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Objective: There are few reports of the long-term outcomes of elderly patients with prostate cancer. We analyzed data from our institution from the past 12 years, including the patient history, treatment methods, and prognosis of patients with prostate cancer aged 80 years or more. Patients and Methods: A total of 179 cases of prostate cancer in patients aged 80 years or more were retrospectively evaluated. We divided them chronologically into groups A, B, C, and D: Group A included 40 cases from 2002–2004; Group B, 48 cases from 2005–2007; Group C, 46 cases from 2008–2010; and Group D, 45 cases from 2011–2013. Results: Sixty-one (30%) patients changed treatment course. Interestingly, no cancer deaths occurred in the patients who changed treatment course. Although 14 (7.8%) cancer deaths occurred (A: B: C: D = 4: 4: 6: 0, respectively), all occurred in 2011 or later. Conclusion: In our study, over 50 patients who underwent treatment survived for 5 years or more. By treating prostate cancer in elderly patients when appropriate, we can lower the mortality rate due to prostate cancer. Our results support the active treatment of prostate cancer in elderly patients.

Background We investigated the impact of postoperative membranous urethral length and other anatomic characteristics of the pelvic floor shape as measured by magnetic resonance imaging on the improvement in continence following robotic-assisted radical prostatectomy. Methods We retrospectively reviewed data from 73 patients who underwent postoperative prostate magnetic resonance imaging following robotic-assisted radical prostatectomy between 2013 and 2018. Patient demographics; pre-, peri-, and post-operative parameters; and pelvic anatomic features on magnetic resonance imaging were reviewed. Patients who used no urinary incontinence pads or pads for protection were considered to have achieved complete continence. Results Urinary continence was restored in 27.4, 53.4, 68.5, and 84.9% of patients at 1, 3, 6, and 12 months after robotic-assisted radical prostatectomy, respectively. When patients were divided into early and late continence groups based on urinary continence at 3 months after robotic-assisted radical prostatectomy, no significantly different clinical characteristics or surgical outcomes were found. However, the mean membranous urethral length (18.5 mm for the early continence group vs. 16.9 mm for the late continence group), levator muscle width (7.1 vs. 6.5 mm, respectively), and bladder neck width on the trigone side (7.2 mm vs. 5.4 mm, respectively) were significantly different between groups (all p p = 0.038) and bladder neck width (odds ratio, 1.585; 95% confidence interval, 1.050–2.393; p = 0.028) were associated with the period of early urinary continence. Conclusions Postoperative membranous urethral length and bladder neck width were significantly associated with early urinary continence recovery after robotic-assisted radical prostatectomy. It is highly recommended that surgeons focus on preserving the membranous urethral length and increasing the bladder neck width on the trigone side during surgery to achieve optimal continence outcomes after robotic-assisted radical prostatectomy.

Objectives To experimentally evaluate the clinical application of N-methyl-4-isoleucine cyclosporin, a novel selective inhibitor of cyclophilin D activation. Methods In vitro, cultured renal tubular cells were exposed to calcium oxalate monohydrate crystals and treated with N-methyl-4-isoleucine cyclosporin. The mitochondrial membrane was stained with tetramethylrhodamine ethyl ester perchlorate and observed. In vivo, Sprague–Dawley rats were divided into four groups: a control group, an ethylene glycol group (administration of ethylene glycol to induce renal calcium crystallization), a N-methyl-4-isoleucine cyclosporin group (administration of N-methyl-4-isoleucine cyclosporin) and an ethylene glycol + N-methyl-4-isoleucine cyclosporin group (administration of ethylene glycol and N-methyl-4-isoleucine cyclosporin). Renal calcium crystallization was evaluated using Pizzolato staining. Oxidative stress was evaluated using superoxide dismutase and 8-hydroxy-deoxyguanosine. Mitochondria within renal tubular cells were observed by transmission electron microscopy. Cell apoptosis was evaluated using cleaved caspase-3. Results In vitro, calcium oxalate monohydrate crystals induced depolarization of the mitochondrial membrane potential, which was remarkably prevented by N-methyl-4-isoleucine cyclosporin. In vivo, ethylene glycol administration induced renal calcium crystallization, oxidative stress, mitochondrial collapse and cell apoptosis in rats, which were significantly prevented by N-methyl-4-isoleucine cyclosporin. Conclusions Herein we first report a new treatment agent determining renal calcium crystallization through cyclophilin D activation.

To evaluate the efficacy of company-initiated training of urologists on shock wave lithotripsy (SWL) treatment results, we retrospectively assessed 602 patients who underwent SWL in Nagoya City University Hospital between January 2004 and June 2011 using Lithotripter S (Dornier MedTech, Japan). Training—provided by a training specialist of the company in June 2010—focused on the targeting of renal and proximal ureter stones with a combination of radiography and ultrasonography (US). The stretcher wedges were positioned in the semi-prone position or the semi-supine position for middle and distal ureter stones, respectively. Success rates between 519 pre-training treatments and 83 post-training treatments were compared. Patient age and stone location, burden, number, and composition did not significantly differ between pre- and post-training. Training improved the overall success rate from 66.3 to 87.2 % (P < 0.0001). The mean number of SWL treatments decreased from 1.8 ± 1.8 to 1.4 ± 1.3 (P = 0.01). The first SWL treatment success rate increased from 67.1 to 83.7 % (P = 0.002), and the need for multiple treatments decreased. The frequency of detection of renal and proximal ureter stones by both radiography and US increased from 10.5 % before training to 58.2 % after training (P < 0.0001). Significant factors for successful SWL were determined to be training and prone position for distal ureter stones by multivariate analysis and ultrasonic detection for renal and proximal ureter stones by univariate analysis. Skills in targeting stones using ultrasonography and selecting the proper therapeutic position are essential for improving the success rate of stone removal.

Objective: Tamsulosin is often administered at a dose of 0.2 mg in Japan, Korea, and elsewhere in Asia, while a dose of 0.4 mg is more common in the West. In order to determine the higher dose might also be appropriate in the North-East Asian setting, we studied whether the effect of increasing the dose to 0.4 mg in Japanese patients who had dysuria associated with benign prostatic hyperplasia. Patients and Methods: Twenty-two cases with a voiding volume ≥ 100 ml assessed by uroflowmetry out of 31 patients with benign prostatic hyperplasia and an IPSS (International Prostate Symptom Score) ≥ 8 whose symptoms were controlled with 0.2 mg of tamsulosin were entered into this study. We evaluated IPSS and QOL (quality of life) score, urinary flow parameters and residual urine volume before and 4 weeks after increasing the dose of tamsulosin. Results: Statistical analyses performed using the Wilcoxon test showed no significant alteration in IPSS total score or QOL score with the increased dose, but Qmax (maximum urinary flow rate) improved from 10.1 ± 5.5 ml/s to 12.1 ± 6.5 ml/s (p = 0.013), and residual urine volume improved from 37.6 ± 26.4 ml to 22.2 ± 24.3 ml (p = 0.012). Two of the 31 patients complained of new symptoms; 1 complained of breast pain and the other complained of dizziness. Conclusions: From the lack of side effects of more than moderate grade in the present study, increasing the dose of tamsulosin might be recommended before switching patients to other drugs.

INTRODUCTION AND OBJECTIVES: We recently reported that renal tubular cell injury induced by oxidative stress and subsequent mitochondrial collapse is the initial step in the process of kidney stone formation. Recently, it was shown that the mitochondrial permeability transition (MPT) is involved in mitochondrial collapse. Cyclophilin D (CypD) is a mitochondrial matrix protein involved in MPT. Thus, we hypothesized that CypD-dependent MPT causes mitochondrial collapse and is a trigger of kidney stone formation. In this study, we investigated whether mitochondrial collapse depends on CypD and determined its relationship to kidney stone formation using CypD-deficient mice. METHODS: We administered 80 mg$kg 1 glyoxylic acid, a precursor of oxalic acid, intraperitoneally for 6 consecutive days to 8week-old male CypD-deficient mice (CypD-/-, n 1⁄4 6) and wild-type mice (CypDþ/þ, n 1⁄4 6). We removed the kidneys of the mice in each group 6 days after glyoxylic acid administration. Stone formation and morphology were evaluated using a polarization microscope and Pizzolato staining, and the stone formation rate was estimated using image analysis software. The form of mitochondria was observed using a transmission electron microscope (TEM). Superoxide dismutase (SOD) and malondialdehyde (MDA), markers of oxidative stress, osteopontin (OPN), a stone matrix protein, and caspase 3, a marker of apoptosis, were evaluated by immunohistochemical staining and western blotting. RESULTS: The stone formation rate of CypD-/mice (0.05%) was significantly lower than that of CypDþ/þ mice (0.22%). Expression of MDA, OPN, and caspase 3 was lower in CypD-/mice than in CypDþ/þ mice. Expression of SOD was higher in CypD-/than in CypDþ/þ mice. Based on TEM observations, CypDþ/þ mice had a disorganized internal structure and rupture of the double membrane of the mitochondria suggesting mitochondrial collapse, but such morphological changes were rare in CypD-/mice. CONCLUSIONS: According to the results of this study, during kidney stone formation, CypD influences MPT by generating mitochondrial collapse via oxidative stress, leading to renal tubular cell injury and kidney stone formation. We elucidated the mechanism of CypDdependent MPT in promoting kidney stone formation.

A 20-year-old man was admitted to our hospital with persistent cough and dyspnea. He had bilateral distention of the jugular veins, and swollen lymph nodes were palpable in the right subclavicular region. Plain X-ray and computed tomography (CT) of the chest showed a solid soft tissue mass in the upper mediastinum, with leftward displacement of the trachea and complete obstruction of the superior vena cava. Mediastinal radiotherapy (1.8 Gy/day) and methylprednisolone (100 mg/day) were started immediately. Biopsy of the right subclavicular lymph nodes revealed metastatic seminoma. The patient was referred for chemotherapy, which was performed with a combination of cisplatin, bleomycin and etoposide (BEP). A partial response was observed after completion of 3 cycles of chemotherapy, but there was no further tumor shrinkage after additional salvage chemotherapy. The patient is being followed up on an outpatient basis and has been free of recurrence for 32 months after intensive treatment.

INTRODUCTION AND OBJECTIVES: Renal tubular cell injury induced by oxalate plays an important role in kidney stone formation. Water containing oxygen nano-bubbles (ONB: nanometersized bubbles generated from oxygen micro-bubbles) has anti-inflammatory effects. Therefore, we investigated the inhibitory effects of ONB water on kidney stone formation in ethylene glycol (EG)-treated rats. METHODS: ONB water can be produced by rapidly collapsing oxygen micro-bubbles in hard water with a salt concentration of 1.0% by mass. Further, ONB water with a salt concentration of 0% by mass can be prepared by passing the resulting ONB water twice through a reverse osmosis membrane, obtaining ONB water was defined as 100% ONB water. A mixture comprising half 100% ONB water and half distilled water was defined as 50% ONB water. We divided 60 rats, aged 4 weeks, into 5 groups: (1) control, a water-fed group; (2) 100% ONB, a 100% ONB water-fed group; (3) EG, the EG-treated water-fed group; and (4), and (5) EG+50% ONB and EG+100% ONB, the 2 EGtreated, ONB water-fed groups. The rats consumed these fluids by free access for 5 weeks, and the EG-treated groups were also administered 1.2 mL of 10% EG and 0.5 mg of vitamin D3 via a stomach tube for the last 2 weeks. Six rats in each group were sacrificed after 7 days and 6 after 14 days. The pooled 24-hour urine and blood samples of these rats were collected, and their kidneys were excised. Renal CaOx deposits, urinary excretion of N-acetyl-b-D-glucosaminidase (NAG), and renal expression of MCP-1 and OPN as inflammation-related proteins, and the crystal binding molecule hyaluronic acid were compared among the 5 groups. RESULTS: In the EG group, CaOx deposits tended to increase at 14 days compared to 7 days after EG administration. However, CaOx deposits were significantly lower in the EG+50% ONB and EG+100% ONB groups than in the EG group 14 days after administration (Figure). In the EG+50% ONB and EG+100% ONB groups, ONB water significantly decreased urinary NAG excretion, and renal MCP-1, OPN, and hyaluronic acid expression compared to the EG group. CONCLUSIONS: ONB water exerted substantial effects on kidney stone formation in the rat kidney by inhibiting renal tubular cell injury. ONB water may be a prophylactic for kidney stones.

the kidneys were harvested and examined calcium oxalate stones/crystals were suspected. Histopathological analysis on H&E stainings, fluorescent microscopy and stone analysis by infrared spectrum analysis confirmed calcium oxalate stones/crystal formation within the renal cortex and medulla. No crystal deposition was observed in the control group. CONCLUSIONS: Pigs fed ethylene glycol in combination with vitamin D, ammonium chloride, gentamycin, or Lasix formed calcium oxalate stones/crystals. The use of the above feeding substrate is inexpensive and effective at producing a novel porcine calcium oxalate stone forming model.

We developed an in vitro system composed of renal tubular cells, adipocytes and macrophages to simulate metabolic syndrome conditions. We investigated the molecular communication mechanism of these cells and their involvement in kidney stone formation.Mouse renal tubular cells (M-1) were cocultured with adipocytes (3T3-L1) and/or macrophages (RAW264.7). Calcium oxalate monohydrate crystals were exposed to M-1 cells after 48-hour coculture and the number of calcium oxalate monohydrate crystals adherent to the cells was quantified. The expression of cocultured medium and M-1 cell inflammatory factors was analyzed by enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, respectively.The inflammatory markers MCP-1, OPN and TNF-α were markedly up-regulated in cocultured M-1 cells. OPN expression increased in M-1 cells cocultured with RAW264.7 cells while MCP-1 and TNF-α were over expressed in M-1 cells cocultured with 3T3-L1 cells. Coculturing M-1 cells simultaneously with 3T3-L1 and RAW264.7 cells resulted in a significant increase in calcium oxalate monohydrate crystal adherence to M-1 cells.Inflammatory cytokine changes were induced by coculturing renal tubular cells with adipocytes and/or macrophages without direct contact, indicating that crosstalk between adipocytes/macrophages and renal tubular cells was mediated by soluble factors. The susceptibility to urolithiasis of patients with metabolic syndrome might be due to aggravated inflammation of renal tubular cells triggered by a paracrine mechanism involving these 3 cell types.

平成25年度

To reduce the incidence of surgical site infection (SSI) after radical cystectomy, a new closing method using subcutaneous continuous aspiration drain was developed and compared to the conventional closing method. The new method involved (a) closed aspiration with an indwelling aspiration drain without suture of the subcutaneous fat and (b) covering with hydrocolloid wound dressing after suture of the dermis with 4-0 absorbable thread and reinforcement using strips. The incidence of SSI was significantly improved by using the new method. Furthermore, univariate and multivariate analysis associated with SSI revealed that the new closing method was statistically correlated with 85% reduction of SSI (odds ratio: 0.15, 95% confidence interval: 0.03–0.69).Our new method using continuous aspiration with subcutaneous drain is useful for preventing SSI through removal of effusions and reduction of dead space by apposition of the subcutaneous fat.

A 63-year-old man with a history of difficulty in defecating was diagnosed with a retroperitoneal tumor fully occupying the pelvic space. However, extensive histological examination of the resected ma

Recurrence of seminoma in the scrotum after inguinal orchidectomy is extremely rare. Herein, we report the second case in the literature of recurrence of seminoma in the scrotum following inguinal orchidectomy for stage I seminoma.

Renal tubular cell injury induced by oxalate plays an important role in kidney stone formation. Water containing oxygen nano-bubbles (nanometer-sized bubbles generated from oxygen micro-bubbles; ONB) has anti-inflammatory effects. Therefore, we investigated the inhibitory effects of ONB water on kidney stone formation in ethylene glycol (EG)-treated rats. We divided 60 rats, aged 4 weeks, into 5 groups: control, the water-fed group; 100 % ONB, the 100 % ONB water-fed group; EG, the EG treated water-fed group; EG + 50 % ONB and EG + 100 % ONB, water containing EG and 50 % or 100 % ONB, respectively. Renal calcium oxalate (CaOx) deposition, urinary excretion of N-acetyl-β-d-glucosaminidase (NAG), and renal expression of inflammation-related proteins, oxidative stress biomarkers, and the crystal-binding molecule hyaluronic acid were compared among the 5 groups. In the control and 100 % ONB groups, no renal CaOx deposits were detected. In the EG + 50 % ONB and EG + 100 % ONB groups, ONB water significantly decreased renal CaOx deposits, urinary NAG excretion, and renal monocyte chemoattractant protein-1, osteopontin, and hyaluronic acid expression and increased renal superoxide dismutase-1 expression compared with the EG group. ONB water substantially affected kidney stone formation in the rat kidney by reducing renal tubular cell injury. ONB water is a potential prophylactic agent for kidney stones.

treated mice had stones. The number of stones ranged from 16-45 (25.86 / 10.96, n 181). All stones were in the small group, except one 3mm stone. Mean stone weight was 29.2 / 14.8mg (range 14.2-52.3mg). Mean bladder weight in mice with stones was 65.4 / 18.6mg (range 42.2-101.1) and without stones it was 18.6 / 5.2mg (range 10.2-25.2mg). Stone number, stone weight, and bladder weight were significantly different between the two groups (two-tailed t-test, p 0.05) and the difference in stone burden between the groups was clearly evident by micro CT. There was no significant difference in cystine concentration (nmol/mg creatinine) between the two groups (5,410 / 2,124 versus 4,343 / 1,577), suggesting that urine was saturated with cystine in both groups. CDME treatment had no side effects. A dose of 5 mg/ml administered in the water supply also had beneficial effects and no side effects. CONCLUSIONS: CDME-treated mice had a significantly smaller stone mass and stone size, strongly suggesting that CDME is inhibiting, but not preventing, the growth of cystine crystals into stones. While current treatments for cystinuria in humans have poor compliance and multiple side effects, CDME in mice had therapeutic potential and was without adverse effects. Further research is warranted to determine if CDME may provide a new treatment approach for cystinuria, which is clinically invaluable, since cystinuria patients are at risk for multiple surgeries and renal insufficiency.

In 2002, speedy elimination of ureterolithiasis in the lower part of ureter was first reported with the alpha 1 blocker. Thereafter, there are a lot of reports including meta-analysis about tamsulosin. In 2011 EAU Guidelines on Urolithiasis, it is the most important to establish effective MET (medical expulsive therapy) to facilitate spontaneous stone passage. Alpha 1 blockers are the preferred agents for MET. As a basic evidence for MET, we reported that alpha 1a and 1d AR subtype mRNA was highly expressed in the human ureter and that alpha 1A AR is the main participant in the human ureteral contraction. It is published newly in Japanese Guidelines on Urolithiasis revised edition to schedule to be published soon.