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Objectives: Postoperative inguinal hernia (IH) is one of the most common complications of radical prostatectomy (RP) including robot‐assisted RP (RARP). However, a procedure to prevent IH after RARP has not been established. We investigated the impact of processus vaginalis transection (PVT) and PVT with peritoneal closure on IH after RARP. Methods: A retrospective analysis was performed on data from patients who underwent RARP at two tertiary hospitals in Japan, where PVT with subsequent peritoneal closure was introduced after 2014. The incidence of IH for 2 years after RARP was compared among 79 patients without PVT or peritoneal closure, 232 patients with only PVT, and 325 patients with PVT and peritoneal closure. Multivariable Cox proportional hazard models that adjusted for hospital, age, history of abdominal operation, body mass index, operation time, and prostate weight were used. Results: Postoperative IH was observed in seven (8.9%) patients without PVT or peritoneal closure, 34 (15%) patients with only PVT, and nine (2.8%) patients with PVT and peritoneal closure. Compared with patients without PVT or peritoneal closure, the incidence of IH was not different in patients with only PVT (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.34, 2.38) and significantly lower in patients with PVT and peritoneal closure (HR 0.22, 95% CI 0.07, 0.70). Conclusion: PVT with peritoneal closure may reduce the risk of postoperative IH after RARP. Future randomized controlled trials are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To clarify the trends in radical cystectomy and to compare surgical outcomes among surgical approaches focusing on robot‐assisted radical cystectomy based on a Japanese nationwide database. Methods: The Diagnosis Procedure Combination database was used to extract data on radical cystectomy cases. Trends in open radical cystectomy, laparoscopic radical cystectomy, minimum incision endoscopic radical cystectomy, and robot‐assisted radical cystectomy between April 2012 and March 2021 were evaluated. Basic characteristics and peri‐operative indicators were compared among the four groups. Propensity score matching was applied to assess the differences between open radical cystectomy and robot‐assisted radical cystectomy. Results: During the study period, a decreasing number of open radical cystectomies and an increasing number of minimally invasive radical cystectomies were shown in the total cohort of 28 345 cases. The number of robot‐assisted radical cystectomies rapidly increased after government approval in 2018. Minimally invasive radical cystectomies, including robot‐assisted radical cystectomies, had a significantly lower complication rate, a shorter length of stay, and a lower blood transfusion rate, but a longer anesthesia time than open radical cystectomies. In the propensity score matching analysis comparing the surgical outcomes of robot‐assisted radical cystectomy and open radical cystectomy, similar results were demonstrated, and blood transfusion rates were equivalent. Conclusion: For the past decade, the number of minimally invasive radical cystectomies has steadily increased without compromised surgical outcomes, except for anesthesia time. Robot‐assisted radical cystectomies in particular rapidly became widespread in Japan after government approval in 2018 and became a standard surgery within the first 3 years. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the trends and safety of robot‐assisted partial nephrectomy during the initial 2‐year period after government approval for this type of procedure in April 2016. Methods: This nationwide retrospective study included 3722 received robot‐assisted partial nephrectomy cases carried out from April 2016 to March 2018 in 124 participating institutions. The institutions were divided into lower‐ and higher‐volume institutions according to the median of 19 robot‐assisted partial nephrectomy cases during the study period. Surgical outcomes between 616 cases from lower‐volume institutions and 3106 cases from higher‐volume institutions were compared using propensity score matching. Results: During the study period, both the number of robot‐assisted partial nephrectomy surgeries and the number of institutions in which the surgery was carried out steadily increased. Overall, the median anesthesia time was 217 min, the median postoperative length of stay was 9 days, and the proportion of blood transfusions, complications and readmissions were 0.8%, 5.1% and 1.0%, respectively. There were no significant differences in anesthesia time, incidence of blood transfusions, and complication rates between the lower‐volume and higher‐volume institutions. However, a slightly, but significantly, longer postoperative length of stay and a lower incidence of readmission were observed in lower‐volume institutions both before and after propensity score matching. Conclusions: Robot‐assisted partial nephrectomy has become widespread during the initial 2‐year period after government approval with an acceptable safety profile, regardless of the institutional caseloads. This technique has become a standard of care for stage 1 renal cancer patients in Japan. [ABSTRACT FROM AUTHOR]

A 34-year-old Japanese man with malignant pheochromocytoma of the bladder underwent surgical resection and chemoradiotherapy for a local recurrence of lymph node metastasis. Radiotherapy seemed to be effective, indicated by the growth inhibition of the irradiated tumor, decreases in serum and urinary catecholamine levels and a clinical improvement in the refractory stage of the combined chemotherapy. [ABSTRACT FROM AUTHOR]

Objectives: To show the epidemiological characteristics of epithelioid angiomyolipoma in a Japanese population, and to establish the preoperative diagnosis method of epithelioid angiomyolipoma., Methods: Among the 855 tumors of patients who underwent partial/radical nephrectomy or renal biopsy for presumed renal cell carcinoma between 2007 and 2018, 39 renal tumors were diagnosed as nonclassical angiomyolipoma, including epithelioid angiomyolipoma and fat-poor angiomyolipoma. We retrospectively evaluated the incidence of epithelioid angiomyolipoma. Furthermore, we analyzed computed tomography and magnetic resonance imaging results, including diffusion-weighted magnetic resonance imaging findings of epithelioid angiomyolipoma and fat-poor angiomyolipoma., Results: The incidence of epithelioid angiomyolipoma (n = 7) was 17.9% of surgically resected non-classical angiomyolipoma. The radiological appearance of epithelioid angiomyolipoma was hyperattenuating on unenhanced computed tomography images with iso or low intensity on T2-weighted magnetic resonance imaging. The mean apparent diffusion coefficient value of the solid component in epithelioid angiomyolipoma was significantly lower than that in fat-poor angiomyolipoma (median 0.79 × 10 -3 vs 1.07 × 10 -3 mm 2 /s, P = 0.0019)., Conclusions: The proportion of epithelioid angiomyolipoma in our Japanese cohort was equivalent to that of the reported series in the USA. The apparent diffusion coefficient value is potentially useful to differentiate between epithelioid angiomyolipoma and fat-poor angiomyolipoma. Further research is required to establish the imaging diagnostic criteria for epithelioid angiomyolipoma., (© 2020 The Japanese Urological Association.)

In order to facilitate assists in surgical procedure, it is important for scrub nurses to understand the operation procedure and to share the operation status with attending surgeons. The potential utility of head-mounted display as a new imaging monitor has been proposed in the medical field. This study prospectively evaluated the usefulness of see-through-type head-mounted display as a novel intraoperative instructional tool for scrub nurses. From January to March 2014, scrub nurses who attended gasless laparoendoscopic single-port radical nephrectomy and radical prostatectomy wore the monocular see-through-type head-mounted display (AiRScouter; Brother Industries Ltd, Nagoya, Japan) displaying the instruction of the operation procedure through a crystal panel in front of the eye. Following the operation, the participants completed an anonymous questionnaire, which evaluated the image quality of the head-mounted display, the helpfulness of the head-mounted display to understand the operation procedure, and adverse effects caused by the head-mounted display. Fifteen nurses were eligible for the analysis. The intraoperative use of the head-mounted display could help scrub nurses to understand the surgical procedure and to hand out the instruments for the operation with no major head-mounted-display wear-related adverse event. This novel approach to support scrub nurses will help facilitate technical and nontechnical skills during surgery.

Background: To eradicate hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a stepwise infection control strategy that includes an avoidance of antimicrobial prophylaxis (AMP) based on surgical wound classification and an improvement in operative procedures in gasless single-port urologic surgery., Methods: The study was conducted at an 801-bed university hospital. Since 2001, in the urology ward, we have introduced the stepwise infection control strategy. In 2007, surveillance cultures for MRSA in all urological patients were commenced. The annual incidence of MRSA was calculated as a total number of newly identified MRSA cases per 1,000 patient days. Trend analysis was performed using a Poisson regression., Results: Over the study period, 139,866 patients, including 10,201 urology patients, were admitted to our hospital. Of these patients, 3,719 patients, including 134 ones in the urology ward, were diagnosed with MRSA throughout the entire hospital. Although the incidence of MRSA increased throughout the entire hospital (p = 0.002), it decreased significantly in the urology ward (p < 0.0001). Of the 134 cases, 45 (33.6%) were classified as "imported," and 89 (66.4%) as "acquired." In the urology ward, the incidence of acquired MRSA decreased significantly over time (p < 0.0001), whereas the incidence of imported MRSA did not change over time (p = 0.66). A significant decrease (p < 0.0001) in the incidence of clinically significant MRSA infection over time was found., Conclusions: Stepwise infection control strategy that includes a reduction or avoidance of antimicrobial prophylaxis in minimally invasive surgery can contribute to a reduction in hospital-acquired MRSA., Trial Registration: Current study has approved by the institutional ethical review board (No.1141).