalyzed. In addition, in cases where IVF including intracytoplasmic sperm injection (ICSI) was performed before and after supplementation, laboratory results including fertilization rate, blastocyst development rate before and after supplementation were analyzed. (Results) Of the 46 patients who consented to participate in this study, 35 patients who completed to the second semen analysis were included. SDF improved significantly from 31.6% to 25.3% (p<.05) before and after supplementation. Sperm concentration, motility rate, sperm motility index (SMV) and sORP showed no statistically significant difference. When restricted to cases with high sORP (≥1.38), the differences were more pronounced as follows. SDF decreased significantly from 34.0% to 26.1% (p<.05). Similarly, there was a significant improvement in sperm concentration and SMV from 12.5 million/ml to 24.3 million/ml (p<.05) and from 73.6 to 114.4 (p<.05) respectively. When IVF outcomes were compared before and after supplementation, the blastocyst rate (42.4% vs. 51.2%) and good blastocyst rate (45.5% vs. 54.5%) showed a trend towards improvement, but no significant differences were observed due to the small sample size. (Conclusion) Myseed^® Supplementation significantly reduced SDF, which was more pronounced in patients with higher sORP levels, suggesting that SDF and sORP may serve as clinical indicators for antioxidant use.

Denys-Drash syndrome (DDS) is characterized by rapidly progressing nephropathy, Disorders of Sex development, and Wilms tumor. Gonadal removal is recommended owing to the increased risk of developing gonadal tumors; however, the optimal timing remains uncertain. Herein, we report three cases with gonadoblastoma discovered in excised gonads. Case 1 involves a 13-year-old girl for whom peritoneal dialysis (PD) was initiated at 6 months of age. The left gonad removal at 9 months revealed hypoplastic testicular tissue. At 2 years and 8 months, kidney transplantation and bilateral nephrectomy were performed. A living kidney transplant was received at the age of 10 years. Subsequently, virilization signs and right gonadal swelling led to a diagnosis of gonadoblastoma during right gonadectomy at 13 years and 7 months. Case 2 involves a 6-year-old girl for whom PD was initiated 1 month after birth. Left nephrectomy was performed at 1 years and 11 months, followed by right nephrectomy at 5 years and 4 months. At the age of 6 years and 1 months, living kidney transplantation and simultaneous right gonadectomy revealed gonadoblastoma with a dysgerminoma component, without metastasis. Left gonadectomy 3 months post-transplantation revealed testis pathology. Case 3: involves a 4-year-old girl for whom PD was initiated 9 days after birth. Bilateral nephrectomy was performed at 1 year of age. Bilateral gonadectomy at 4 years and 5 months revealed bilateral ovotestis with a left gonadoblastoma component. While gonadoblastoma has limited malignant findings, it serves as the precursor of highly malignant gonadal tumors, highlighting the importance of timely excision. In DDS cases, determining the optimal timing for gonadectomy remains complex owing to variations in nephropathy progression. The priority given to PD initiation and Wilms' tumor prevention further complicates excision timing. Notably, the case of dysgerminoma in our 6-year-old patient appears to be one of the youngest cases in the literature.

(Objective) This study aimed at evaluating the efficacy and safety of upfront docetaxel (DTX) treatment and androgen deprivation therapy (ADT) in male patients with high-volume metastatic castration-sensitive prostate cancer (HV-mCSPC). (Methods) This retrospective study was conducted using the medical records of 30 patients treated for HV-mCSPC by using upfront DTX treatment along with ADT at Atsugi City Hospital between December 2015 and December 2022. The patient characteristics, demographics, oncological outcomes, adverse events, and sequential therapy were evaluated. (Results) Thirty patients were included in the final analysis. The median patient age and prostate-specific antigen at diagnosis were 73 years (range, 53-83 years) and 250 mg/ml (range, 0.54-3,817 ng/ml), respectively. The completion rate of six cycles of upfront DTX treatment was 86.7%. The median progression-free survival was 24 months; the median overall survival was not reached, and the 5-year survival rate was 71.5%. Alopecia was the most frequent non-hematological adverse event (60%) followed by fatigue (53.3%). Overall, adverse events of grade 3 or higher occurred in 46.7% of the patients, with neutropenia being the most frequent. The incidence of neutropenia of grade 3 or higher was significantly lower in the group receiving primary prophylaxis with long-acting granulocyte colony-stimulating factor (7.7% vs. 75%, P = 0.009). Abiraterone was the most frequently administered sequential treatment in 12 patients (60%). (Conclusion) In the triplet combination treatment era, upfront DTX treatment and ADT for patients with HV-mCSPC was safe as primary prophylaxis for severe neutropenia and effective as an upfront treatment. However, it should be selected if its effectiveness is superior to triplet treatment considering adverse events, cost-effectiveness, and quality of life.

(Objective) The study aimed to retrospectively evaluate the therapeutic effects of adjuvant chemotherapy (AC) in patients following radical cystectomy (RC) in locally advanced bladder cancer. (Methods) A single-center-derived database registered 227 patients diagnosed with muscle-invasive bladder cancer and treated with RC and pelvic lymphadenectomy between March 2003 and December 2021. Of these, patients diagnosed with non-organ-confined diseases were classified as either pT3-T4 or pN-positive without distant metastasis. Platinum-based AC was administered for the following categories: two courses for patients with pT3-T4 and pN-negative and three courses for those with pTany and pN-positive. The primary endpoint was the disease-free survival (DFS) and overall survival (OS) between the patients receiving and not receiving AC. (Results) Among all patients, 90 were diagnosed with non-organ-confined disease: 43 (47.8%) were treated with AC and the remaining 47 (52.2%) were left untreated. The methotrexate, vinblastine, doxorubicin, and cisplatin regimen; the gemcitabine and cisplatin regimen; and the gemcitabine and carboplatin regimen were administered to 14 (32.6%), 25 (58.1%), and 4 (9.3%) patients, respectively. With a median follow-up period of 26 months, the groups that received and did not receive AC had 2-year DFS rates of 36.3% and 25.9% (median DFS time: 15 vs. 8 months, p=0.026) and 2-year OS rates of 64.3% and 41.4% (median OS time: 38 vs. 18 months, p=0.064), respectively. In patients with pT3-T4 and pN-negative, no significant difference in the median DFS and OS between the AC and non-AC groups was observed. However, in patients with pTany and pN-positive, the DFS (median: 14 vs. 4.5 months, p=0.002) and OS (38 vs. 11.5 months, p=0.009) were longer in the AC than those in the non-AC group, respectively. The multivariate Cox regression analysis revealed that AC administration was an independent predictor for DFS (hazard ratio: 0.44, 95% confidence interval: 0.24-0.79, p=0.006). (Conclusion) Platinum-based AC following RC significantly improved DFS in pN-positive patients with locally advanced bladder cancer.

(Objective) We report the effectiveness of combination therapy with vibegron in pediatric patients with neurogenic bladder inadequately responding to anticholinergic agents. (Subjects and methods) This retrospective study involved 13 pediatric patients with neurogenic bladder treated with anticholinergics at our department from November 2019 to January 2021 who had an inadequate response and received combination therapy with vibegron. Changes in the volume of urinary incontinence before and after the use of vibegron reported during interviews from the 13 patients were compared. In addition, bladder capacity at the end of examination, bladder capacity at the end of examination/expected bladder capacity (EBC), and bladder compliance were compared using the Wilcoxon signed rank test in 9 patients for whom urodynamics (UDS) or video urodynamics (VUDS) was performed before and after introduction of vibegron. (Results) The 13 patients comprised 8 boys and 5 girls. The median age was 13 years (range, 5-18 years). Underlying diseases included 9 cases of spina bifida, 1 case of Hinman syndrome, 1 case of cervical vertebra injury, 1 case of idiopathic cervical epidural hematoma combined with spina bifida, and 1 case of spinal cord infarction. Eight of the 13 patients experienced decrease in urinary incontinence after the introduction of vibegron. All 9 patients who underwent UDS or VUDS before and after introduction of vibegron displayed significant differences in bladder capacity at the end of the examination, bladder capacity at the end of the examination/EBC, and bladder compliance, indicating improvement. (Conclusion) Combination therapy with vibegron is effective for pediatric patients with neurogenic bladder who have inadequately responded to anticholinergic agents.

(Objective) To compare the initial results of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) for uretero-pelvic junction obstruction (UPJO). (Methods) Between April 2008 to October 2021, we identified 104 cases of UPJO where LP was performed and 18 cases where RALP was performed at our hospital. We retrospectively analyzed their perioperative outcomes. Furthermore, we recorded the operative times for each cases of LP and RALP. (Results) The median operative time for RALP was 141 minutes, which was significantly shorter than that for LP (204 minutes). No patient in the RALP group demonstrated any Clavien-Dindo complications (≥grade 3). During the observation period, improvement of symptoms was observed in all cases. The median suturing time in RALP was 38 minutes. Compared with the last 20 cases of LP, the time to expose the uretero-pelvic junction, the time of renal pelvis incision, and suturing time were significantly shorter in RALP. In addition, the console and suturing times were stable since the initial stage. In cases with a high grade of hydronephrosis, there was a large variation in the time to expose the uretero-pelvic junction and suture the renal pelvis and ureter in LP; however, this variation was smaller in RALP. (Conclusion) At our hospital, RALP for UPJO is considered to be a safe procedure. In the future, it is necessary to consider the long-term results and effectiveness of RALP.