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Introduction To describe laparoendoscopic single-site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney. Case presentation Case 1: a 58-year-old female with fever was referred to our hospital. Computed tomography demonstrated a markedly atrophic right kidney and mild hydronephrosis. Case 2: a 64-year-old male with a history of several intra-abdominal surgeries visited our hospital with a complaint of left back pain and fever. Computed tomography demonstrated left marked hydronephrosis, thinning of renal parenchyma, and duplicated inferior vena cava. After antibiotic treatment, transperitoneal reduced port simple nephrectomy and retroperitoneal laparoendoscopic single-site simple nephrectomy were performed in Case 1 and 2, respectively, because the function of the affected kidney was almost lost on renography. Although adhesion was slightly noted around the renal hilum in Case 1, neither conversion to laparotomy nor placement of additional ports was needed. Conclusion Laparoendoscopic single-site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney may be options for experienced laparoscopic surgeons.

To evaluate the oncological feasibility of pure laparoscopic radical nephroureterectomy (p-LRNU) for upper tract urothelial carcinoma (UTUC) compared with conventional LRNU (c-LRNU) using a propensity-adjusted multi-institutional collaboration dataset. Among the 503 UTUC patients who underwent RNU, we identified 219 who underwent c-LRNU (laparoscopic nephrectomy with open bladder cuff resection) and 72 who underwent p-LRNU (dissecting the kidney, ureter, and bladder cuff under complete laparoscopy). We adopted a propensity score (PS) matching method to achieve homogeneity with respect to patient backgrounds. PS matching-adjusted Cox-regression analysis was performed to evaluate the risk factors that influenced oncological outcomes. Sixty-eight p-LRNU and 68 c-LRNU patients were matched. Overall, 51 (37.0%) developed intravesical recurrence (IVR), 21 (15.4%) had disease recurrence, and 20 (14.7%) died. Patients who underwent p-LRNU had a significantly shorter operation time and less blood loss than those who underwent c-LRNU. Although no significant differences in 3-year recurrence-free survival were found between the two methods, atypical recurrence sites were observed in the p-LRNU group, including the brain, sigmoid colon, vagina, and peritoneum. Regarding IVR, the 3-year IVR-free survival rate was 41.8% in the p-LRNU group, which was significantly lower than that in the c-LRNU group (66.6%, p = 0.004). Multivariate analysis demonstrated that a history of bladder cancer, ureteral cancer, and p-LRNU were independent risk factors for subsequent IVR. Although p-LRNU is less invasive, the current technique may increase the incidence of atypical disease recurrence and subsequent IVR due to extravesical and intravesical tumor dissemination.

CONTEXT The oversecretion of plasma aldosterone by unilateral aldosterone-producing adenoma (APA) can be cured by adrenalectomy. However, the time needed for the endocrine environment to normalize remains unclear. OBJECTIVE To clarify adequate timing for a biochemical evaluation in unilateral APA patients after adrenalectomy. DESIGN AND PATIENTS A total of 166 unilateral APA patients were retrospectively reviewed. We evaluated the plasma aldosterone concentration (PAC) (pg/mL), active renin concentration (ARC) (pg/mL), aldosterone-renin ratio (ARR; PAC/ARC), serum potassium concentration and estimated glomerular filtration rate (eGFR) at 1, 3 and 6 postoperation months (POM). RESULTS PAC was significantly lower at 1POM than at presurgery (presurgery; 407.2, 1 POM; 90.0 pg/mL, P

INTRODUCTION AND OBJECTIVE:Smaller number of prostate biopsy cores at cancer diagnosis may underestimate pathological characteristics of prostate cancer (PCa). We summarize clinical outcomes of PCa...

Introduction To describe laparoscopic surgery for psoas abscess caused by migrated urolithiasis. Case presentation A 64-year-old female had renal stones in the right kidney for 5 years. She developed right back pain. Her body temperature was 37.4°C, and right costovertebral angle tenderness was detected. In blood examination, her C-reactive protein level was elevated. Computed tomography revealed that one stone had migrated into the right psoas muscle and caused psoas abscess. Another stone was detected in the renal parenchyma. Percutaneous drainage and antibiotic treatment were performed until her symptoms and inflammation improved. However, psoas abscess recurred after removal of the drainage tube. The migrated stone was laparoscopically removed after fenestration of psoas abscess, and laparoscopic nephrolithotomy was simultaneously performed for the other stone. Conclusion To the best of our knowledge, this is the first case report of psoas abscess caused by migrated urolithiasis that was managed by minimally invasive surgery.

Metastasectomy is a widely accepted treatment for renal cell carcinoma (RCC) metastasis, and is regarded as the most effective strategy for increasing the rate of cancer-specific survival. However, since bilateral synchronous or metachronous adrenal metastasis of RCC is extremely rare, a standard approach has yet to be established. Partial adrenalectomy may avoid lifelong hormonal supplementation and reduce the risk of Addisonian crisis. A 71-year-old man had a previous history of left nephrectomy and ipsilateral adrenalectomy for metachronous adrenal metastasis. Metachronous contralateral adrenal metastasis was detected 2 years after ipsilateral adrenalectomy, and he underwent retroperitoneoscopic partial adrenalectomy using a vessel sealing device. Although corticosteroid replacement therapy was not prophylactically performed, the patient did not exhibit any symptoms of hypocorticism. Nine months after the surgery, the patient remains well without steroid supplementation, and neither local recurrence nor metastasis has been detected. To the best of our knowledge, this is the first case report of laparoscopic partial adrenalectomy for RCC metastasis. The vessel sealing device was highly effective and suitable for laparoscopic partial adrenalectomy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s13691-019-00383-5) contains supplementary material, which is available to authorized users.

Iatrogenic ureteral rupture is a serious complication. In the past, ileal ureter substitution was performed with open, laparoscopic, and robot-assisted procedure; however, there are problems with operation invasiveness and difficulty. We present a 72-year-old female whose ureter was completely injured at the ureteropelvic junction and torn longitudinally in full length at the time of transurethral lithotripsy. Although initially she had nephrostomy, we were able to internalize with hand-assisted laparoscopic ileal ureter substitution for obstruction over the full length of the ureter.

Contralateral ureteral metastasis after renal cell carcinoma (RCC) nephrectomy is uncommon. In such cases, a mass in the contralateral ureter needs to be differentiated from the primary ureteral tumor. If high grade primary ureteral tumor is found and total nephroureterectomy is performed, dialysis is introduced. In cases of metastasis of RCC, the kidney may be preserved by local treatment by partial ureterectomy. We report a case of contralateral ureteral metastasis after nephrectomy for right RCC. We underwent an originative method of pure laparoscopic partial ureterectomy and ureteral end-to-end anastomosis.

Primary carcinoma of the ureteral stump following a radical nephrectomy is rare, and it is even rarer that the cause of the nephrectomy is renal cell carcinoma (RCC). Treatment by complete ureterectomy with a bladder cuff is considered as the standard treatment. We report a case of a 70-year-old female with urothelial carcinoma with glandular differentiation that occurred in the ureteral stump after nephrectomy for left RCC. We performed a novel technique of pure laparoscopic resection of the ureteral stump with a bladder cuff.

INTRODUCTION AND OBJECTIVES:No reliable biomarker is available for predicting worse clinical outcome in chemo-resistant urothelial carcinoma (UC) patients treated with pembrolizumab. We focused on ...

We investigated the relationship between pretreatment neutrophil-to-lymphocyte ratio (pre-NLR) levels just before the initiation of treatment with pembrolizumab and clinical outcomes in platinum-resistant metastatic urothelial carcinoma (UC) patients treated with pembrolizumab.Our study population comprised 78 patients diagnosed with metastatic UC and treated with pembrolizumab after platinum-based chemotherapy at our institutions between December 2017 and April 2019. We examined the relationships between pre-NLR levels just before pembrolizumab treatment and clinical outcomes. A pre-NLR level of ≥3.35 was defined as elevated according to a calculation by a receiver-operating curve analysis.The high pre-NLR group consisted of 33 patients (42.3%). Overall, 29.5% of patients had a clinical response and the sum of the target lesion longest diameter was decreased in 18.8% of the high pre-NLR group, which was significantly lower than that in the low pre-NLR group (58.1%, P = 0.005). Six-month progression-free survival and cancer-specific survival rates for the high pre-NLR group were 9.1 and 58.0%, which were significantly lower than those for their counterpart (45.9 and 89.1%, P0.001 and P = 0.002, respectively). The pre-NLR level was an independent indicator of disease progression and cancer-specific death (P0.001 and P = 0.003). Furthermore, patients with a postpembrolizumab NLR level that had decreased ≥25% from the pre-NLR level had significantly lower disease progression and cancer-specific death rates than their counterparts (P = 0.01 and P = 0.022, respectively).Elevated pre-NLR may be a novel biomarker for identifying poor responders to pembrolizumab among platinum-resistant metastatic UC patients.

BACKGROUND The effects of the administration of dutasteride (DUT) on steroid metabolite pathways in BPH patients have not been examined. METHODS Urine and blood samples as well as clinical parameters were prospectively collected after the administration of DUT to 60 BPH patients, and after its withdrawal in another set of 25 BPH patients. Urine samples were assessed using gas chromatography/mass spectrometry for the urinary steroid profile (USP), which simultaneously measures 63 steroid metabolites. We examined pharmacological changes in the 5α/5β ratio of urinary metabolites and their relationships with clinical parameters in patients treated with DUT. RESULTS The mean urinary androsterone/etiocholanolone (An/Et) ratio in sex-steroid pathways significantly decreased from 1.39 to 0.02 (p

Monitoring the serum level of prostate specific antigen (PSA) is indispensable for surveillance after radical therapy, and the aim of this study was to establish the optimal follow-up schedule.We retrospectively reviewed the clinicopathological data of 1,010 consecutive patients who underwent radical prostatectomy. After excluding patients who received neoadjuvant or adjuvant therapy and those without a nadir PSA level0.2ng/ml, the remaining 779 patients were enrolled. Biochemical recurrence (BCR) was defined as elevation of PSA to0.2ng/ml. We investigated the PSA doubling time (PSA-DT) following BCR at various times after surgery.During a mean follow-up of 8.8 years, BCR occurred in 180/779 patients. The annual BCR rate was 6% in the first year after surgery, 6% between 1 and 2 years, 3% between 2 and 3 years, 3% between 3 and 5 years, and 2% at5 years postoperatively. During these periods, the minimum PSA-DT after BCR was 1.6, 2.4, 3.1, 6.1, and 6.4 months, respectively. These minimum PSA-DTs were used to determine the optimal follow-up interval during each period after surgery. If the baseline level is 0.1ng/ml, PSA should be measured at approximately 3-month intervals for the first year, at 4-month intervals between 1 and 2 years, at 6-month intervals between 2 and 3 years, and annually thereafter to definitely detect BCR before the serum PSA level exceeds 0.4ng/ml.The PSA-DT following BCR varies according to the time after surgery. Our data on minimum PSA-DT values after BCR are useful for setting the optimal follow-up schedule.

Paraganglioma (PGL) is a rare type of tumor that arises from the extra-adrenal paraganglia. A PGL tumor hypersecretes catecholamines and causes symptoms identical to those in patients with hyper-functioning adrenal pheochromocytoma (PCC). In this study, we compared the surgical outcome of laparoscopic surgery, including laparoendoscopic single-site (LESS) surgery, in patients with PCC and patients with retroperitoneal solitary PGL.The records of 49 patients with PCC and 9 patients with unilateral retroperitoneal PGL at our institution from January 2001 to March 2013 were retrospectively reviewed. Multiple tumors, tumors suspected of being malignant preoperatively, and tumors operated on using a retroperitoneal approach were excluded from the study.Each group was equivalent with respect to patient background, hemodynamic variables, and preoperative biochemical assessments, including plasma catecholamine levels and catecholamine levels in 24-hour urine samples. The mean operative time was significantly longer in the PGL group (149.4 ± 56.5 minutes v 189.8 ± 44.9 minutes, P=0.019). In univariate and multivariate analyses, tumor size ≥ 50 mm and PGL were statistically significant factors that predicted prolonged operative time. Intraoperative hypotension occurred in 15 patients in the PCC group and in 8 patients in the PGL group, and the difference was statistically significant (P=0.002). One postoperative complication in the PCC group and two postoperative complications (Clavien-Dindo grade II or higher) in the PGL group were observed, and the difference was statistically significant (P=0.012). Twenty-two patients in this series underwent LESS surgery (PCC: n=19; PGL: n=3), and there was no statistically significant difference in the perioperative outcomes between the two groups.The present results demonstrate that the operation for solitary extraperitoneal PGL required a longer operative time and had more hypotensive episodes and higher postoperative morbidity than the PCC group. Though the perioperative outcome of LESS surgery for PGL is comparable to that of PCC, we should treat the patients with PGL accordingly.

Objective To evaluate the suitability of preoperative multiparametric magnetic resonance imaging (MRI) positivity as a predictor of biochemical recurrence after radical prostatectomy (RP). Patients and Methods We reviewed the clinical records of patients who underwent either standard RP or laparoscopic RP between January 2005 and December 2009 at our institution. Patients who received radiotherapy or androgen deprivation therapy before surgery were excluded. A total of 314 patients met the study inclusion criteria. Cox proportional hazard regression models were used for analyses. In accordance with the criteria in the established guidelines, a radiologist scored the probability of the presence of prostate cancer using a five-point scale of diagnostic confidence level. The highest confidence level of any pulse sequence was considered as the evaluation result. Results MRI positivity was significantly associated with a high clinical stage (cT ≥ 2; P = 0.039), a high positive biopsy core rate (≥0.2; P < 0.001), a high biopsy Gleason score ([GS] ≥8; P < 0.001) and a high pathological GS (≥8; P = 0.005). Univariate analysis and multivariate analysis showed that MRI positivity was a prognostic indicator in the analysis that included only preoperative variables and also in the analysis including preoperative and pathological variables. Conclusion Multiparametric MRI positivity can independently predict biochemical recurrence after RP.

To determine predictive factors for perioperative complications of laparoscopic adrenalectomy (LA) including single-site surgery performed or supervised by experienced laparoscopic surgeons.We retrospectively reviewed 265 consecutive unilateral LAs performed at a single institution from 2001 to 2011. All surgical procedures were performed or supervised by one of two experienced laparoscopic surgeons. The transabdominal approach was used in 248 patients, while a retroperitoneal approach was used in 17 patients. Laparoendoscopic single-site adrenalectomy was performed in 58 patients. Predictive factors for postoperative complications were analyzed.There were no postoperative deaths. At least one postoperative complication occurred in 12 (4.6%) patients. No patient underwent reoperation for a complication. Only one (0.4%) patient's procedure was converted to open surgery, and only this patient needed a blood transfusion during the operation. One patient who underwent laparoendoscopic single-site adrenalectomy had the procedure converted to conventional laparoscopic adrenalectomy. Multivariable logistic regression analysis showed that an American Society of Anesthesiologists-physical status grade 3 or above was the only predictive factor for perioperative complications.American Society of Anesthesiologists-physical status grade 3 or above was a statistically significant factor for perioperative complications associated with laparoscopic adrenalectomy that involved laparoendoscopic single-site adrenalectomy, which was performed or supervised by an experienced laparoscopic surgeon. According to the findings of this retrospective study, single-site operation, obesity, adrenal tumor size, and tumor type may not be considered as risk factors for perioperative complications after LA performed or supervised by an experienced laparoscopic surgeon.

Objectives: To report our initial experience with transumbilical laparo-endoscopic single-site adrenalectomy for adrenal tumors by using a single port with a multichannel cannula and bent laparoscopic instrumentation. Methods: Between December 2009 and December 2010, 30 patients underwent transumbilical laparo-endoscopic single-site adrenalectomy at our hospital. The procedure was carried out for adrenal cortical adenoma in 17 patients, adrenal pheochromocytoma in seven patients and other types of tumors in six patients. A multichannel port, bent laparoscopic instruments and Opti4 laparoscopic electrodes were used in all patients. The intraperitoneal space was approached through the umbilicus. The multichannel port was placed through a 2-cm incision at the inner edge of the umbilicus. A 5-mm flexible laparoscope was introduced to maintain an adequate laparoscopic view, and surgical specimens were extracted using an Endocatch bag. Results: All procedures were successfully completed, with only one incision through the umbilicus, and without conversion to a standard laparoscopic approach. Mean operative time was 120.1 ± 34.7 min. Tumor laterality and patient body mass index did not affect surgical morbidity. The initial 15 patients had a significantly longer mean pneumoperitoneum time (95.8 ± 37.5 min) than the last 15 patients (70.5 ± 18.7 min). Only one postoperative complication was observed (postoperative hematoma). Conclusions: A transumbilical approach for laparo-endoscopic single-site adrenalectomy is safe and feasible, and it results in superior cosmesis. Improvements in surgical devices might facilitate further development of this approach.

Background The optimal timing of catheter removal following laparoscopic radical prostatectomy (LRP) has not yet been determined. This prospective study was designed to compare the efficacy and safety of catheter removal on postoperative day (POD) 2 versus POD 4 after LRP and its impact on urinary continence outcomes. Methods One hundred and thirteen patients underwent LRP and were prospectively randomized into two groups: group 1 (n = 57) had the urinary catheter removed on POD 2 while group 2 (n = 56) had the catheter removed on POD 4. The urine loss ratio (ULR) was defined as the weight of urine loss in the pad divided by the daily micturition volume. Continence was defined as a pad-free status. Results No significant differences were observed in clinical features between groups 1 and 2. Acute urinary retention (AUR) after catheter removal occurred in 21 patients (18.6 %) (13 (22.8 %) in group 1 and 8 (14.3 %) in group 2 (p = 0.244). The first-day mean ULR values were 1.16 ± 4.95 in group 1 and 1.02 ± 3.27 in group 2 (p = 0.870). The last-day mean ULR values were 0.57 ± 1.60 in group 1 and 2.78 ± 15.49 in group 2 (p = 0.353). Continence rates at 3, 6, 9, and 12 months were 21.8, 41.1, 58.0, and 71.4 % in group 1 and 34.5, 66.0, 79.2, and 83.7 % in group 2 (p = 0.138, 0.009, 0.024, and 0.146, respectively). In AUR cases, continence rates at 3, 6, 9, and 12 months were 0, 23.1, 38.5, and 54.5 % in group 1 and 37.5, 75.0, 87.5, and 87.5 % in group 2 (p = 0.017, 0.020, 0.027, and 0.127, respectively). A multivariate analysis identified AUR after catheter removal on POD 2 as the only predictive factor for incontinence 6 and 9 months after LRP (p = 0.030 and 0.018, respectively). Conclusions Our results demonstrated that early catheter removal on POD 2 after LRP may increase the risk of incontinence. Trial registration The study was registered as Clinical trial: (UMIN000014944); registration date: 12 March 2012.

INTRODUCTION AND OBJECTIVES: There are few molecular markers which are known to predict a poor prognosis in upper tract urothelial carcinomas (UTUC). Axl, which is in the TAM family of receptor tyrosine kinases, has been shown to be associated with tumor progression and cancer metastasis in some types of cancer, although the association with UTUC is still not clear. We therefore investigated the biological significance of Axl on UTUC outcome. METHODS: The protein expression of Axl by immunohistochemistry and its correlation with clinicopathologic features were investigated in surgical specimens obtained from 167 patients who had been surgically treated for UTUC at our institution. The mean follow-up period was 81.8 (1-291) months. The immunoreactivity for Axl was assessed independently by a single uropathologist. RESULTS: Axl labeling was strong in 85 of 167 (55%) cases and was weak in 82 of 167 (45%) cases. Overall strong positivity of Axl expression was statistically significantly associated with high grade tumors (p1⁄40.004), positive lymphovascular invasion (LVI) (p1⁄40.001), and occurrence of postoperative metastasis (p

IgG4-related disease (IgG4RD) is a novel clinical entity characterized by tissue infiltration of IgG4-positive plasma cells. We report here 3 cases of IgG4RD associated with urinary tract obstruction. Patient 1 was a 59-year-old male who complained of difficulty on urination. A CT scan showed bilateral ureteral wall thickness, hydronephrosis, and an enlarged prostate. His serum IgG4 was 817 mg/dl. We made a diagnosis of IgG4RD and performed bilateral ureteral stenting and steroid therapy. A significant reduction in the size of the lesion was detected, and IgG4 was decreased to 272 mg/dl. He was doing well after removal of the ureteral stent. Patient 2 was a 51-year-old female who complained of bilateral swelling of the submaxillary gland. A CT scan showed left ureteral wall thickness and hydronephrosis. Her serum IgG4 was 1,020 mg/dl. We made a diagnosis of IgG4RD and performed left ureteral stenting and steroid therapy. A significant reduction in the size of the lesion was detected, and IgG4 was decreased to 337 mg/dl. She was doing well after removal of the ureteral stent. Patient 3 was a 64-year-old male who underwent evaluation for autoimmune pancreatitis. He complained of back pain and bilateral hydronephrosis was detected. His serum IgG4 level was 649 mg/dl. Bilateral ureteral stenting was performed based on a diagnosis of IgG4RD. He did not receive steroid therapy because of poorly-controlled diabetes mellitus. After insertion of the ureteral stent, hydronephrosis and back pain were relieved. We could only find a few case reports in the literature on IgG4RD associated with urinary tract obstruction. It is important for clinicians to bear in mind that IgG4RD sometimes causes urinary tract obstruction.

INTRODUCTION AND OBJECTIVES: Laparoendoscopic single-site adrenalectomy (LESS-A) has been developed as a treatment option for adrenal tumors that has cosmetic benefit and less postoperative pain. Some reports proposed that patient selection criteria should be stringent, and pheochromocytoma (PHE) should be taken as advanced indication. Here, we examined the perioperative outcomes of PHE patients who underwent laparoscopic adrenalectomy (LA), while paying special attention to any differences in surgical techniques. METHODS: The records of a total of 233 consecutive patients who underwent LA at our hospital from May 2001 to February 2012 were entered into a database. Surgical procedures were performed by two experienced laparoscopic surgeons. 1) 50 patients who underwent LA for PHE (group PHE, n 50) were compared with patients who underwent LA for other benign adrenal tumors (group non-PHE, n 183). 2) 20 consecutive patients with PHE who underwent LESS-A were compared with patients with PHE who underwent conventional LA (c-LA, n 30). RESULTS: 1) Each group was equivalent with respect to age, sex, BMI, tumor side, perioperativeiicomplication rate, and intraoperative bleeding. There were significant differences in mean size (nonPHE/PHE: 22.8 14.8 mm/46.0 21.9 mm, p 0.001) and mean pneumoperitoneum time (non-PHE/PHE: 85.3 33.0 mm/123.7 55.1 min, p 0.001) between the two groups. At least one postoperative complication (Clavien-Grade 2) occurred in 13 patients (non-PHE/PHE: 10 cases/3 cases). 2) Each group was statistically equivalent with respect to age, BMI, tumor size, operative time, intraoperative bleeding, and postoperative hospital stay. There were no significant differences in preoperative hemodynamic variables between the two groups. There were no significant differences in the highest intraoperative blood pressure (LESSA/c-LA: 161.7 7.8 mmHg/180.6 7.4 mmHg, p 0.096), hypertensive episodes (LESS-A/c-LA: 10 cases/23 cases, p 0.051), or intraoperative hypotensive episodes (LESS-A/c-LA: 4 cases/9 cases, p 0.557). In one case of LESS-A, two additional ports were added. There were 3 perioperative complications (LESS-A/c-LA: 2 cases/1 case, p 0.331). CONCLUSIONS: LA was safely performed in patients with PHE compared with that of non-PHE patients. We concluded the safety of LESS-A for PHE as being similar to that of LA. With appropriate preand intra-operative hemodynamic control and experienced hands, LESS-A could become one of the treatments of choice for resection of PHE.

A 53-year-old man presented for further evaluation due to microscopic hematuria and left lumbar pain. Computed tomography revealed a large tumour in the left renal pelvis with multiple metastases. Despite effective systemic chemotherapy, he developed dyspnea, and was diagnosed with cardiac tamponade. Pericardial involvement in an advanced malignancy is common, but symptomatic cardiac metastasis from urothelial carcinoma is rare. Of the reports of symptomatic cardiac metastasis from urothelial carcinoma, only 3 cases presented as cardiac tamponade. We report here a rare case of cardiac tamponade caused by a renal pelvic carcinoma with positive cytodiagnosis of pericardial effusion. We also summarize and discuss the symptoms, treatment, and prognosis of the pathological condition, and present a brief review of previously published reports.

Background Our aim was to evaluate the effect of visceral obesity and impact of severe hydronephrosis on surgical complexity in patients undergoing laparoscopic radical nephroureterectomy (LRNU). Methods From January 2000 to December 2013, 169 patients underwent radical nephroureterectomy at our institution. We retrospectively reviewed the medical records of 70 patients who underwent LRNU. We measured total fat area (TFA) and visceral fat area (VFA) at the level of the umbilicus using computed tomography. We defined accumulated visceral fat distribution as a VFA/TFA ratio ≥0.45. Ipsilateral hydronephrosis was graded from 0 to 4 by two uro-radiologists blinded to the clinical outcomes. Results Among the 70 patients, VFA/TFA ratio was ≥0.45 in 40 patients (57.1%) and 28 (40.0%) had severe hydronephrosis (grade 3 or greater). Patients with a VFA/TFA ratio ≥0.45 had significantly longer pneumoperitoneum and total operation times compared to their counterparts (p = 0.047 and p = 0.002, respectively). Patients with severe hydronephrosis had significantly longer pneumoperitoneum and total operative times compared to their counterparts (p = 0.006 and p = 0.002, respectively). Multivariate logistic regression analysis showed that a high VFA/TFA and severe hydronephrosis were independent predictive factors for prolonged pneumoperitoneum (p = 0.048, HR = 2.90; p = 0.015, HR = 3.82, respectively) and total operative times (p