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Background: Upper urinary tract urothelial carcinoma (UTUC) is uncommon. In advanced cases, radical nephroureterectomy (RNU) alone is not curative, and recurrence and metastasis are likely to occur. Adjuvant chemotherapy (AC) is an evidence-based treatment. However, the optimal number of AC cycles is not clear. This multicenter study investigated the number of cycles required for the beneficial effects of AC in Japanese patients with UTUC., Methods: Patients who were diagnosed with UTUC and underwent RNU at our hospital and affiliated hospitals from January 2010 to September 2020 were included in the study. Patients with pathological T3 or higher or lymph node metastasis were observed or given AC, and their responses were compared. The AC regimens included gemcitabine and cisplatin or carboplatin. Patients were also classified into two groups: the observation and two cycles of AC group and the three to four cycles of AC group. The survival curves for recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analyses., Results: Of the 133 patients enrolled in the study, 24 received 2 cycles of AC, 37 received 3-4 cycles, and 72 were observed only. The 5-year RFS was 67.1% for the 3-4 cycles of AC group and 41.7% for the observation and two cycles of AC group. The 5-year CSS was 72.2% for the 3-4 cycles of AC group and 35.9% for the observation and two cycles of AC group. RFS and CSS were significantly longer in the 3-4 cycles of AC group compared to the observation and 2 cycles group ( P = 0.048 and P = 0.005 respectively)., Conclusion: AC prolonged RFS and CSS in the real-world setting. However, at least three cycles of AC are required to achieve beneficial effects in patients with UTUC., Competing Interests: The authors declare no conflict of interest., (©2024 Tottori University Medical Press.)

Background: Urosepsis is an acute life-threating disease, and some cases show refractory outcome to therapy. In an aging society of developed countries, characteristics of urosepsis are becoming complicated. We performed a comprehensive investigation regarding the clinical and social aspects that are related to refractory outcomes in urosepsis patients., Methods: The patient cohort consisted of 66 patients with urosepsis. Multiple factors from clinical and social aspects were reviewed retrospectively. Two categories of refractory outcomes were defined. One was afebrile resistance (AR); fever continued more than 7 days from the initiation of therapy. Another was discharge resistance (DR); hospitalization continued for more than 30 days. Logistic regression analyses were performed to identify significant factors that are related to the AR or DR., Results: Univariate analysis demonstrated that high score of Eastern Cooperative Oncology Group Performance Status (ECOG PS) (≥ 2) and Age-adjusted Charlson comorbidity index (CCI) (≥ 4), high serum C-reactive protein (CRP) level (≥ 14.9 mg/dL), and low serum albumin level (≤ 2.26 g/dL) were significantly related to AR. Univariate analysis results also revealed that high score of ECOG PS (≥ 2), high serum creatinine level (≥ 1.54 mg/dL) and vasopressor administration were significantly related to DR. Multivariate analyses demonstrated that low serum albumin level (≤ 2.26g/dL) was the only significant factor that was related to AR. In contrast, high score of ECOG PS (≥ 2) and high serum creatinine level (≥ 1.54 mg/dL) were significant factors that were related to DR., Conclusion: It is suggested that evaluating serum albumin levels is essential for the therapeutic first step because hypoalbuminemia was the significant factor that was related to obstruction to antipyresis. It is also suggested that the deterioration of patients' activities of daily living and renal dysfunction might be the refractory factors for discharge from the hospital, which was the ultimate therapeutic goal., Competing Interests: The authors declare no conflicts of interest., (©2022 Tottori University Medical Press.)

Background: To explore new factors that are predictive of post-partial nephrectomy (PN) renal global function, we analyzed various clinico-pathological factors with a special focus on renal volume measured via three-dimensional imaging technology and histopathological parameters in non-neoplastic parenchyma., Methods: Estimated glomerular filtration rate (eGFR) and computed tomography (CT) scan were examined pre- and 6 months. post-operatively in 52 patients treated by PN. The post-operative percent eGFR decline was employed as the measure of global renal functional deterioration. The novel factors analyzed included the percent renal parenchymal volume decline of the diseased side, contralateral and bilateral sides and the global glomerulosclerosis (GS) extent in non-neoplastic parenchyma. Renal parenchymal volumetry by CT scan was performed using SYNAPSE VINCENT (Fujifilm). Additional factors analyzed included patient demographics and comorbidities, surgical factors and tumor pathology. All factors demonstrating significant tendencies ( P < 0.1) in univariate analyses were subjected to multivariate logistic regression analysis., Results: Two groups were categorized according to the degree of eGFR decline. Groups A and B were categorized as less than 15% and greater than 15% decline, respectively. Pre-operative eGFR was significantly lower in group B than in group A. Greater than 10% global GS extent in non-neoplastic parenchyma, male gender and proteinuria were significantly more frequent in in group B than in group A. The renal volume change was not statistically significant. In multivariate logistic regression analysis, greater than 10% global GS extent in non-neoplastic parenchyma was the sole independent affecting factor for Group B., Conclusion: Our study suggested that host factors rather than surgical factors may be useful for the prediction of post-PN renal global function. The evaluation of the global GS extent in non-neoplastic parenchyma is a promising biomarker of post-PN renal global function.

Background: The definition of continence after robot-assisted laparoscopic radical prostatectomy (RARP) has not been consistently defined, with many studies only noting the amount of safety pads used. We therefore examined what definition of continence would be appropriate, employing both the International Consultation on Incontinence Modular Questionnaire Short Form (ICIQ-SF) and the number of pads used by patients. We also evaluated the relationship between the number of pads used and degree of incontinence., Methods: Patients who underwent RARP between October 2010 and July 2014 in our department were included in the present study. All patients were evaluated by ICIQ-SF and the number of pads used 1, 3, 6 and 12 months after surgery. Frequency of incontinence and amount of incontinence were evaluated by ICIQ-SF Questions 1 and 2 respectively at 12 months. Quality of life (QOL) was evaluated by ICIQ-SF Question 3 at 1, 3, 6, and 12 months after RARP., Results: The overall study population was 156 patients. In Question 1, 19 patients answered that they leaked urine several times a day, but 5 patients did not use pads, and 8 patients were using only 1 pad a day. In Question 2, 8 patients answered that they leaked a moderate amount of urine, but 2 patients did not use any pads, and 3 patients used only 1 pad a day. QOL showed significant differences between using no pad, 1 pad, or ≥ 2 pads at 1, 3, 6, and 12 months after RARP., Conclusion: Simply noting the number of pads used by a patient is an insufficient way to evaluate incontinence after RARP. Assessment by an appropriate questionnaire is also needed.

Background: High-risk prostate cancer treatment has been controversial. Some high-risk prostate cancer patients fail to respond to radical prostatectomy only. Thus, we aimed to investigate the predictive factors for biochemical recurrence (BCR) and identify patients who could achieve sufficient therapeutic effect by radical prostatectomy only., Methods: Of 264 medical records reviewed, 141 low-intermediate-risk and 100 high-risk prostate cancer patients, excluding those who had received neoadjuvant hormone therapy, were analyzed. BCR was defined as the first increase in prostate-specific antigen levels (≥ 0.2 ng/mL), with levels not decreasing to undetectable limits, after radical prostatectomy. Log-rank test and Cox proportional hazards regression analyses were performed to determine the prognostic factors. We investigated the perioperative predictive factors for BCR and BCR-free survival rates, with the number of National Comprehensive Cancer Network (NCCN) high-risk factors for high-risk prostate cancer patients who underwent robot-assisted radical prostatectomy., Results: Multivariate analyses showed that clinical T3 was significantly associated with BCR [hazard ratio (HR) = 4.052; 95% confidence interval (CI), 1.26-12.99; P = 0.019]. Of the 100 patients, 77 had 1 high-risk factor and 23 had ≥ 2 high-risk factors; the 1-year BCR-free survival rate of patients with 1 high-risk factor and those with ≥ 2 high-risk factors was 94.8% and 69.6%, respectively. Patients with ≥ 2 high-risk factors were significantly associated with BCR ( P = 0.002). No difference in BCR rate between patients with 1 high-risk factor and those with low- and intermediate-risk was found., Conclusion: High-risk prostate cancer patients with 1 NCCN high-risk factor can be considered for robot-assisted radical prostatectomy treatment only.

Background: Transurethral resection of bladder tumor (TURBT) technique has been considered the routine method for removing most bladder tumors for decades. In contrast, endoscopic submucosal dissection (ESD) is the gold-standard treatment for gastrointestinal superficial tumors. We investigated the effectiveness and applicability of a new technique for en bloc bladder tumor resection using ESD procedure., Methods: Four Landrace Large White Duroc female pigs were anesthetized with isoflurane prior endoscopic resection using a large-caliber prototype fiber bronchoscope. After local infiltration of the submucosa with sodium hyaluronate using an injector needle, a section of the target area (1.0-2.0 cm diameter circular area) was cut with the Dual Knife., Results: In total, seven target sections were resected from the pigs. The median size of the resected sections was 1.8 cm (range 1.0-2.5 cm) and the median time taken to perform the resection of one section was 20 min (range 4-35 min). These target sections were completely resected en bloc. Although the small bladder perforations occurred on two occasions, no other short-term complications such as uncontrollable bleeding were observed., Conclusion: This procedure is a slightly difficult in the pigs with thin bladder walls. However, this procedure with the slim flexible cystoscope may allow us to be able to remove bladder tumors using only light sedation, especially for cases when small tumor recurrence is observed during routine cystoscopy for the patients with non-muscle invasive bladder cancer.

Background: To ensure safe performance in robotic surgery, the Minimal Invasive Surgery Center (MISC) is composed of the anesthesiology department, five surgery departments and co-medical staff in our institution. The objective of this study was to evaluate the outcomes of different types of robotic surgeries for cancer treatment (n = 326) from different surgery departments in the MISC., Methods: The outcomes of robot-assisted radical prostatectomy (RARP), partial nephrectomy (RAPN), transoral robotic surgery (TORS) for pharyngeal cancer, and robotic surgery for lung, gastric and rectal cancer were evaluated using the similar concept of pentafecta in RARP., Results: The pentafecta rates of RARP and robotic surgery for rectal cancer were 33.3 and 56.5%, respectively. The tetrafecta rates of RARP (excluding potency evaluation from pentafecta) and TORS were 48.4 and 57.1%, respectively. The trifecta rates of RAPN, robotic surgeries for lung and gastric cancer were 75.9, 74.2 and 84.2%, respectively. The failure of tetrafecta in RARP achievement was significantly associated with high risk than with low risk according to National Comprehensive Cancer Network classification., Conclusion: This is the world's first comprehensive evaluation of different types of robotic surgeries for cancer treatment in the constitutional framework of an academic institution. MISC, which provides the constitutional framework of an academic institution, is providing immeasurable benefits in terms of robotic surgery quality, and it may ultimately lead to high penta-, tetra-, and trifecta rates for robotic surgeries for cancer treatment in all surgical departments.

Background: The efficacy of adding target prostate biopsy (PBx) of suspected cancer lesions identified on magnetic resonance imaging (MRI) and/or transrectal ultrasonography (TRUS) to initial systematic PBx was evaluated. Moreover, the outcomes were compared between 2 physicians., Methods: We retrospectively investigated 238 patients who underwent first-time PBx in our hospital. All patients were examined with prostate MRI before PBx. Fourteen systematic biopsies were obtained in all patients. When a suspected lesion was present on MRI and/or TRUS, the lesion was the target of target PBx., Results: The overall detection rate of prostate cancer (PCa) was 45% (106/238). With target PBx, the PCa detection rate was 32% overall, while that of suspected lesions seen only on MRI was 32%, that of suspected lesions seen only on TRUS was 8% and that of suspected lesions seen on both MRI and TRUS was 52%. The same tendency was shown for each physician. Comparing systematic PBx and target PBx, the overall rate of Gleason score (GS) upgrading with target PBx was 13%. The rate of PCa detected only by systematic PBx was 95%. There was no significant difference between the 2 physicians., Conclusion: In initial PBx, the addition of target PBx of suspected cancer lesions detected by MRI and/or TRUS to systematic PBx might not be useful to improve the cancer detection rate. However, it may enable more accurate risk classification and detection of minute cancers with a high GS.