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Although robot-assisted nephroureterectomy (RANU) has been increasingly used worldwide, the history of RANU remains short, and the optimal surgical method for performing RANU has yet to be established. Here we introduce the ideal approach for RANU using the Vessel Sealer Extend (VSE).RANU was performed by using a da Vinci Xi surgical system with fenestrated bipolar forceps (by the left arm), and monopolar scissors or needle drivers (by the right arm), and the VSE (by the third arm). First, nephrectomy and lymphadenectomy were performed at the kidney direction stage, followed by the removal of the distal ureter and suturing of the bladder at the bladder direction stage. The key point of our technique is that the console surgeon can continue to obtain the optimal surgical field by traction using the third arm, and thus cut the tissue by smoothly switching between the right hand and the third arm without the need to exchange instruments, especially in the kidney direction stage. In this study we performed RANU in nine patients and lymphadenectomy in seven patients. The median console time was 195 (range: 165-265) min, the median blood loss was 55 (range: 5-179) ml. In eight cases of RANU using the VSE, no lymphatic leakage was observed and all procedures could be performed safely.The use of VSE provides sufficient coagulation and optimal surgical field development, thus allowing console surgeons to perform RANU more safely.

OBJECTIVES The aim of this study was to investigate the longitudinal 5-year long-term outcomes for urinary continence and quality of life (QOL) after robot-assisted radical prostatectomy (RARP), particularly nerve-sparing. METHODS Among patients who underwent RARP between October 2010 and October 2015, postoperative urinary symptoms were retrospectively examined using the International Prostate Symptom Score (IPSS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), QOL index, and number of pads used. Patients were divided into nerve-sparing and non-nerve-sparing groups, and all data were evaluated before and at 1, 3, 6, 12, 24, 36, 48, and 60 months after surgery. RESULTS After propensity score matching, 47 patients each were included in the two groups. No significant difference in the IPSS or QOL index was seen between groups. The IPSS and QOL index showed an increase in the first month after RARP, but at 6 months, values were lower than preoperative levels and then slowly improved. Pad-free rates at 5 years after surgery were 93.6% and 80.1% in the nerve-sparing and non-nerve-sparing groups, respectively (P = .029). ICIQ-SF scores were significantly improved in the nerve-sparing compared with the non-nerve-sparing group at 1, 3, and 6 months after surgery. After 12 months, no significant changes were identified until 60 months. CONCLUSIONS In this study, nerve-sparing had a strong impact on urinary continence in the early postoperative period. After 12 months, urinary continence remained stable until 60 months.

Background: We wanted to clarify whether preoperative magnetic resonance imaging (MRI) in the clinical setting can evaluate the pathologic pseudocapsule (PC) morphology with high accuracy in renal cell carcinoma (RCC). Methods: We retrospectively analyzed 34 consecutive patients who underwent MRI (1.5 or 3.0T, 5 mm slices) prior to partial nephrectomy (PN) for RCC at our institution between January 2010 and December 2019. First, the correlation between PC morphology (complete or incomplete) and tumor infiltration to the renal parenchyma was examined as pathologic validation. Second, the concordance rate of PC morphology between pathologic tissue and preoperative MRI was evaluated as radiologic validation. Third, risk factor for renal parenchymal invasion in RCC was analyzed. Results: In the pathologic validation, parenchymal invasion rates were 11% and 28% in the “complete PC” and “incomplete PC” groups, respectively. In the radiologic validation, pathological PC morphology could be diagnosed on preoperative MRI in 17 patients (50.0%). “None PC” on MRI had the lowest positive predictive value (PPV) (0%), “partial PC” on MRI had a good PPV (76.5%), “complete PC” on MRI had a relatively low PPV (33.3%). Unfortunately, these data were insufficient for diagnostic accuracy. As risk factor for renal parenchymal invasion in RCC, only pathologic subtype (non-clear cell) was found to have significant differences in the multivariate analysis. Conclusion: The results of this study suggest that renal tumors with pathologically incomplete PC have a high possibility of renal parenchymal invasion. However, it is currently difficult to accurately evaluate pathologic PC morphology by preoperative MRI in the clinical setting.

BACKGROUND This study aimed to investigate the response to platinum-based chemotherapy rechallenge in patients with pembrolizumab-refractory urothelial carcinoma. PATIENTS AND METHODS We retrospectively reviewed 14 patients with pembrolizumab-refractory urothelial carcinoma. Each patient received a regimen that they had not previously received (paclitaxel plus carboplatin in 10, gemcitabine plus docetaxel and carboplatin in four). Tumor response and adverse events were assessed. We evaluated overall survival from the chemotherapy rechallenge start date until death. RESULTS The median overall survival was 11.2 months. The disease-control rate was 85.7%. Partial responses occurred in the metastases in lymph nodes in three (37.5%) patients, lung in one (25%), peritoneal in three (75%), and liver in three (100%). Neutropenia of grade ≥3 occurred in 13 (92.9%) patients. CONCLUSION The activity of platinum-based chemotherapy rechallenge after pembrolizumab was maintained. Neutropenia was observed in most patients.

Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy induction in patients with urothelial carcinoma is associated with prognosis. We evaluated patients treated with chemotherapy for urothelial carcinoma between April 2013 and February 2018 at our institution and affiliated centers. Skeletal muscle mass (total psoas muscle, paraspinal muscle, and total skeletal muscle areas) were used to calculate the total psoas muscle index, paraspinal muscle index, and skeletal muscle index. All participants were grouped as per cutoff points set at the median value for each sex. Overall survival was evaluated using Cox regression analysis. Of the 240 patients, 171 were men and 69 were women; mean age during chemotherapy was 71 years (range: 43–88); and 36, 56, and 148 patients were at stages II, III, and IV, respectively. Paraspinal muscle index was most associated with the prognosis; groups with lower paraspinal muscle index were defined as sarcopenic (men: ≤ 20.9 cm2/m2, women: ≤ 16.8 cm2/m2). The overall survival was significantly longer in the non-sarcopenia group including all stages (p = 0.001), and in stage III (p = 0.048) and IV (p = 0.005) patients. There was no significant difference among stage II patients (p = 0.648). After propensity score matching, survival was still significantly longer in the non-sarcopenia group (p = 0.004). Paraspinal muscle index measurements obtained during chemotherapy induction for urothelial carcinoma were independent prognostic factors. The absence of sarcopenia may lead to long-term survival in patients undergoing chemotherapy for urothelial carcinoma.

We investigated the association between positive surgical margin (PSM) status and biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) to develop a prognostic factor-based risk stratification model for BCR.We analyzed the data of 483 patients who underwent RARP at our hospital between October 2010 and April 2019; 435 patients without neoadjuvant therapy were finally included. The BCR-free survival rate was determined using Kaplan-Meier analysis. Effects of the PSM status, including the number of PSMs, Gleason score (GS) at a PSM, and the maximum PSM length for BCR, were investigated using Cox regression analysis.BCR was confirmed after RARP in 61 patients (14.0%), and PSM was confirmed in 74 patients (17.0%); PSM was a significant predictor of BCR (p 0.001). The median number of PSMs was 2 (1-6), and the median maximum length of PSM was 6.0 (2.0-17.0) mm. Multivariable analysis showed lymph node invasion (p 0.001), GS of ≥ 7 at a PSM (p = 0.022) and a maximum PSM length of 6.0 mm (p = 0.003) were significant predictors of BCR. We classified the patients without lymph node invasion into good-, intermediate-, and poor-risk groups according to the other two risk factors (presence of 0, 1, and 2 factors, respectively) and rates of 1-year BCR-free survival (100.0, 72.7, and 48.1%, respectively).Higher GS at PSM and greater length of PSM were significant predictors of BCR after RARP, and console surgeons should be careful to prevent PSM during RARP.

OBJECTIVE: To investigate the impact of penile rehabilitation on the recovery of erectile function after robot-assisted radical prostatectomy. METHODS: Patients who underwent robot-assisted radical prostatectomy in our department from 2010 to 2019 were included. For penile rehabilitation, a phosphodiesterase-5 inhibitor (tadalafil 20 mg) was administered twice a week for 1-6 months postoperatively. The International Index of Erectile Function questionnaire (question 1 and erectile function domain) and the Expanded Prostate Cancer Index Composite questionnaire (sexual function) were used. RESULTS: After propensity score matching, there were 79 patients in the penile rehabilitation group and 79 patients in the non-penile rehabilitation group. There was no significant difference in baseline characteristics between the two groups. Significantly higher scores were seen in the penile rehabilitation group compared with the non-penile rehabilitation group at postoperative 3, 6 and 9 months in the International Index of Erectile Function questionnaire-question 1, at 3, 6, 9 and 12 months in erectile function domain, and at 3, 6, 12 and 24 months in Expanded Prostate Cancer Index Composite questionnaire sexual function (P

Background In recent years, the effectiveness of magnetic resonance imaging (MRI)-ultrasound fusion targeted biopsy (MRF-TB) has been widely reported. In this study, we assessed the effect of reduction of the number of systematic biopsy (SB) cores on the cancer detection rate (CDR). Methods Patients with a high prostate-specific antigen (PSA) level underwent prostate MRI. The Prostate Imaging-Reporting and Data System version 2 (PI-RADS) was then used to rate the lesions. The inclusion criteria were as follows: (1) PSA level between 4.0 and 30.0 ng/mL and (2) patients with one or more lesions on MRI and a PI-RADS score of 3 or more. All enrolled patients were SB naive or had a history of one or more prior negative SBs. A total of 104 Japanese met this selection criterion. We have traditionally performed 14-core SB following the MRF-TB. In this study, the CDRs of 10-core SB methods, excluding biopsy results at the center of the base and mid-level on both sides, were compared with those of the conventional biopsy method. Results We compared CDRs of the 14-core and 10-core SBs used in combination. The overall CDR was 55.8% for the former and 55.8% for the latter, thereby indicating that there was no significant difference (P = 1.00) between the two. In addition, the CDRs of csPCa were 51.9% for the former and 51.1% for the latter, which indicated that there was no significant difference (P = 0.317). Conclusion There was no significant difference in the CDR when the number of SB cores to be used in combination was 14 and 10.

Bladder cancer is divided into two molecular subtypes, luminal and basal, which form papillary and nodular tumors, respectively, and are identifiable by gene expression profiling. Although loss of heterozygosity (LOH) of the long arm of human chromosome 9 (9q) has been observed in the early development of both types of bladder cancer, the functional significance of LOH remains to be clarified. The present study introduced human chromosome 9q into basal bladder cancer cell line, SCaBER, using microcell-mediated chromosome transfer to investigate the effect of LOH of 9q on molecular bladder cancer subtypes. These cells demonstrated decreased proliferation and migration capacity compared with parental and control cells. Conversely, transfer of human chromosome 4 did not change the cell phenotype. Expression level of peroxisome proliferator-activated receptor (PPAR)γ, a marker of luminal type, increased 3.0-4.4 fold in SCaBER cells altered with 9q compared with parental SCaBER cells. Furthermore, the expression levels of tumor suppressor PTEN, which regulates PPARγ, also increased in 9q-altered cells. These results suggested that human chromosome 9q may carry regulatory genes for PPARγ that are involved in the progression of neoplastic transformation of bladder cancer.

Prophylactic urethrectomy is often performed simultaneously with radical cystectomy (RC) in patients who are not selected for neobladder creation for urinary diversion. However, the indications for prophylactic urethrectomy are still controversial. Here, we introduce the ideal urethral dissection technique during robot-assisted radical cystectomy (RARC) in patients without simultaneous prophylactic urethrectomy.At our hospital, RARC is performed using a da Vinci surgical system with the operating table tilted to 20°. After lymph node dissection and bladder mobilization, periurethral dissection is commenced. A notable point of our technique is en bloc resection of the bladder and membranous urethra using a continuous intracorporeal approach. First, while applying traction on the isolated bladder in the cranial direction, we carefully and gradually dissect the urethral smooth muscle from the external urethral sphincter with electrocautery scissors. Next, we ligate the membranous urethra with suture material as far from the prostate as possible. Then, we cut the urethra as far from the prostate as possible after ligation of the urethra with a Hem-o-lok clip just beyond the apex of the prostate. Using this method, we are able to remove at least 1.0 cm of the membranous urethra en bloc with the bladder. Finally, we suture the pelvic floor, including the levator ani muscle, in two layers using 3-0 V-Loc and 2-0 V-Loc sutures.We believe this technique allows separation of the residual urethra from the abdominal cavity and enables safe performance of secondary urethrectomy.

The present study aimed to evaluate the efficacy of the real‐world use of axitinib and to develop a prognostic model for stratifying patients who could derive long‐term benefit from axitinib. This was a retrospective, descriptive study evaluating the efficacy of axitinib in patients with metastatic renal cell carcinoma that had been treated with 1 or 2 systemic antiangiogenic therapy regimens at 1 of 36 hospitals belonging to the Japan Urologic Oncology Group between January 2012 and February 2019. The primary outcome was overall survival (OS). Using a split‐sample method, candidate variables that exhibited significant relationships with OS were chosen to create a model. The new model was validated using the rest of the cohort. In total, 485 patients were enrolled. The median OS was 34 months in the entire study population, whereas it was not reached, 27 months, and 14 months in the favorable, intermediate, and poor risk groups, respectively, according to the new risk classification model. The following 4 variables were included in the final risk model: the disease stage at diagnosis, number of metastatic sites at the start of axitinib therapy, serum albumin level, and neutrophil : lymphocyte ratio. The adjusted area under the curve values of the new model at 12, 36, and 60 months were 0.77, 0.82, and 0.82, respectively. The efficacy of axitinib in routine practice is comparable or even superior to that reported previously. The patients in the new model’s favorable risk group might derive a long‐term survival benefit from axitinib treatment., The accuracy of the overall survival predictions made after the initiation of axitinib treatment, area under the curve (AUC) values were calculated for each model. The adjusted AUC values at 12, 36, and 60 months after the initiation of axitinib were 0.77, 0.82, and 0.82, respectively, for the axitinib treatment prediction model, and 0.69, 0.67 and 0.56, respectively, for the International Metastatic Renal Cell Carcinoma Database Consortium model.

Background Radical prostatectomy and radiotherapy are standard treatments for localized prostate cancer. When making decisions about treatment, it is important to not only consider medical information such as the patient's age, performance status, and complications, but also the impact on quality of life (QOL) after treatment. Our purpose was to compare health related quality of life (HRQOL) after robot-assisted laparoscopic radical prostatectomy (RARP) versus radiation therapy in Japanese patients with localized prostate cancer retrospectively. Methods Patients with localized prostate cancer receiving RARP or radiotherapy at Tottori University Hospital between October 2010 and December 2014 were enrolled in a retrospective observational study with follow-up for 24 months to December 2016. The Medical Outcome Study 8-Item Short-Form Health Survey was performed before treatment and 1, 3, 6, 12, and 24 months post-treatment. Results Complete responses to the questionnaire were obtained from 154/227 patients receiving RARP, 41/67 patients receiving intensity-modulated radiation therapy, 35/82 patients receiving low dose rate brachytherapy, and 18/28 patients given low dose rate brachytherapy plus external beam radiation therapy. The median physical component summary score of the Medical Outcome Study 8-Item Short-Form Health Survey was significantly lower at 1 month after prostatectomy than radiotherapy, but was similar for both treatments at 3 months, and was significantly higher at 6, 12 and 24 months after prostatectomy. The median mental component summary score was also significantly lower in the prostatectomy group at 1 month, but not from 3 months onwards. Conclusion Our study suggested that HRQOL was inferior at 1 month after RARP, however, recovered at 3 months after RARP and was better than after radiotherapy at 6, 12, and 24 months.

Introduction The aim of this article is to evaluate the risk factors and recommend a prophylactic procedure for preventing inguinal hernia (IH) after robotic assisted radical prostatectomy (RARP) without extra products and operative time. Material and methods A total of 279 patients (558 groins) who underwent RARP at our institution from October 2010 to December 2015 were retrospectively reviewed. Age, body mass index, prostate-specific antigen, clinical T stage, prostate volume, console time and the dilatation of internal inguinal ring were evaluated as the risk factors of IH. We also investigated whether the different incision procedures of the peritoneum around the medial side of the internal inguinal ring, 'proximal incision' or 'distal incision', were related to the occurrence of IH. Results Postoperative IH occurred in 39 (7.5%) of 558 groins. The dilatation of the internal inguinal ring was observed in 89 of 558 (15.9%) groins. The proximal and distal incision group included 296 groins (52.8%) and 262 groins (47.2%), respectively. Univariate and multivariate analyses revealed the right side (P = 0.041), the dilatation of internal inguinal ring (P

We sought to evaluate the incidence and extent of orgasmic dysfunction in patients after robot-assisted radical prostatectomy and to identify factors that could predict patients at risk.A single-center, questionnaire-based, cross-sectional study was conducted on patients who underwent robot-assisted radical prostatectomy (n = 523) between October 2010 and November 2019. In addition to six questions about sexual activity, orgasmic function, altered perception of orgasms, dysorgasmia, and climacturia, the International Consultation on Incontinence Questionnaire Short Form was administered. In February 2020, a letter was mailed inviting patients to participate in the survey. The primary outcome measure was the rate of orgasmic dysfunction. Logistic regression analyses were used to identify predictors of orgasmic dysfunction.Overall, 259 questionnaires were used for analysis. Among sexually active patients (n = 145), 33 (22.8%) reported anorgasmia, and 83 (57.2%) reported decreased orgasm intensity. Twenty-two (15.1%) patients reported dysorgasmia; among these patients, the pain was experienced almost always or always in 13.6%, sometimes in 13.6%, and a few times in 72.8% of cases. Climacturia was reported by 44 patients (30.3%). Nerve-sparing procedures decreased the risk of anorgasmia (odds ratio 0.37, 95% confidence interval 0.15-0.88) and urinary incontinence increased the risk of climacturia (odds ratio 3.13, 95% confidence interval 1.20-8.15).These results indicate that orgasmic dysfunction after robot-assisted radical prostatectomy is relatively common.

We investigated the effect of the extent of pelvic lymph node dissection (LND) on biochemical recurrence (BCR) in patients with prostate cancer (PCa) without lymph node involvement (LNI) treated with robot-assisted radical prostatectomy (RARP).We retrospectively analyzed data from 378 patients who underwent RARP with LND at our hospital between October 2010 and June 2019. The BCR-free survival rate was determined using Kaplan-Meier analysis, and Cox regression analysis was used to investigate BCR prognostic factors. The total score calculated from the D'Amico risk classification and the percentage of positive biopsy cores were used for analysis. Patients were classified into 3 BCR risk groups (low risk: 0-3 points, intermediate risk: 4-5 points, and high risk: 6-8 points).Limited LND was performed in 161 patients (42.6%), extended LND in 217 patients (57.4%), and BCR was confirmed in 66 patients (17.5%) after RARP. Both univariate and multivariate analyses showed no significant difference in the association between the extent of LND and BCR. The Kaplan-Meier curve for BCR generated using our risk classification for patients with PCa without LNI showed no significant association between the extent of LND and BCR in the low-risk group (p = 0.790). A significantly improved BCR-free survival was observed in the extended LND group among patients with PCa at intermediate risk or higher (p 0.05).According to our risk classification, BCR may be less likely to occur when extended LND is performed during RARP for patients with localized PCa at intermediate risk or higher.

Background: The efficacy of docetaxel and carboplatin with oral estramustine was evaluated in patients with castration-resistant prostate cancer. Patients and Methods: Patients were treated with intravenous docetaxel at 30 mg/m2 on days 1, 8, 15, and 22 of a 28-day cycle. Intravenous carboplatin (area under the curve, 6 mg/ml/min) was administered on day 1. Patients received oral estramustine at 626.8 mg/day throughout the treatment protocol. Patients were evaluated for response, with treatment continued until cancer progression or onset of severe adverse events. Results: Twenty patients with castration-resistant prostate cancer were treated for a median of 3.5 cycles. Prostate-specific antigen decreased by more than 30% in 18 patients, including 14 patients with a decrease of more than 50%. Median overall survival was 11 months, prostate-specific antigen progression-free survival was 6.5 months, and radiographic progression-free survival was 7 months. Conclusion: Docetaxel and carboplatin with oral estramustine shows efficacy against castration-resistant prostate cancer.

This study investigated the effects of adipose-derived stem cell sheets on a rat model of detrusor underactivity.Adipose-derived stem cell sheets were prepared from the subcutaneous adipose tissue of male Lewis rats. Female Lewis rats were assigned into four groups: control, sham operation, cryo-injury, and cryo-injury+sheet (n = 8 per group). Rats in the cryo-injury+sheet group were implanted with ASC sheets 3 days after cryo-injury induction and underwent cystometry 7 days later. Subsequently, reverse transcription-polymerase chain reaction (RT-PCR) and histopathological examinations were performed. Cell sheets expressing the green fluorescent protein were prepared and transplanted to confirm the viability and differentiation of the sheets. Fluorescence was confirmed using a fluorescence stereomicroscope on days 3, 7, 14, 21, and 28 after sheet implantation, and tissue immunostaining was performed.Cystometry showed that sheet implantation improved the maximum intravesical pressure (P = 0.009) and the residual urine volume (P = 0.011). Furthermore, RT-PCR indicated that the mRNA levels of the angiogenic factors vascular endothelial growth factor and hepatocyte growth factor were significantly higher in the cryo-injury+sheet group than in the cryo-injury group (P = 0.045, P = 0.037, respectively). Histologically, sheet implantation resulted in an improvement in inflammation and increased the number of blood vessels. Green fluorescent protein-positive cells fused with von Willebrand factor-positive cells and differentiated into blood vessels 7 days after sheet implantation.Adipose-derived stem cell sheets transplanted into the bladder of cryo-injured rats differentiated into blood vessels and restored bladder contractile function 7 days after transplantation.

Background: The aim of this study was to evaluate the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy.Methods: We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Comparisons between patients with prior abdominal surgery and with no prior abdominal surgery were based on perioperative outcomes. Furthermore, patients underwent transperitoneal robot-assisted partial nephrectomy was compared between those with and without prior abdominal surgery. The Mann–Whitney U test and the chi-square test were used for statistical analyses of variables. Results: Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58 %) had no prior abdominal surgery, whereas 66 patients (42 %) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (38.8 %) had prior abdominal surgery, whereas 49 patients had no prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, p = 0.031). The other perioperative outcomes were no significant differences. In the conversion rate, no significant difference was observed between the two groups (p = 0.556).Conclusions: Prior abdominal surgery does not appear to affect Robot-assisted partial nephrectomy. Robot-assisted partial nephrectomy can be a safe procedure for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. The conversions to radical nephrectomy and open partial nephrectomy were not associated with prior abdominal surgery. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery.

Background: In recent years, the effectiveness of magnetic resonance imaging (MRI)–ultrasound fusion targeted biopsy (MRF–TB) has been widely reported. In this study, we assessed the effect of reduction of the number of systematic biopsy (SB) cores on the cancer detection rate (CDR).Methods: MRI was performed for patients with high prostate-specific antigen (PSA) levels, and the PI–RADSTM (Prostate Imaging-Reporting and Data System version 2) was used to rate the lesions. Patient selection criteria were to satisfy both of the following conditions: ①PSA level between 4.0 ng/ml and 30.0 ng/ml ②Patients having one or more MRI lesions with a PI–RADS score of 3 or more. A total of 104 Japanese met this selection criterion. We have traditionally performed 14-core SB following the MRF–TB. In this study, the CDRs of 10-core SB methods, excluding biopsy results at the center of the base and mid-level on both sides, were compared with those of the conventional biopsy method.Results: We compared CDRs of 14-core and 10-core SBs used in combination. The overall CDR was 55.8% for the former and 55.8% for the latter, indicating no significant difference (p = 1.00). In addition, the CDRs of csPCa were 51.9% for the former and 51.1% for the latter, indicating no significant difference (p = 0.317).Conclusion: Even a 10-core SB used in combination with MRF-TB yields a good CDR. Reducing the number of biopsy cores leads to lower patient burden and lower testing costs.

OBJECTIVE We evaluated the impact of the duration between the biopsy and surgery on the biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). METHODS We retrospectively evaluated 302 patients who underwent RARP in our institution from April 2010 to December 2017. Patients were categorized into 2 groups, an interval between biopsy and surgery of 180 days or less (Group A) and longer than 180 days (Group B). Factors retrospectively analyzed for the BCR for the interval between the biopsy and RARP included patient's characteristics, intraoperative and postoperative results. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the predictors of BCR. RESULTS The median follow-up was 42 months, with 24 patients developing BCR at a mean of 13.5 months after RARP. There was no difference in the rate of BCR in Group A and Group B. Multivariate analysis showed that BMI (

We report a case of a 87-year-old woman with a Burkitt's Lymphoma of the Bladder. She presented with hematuria. Cystoscopy, computed tomography and magnetic resonance imaging revealed extramural invasion of a 6-cm-sized tumor that extended from the right wall to the neck of the bladder. The histological pattern was Burkitt's lymphoma. The patient was then treated by chemotherapy. The tumor disappeared after 4 cycles of chemotherapy. The urogenital tract has been described in the literature as a primary tumor location in cases of non-Hodgkin's lymphoma, however, it is rarely the tumor site in Burkitt's lymphoma cases., Highlights • We report a case of a 87-year-old woman with a Burkitt's Lymphoma of the Bladder. • Burkitt's Lymphoma of the urinary bladder is extremely rare. • For patients with Burkitt's Lymphoma, intensive chemotherapy may offer the best chance for durable disease control. • Prompt diagnosis is important, because Its early detection is crucial for effective intervention.

Background The aim of this study is to compare the results of laparoscopic pyeloplasty and robotic-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Methods Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Results Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs 2 days, respectively, P = 0.029). Conclusions Laparoscopic and robotic-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach.

Sunitinib, a tyrosine kinase inhibitor, is among the first-line treatments for metastatic or advanced stage renal cell carcinoma (RCC). However, patients with RCC develop resistance to sunitinib. We have previously demonstrated that lysosome-associated membrane protein 2 (LAMP-2), which has three splice variants with different functions (LAMP-2A, LAMP-2B, and LAMP-2C), is involved in RCC. In the present study, we examined which splice variants of LAMP-2 contributed to sunitinib resistance in RCC cells. In vitro analysis using ACHN, human RCC cell line, revealed that the IC50 of sunitinib was significantly increased by overexpression of LAMP-2A and LAMP-2B, but not LAMP-2C (P

INTRODUCTION AND OBJECTIVE:To investigate the association between preoperative benign prostatic hyperplasia (BPH) patterns, especially intravesical prostatic protrusion (IPP), and continence after ...

INTRODUCTION AND OBJECTIVE:The modulatory effects of glutamate are mediated by activation of metabotropic glutamate receptors (mGluRs). Eight mGluRs (mGluR1−8) have been classified into three group...

We investigated prognostic factors for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node (LN) dissection. We included 173 patients who underwent RARP with extended pelvic LN dissection without neoadjuvant therapy at our hospital between October 2010 and April 2018. BCR was defined as prostate serum antigen (PSA) levels ≥ 0.2 ng/mL; BCR-free survival rates were determined using Kaplan–Meier analysis. We used Cox regression analysis to evaluate effects of PSA and pathologic variables on BCR. Median follow-up was 27.9 (range 6.1–86.9) months. Five-year BCR-free survival was 89.5%. In multivariate analysis, positive LNs (HR 7.117; 95% CI 2.826–17.925; P