Language：English   Publisher：Luts Lower Urinary Tract Symptoms  

Objectives: To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function. Methods: Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group. Results: A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, p = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU. Conclusions: A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction. Trial Registration: UMIN000056036.

DOI： 10.1111/luts.70042

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Tumor development in the ileal conduit is rare. Herein, we present a case of metastatic malignant melanoma occurring within the ileal conduit 17 years after radical cystectomy. CASE PRESENTATION: A 76-year-old Japanese man, with a history of bladder cancer treated with radical cystectomy and ileal conduit diversion, presented with gross hematuria. He had malignant melanoma diagnosed 10 years prior, with recurrent metastases managed through surgery and adjuvant therapy. During his recent admission, metastases to the subcutaneous tissue and retroperitoneum were noted. Contrast-enhanced computed tomography revealed bilateral hydronephrosis and a tumor in the ileal conduit. Endoscopic resection confirmed metastatic malignant melanoma. The patient's renal function stabilized postoperatively, and hematuria was controlled. A palliative care approach was adopted to treat the melanoma. CONCLUSION: This rare case of metastatic malignant melanoma within an ileal conduit highlights the importance of histopathological examinations in patients with overlapping malignancies. Trial Registration: 2016-0474.

DOI： 10.1002/iju5.70073

Open Access

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1111/iju.70071

Open Access

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Bladder preservation therapy has emerged as an essential alternative to radical cystectomy for muscle-invasive bladder cancer, particularly in elderly or frail patients. Trimodal therapy, combining maximal transurethral resection of bladder tumors, chemotherapy, and radiotherapy, has shown comparable oncological outcomes to radical cystectomy in selected cases. Recent advances in radiotherapy techniques and systemic therapies, including immune checkpoint inhibitors, have expanded the role of bladder-preserving strategies in the management of bladder cancer. Clinical trials investigating various combinations of radiotherapy, chemotherapy, and immune checkpoint inhibitors have redefined the treatment landscape. Observational studies have reported survival outcomes comparable to those of radical cystectomy, along with improved quality-adjusted life years. Emerging therapeutic strategies offer additional potential for improving outcomes. Bladder preservation therapy continues to evolve, with future approaches aimed at enhancing survival while preserving the quality of life.

DOI： 10.1111/iju.70164

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Secondary extramammary Paget's disease features intraepidermal carcinoma caused by tumor invasion and migration into adjacent skin. CASE PRESENTATION: A 68-year-old man underwent radical cystectomy and bilateral cutaneous ureterostomy for bladder cancer and right ureteral cancer. Postoperative follow-up computed tomography and urine cytology at 3 years suggested right ureteral cancer recurrence. Contemporaneous erythema and bulging of the skin around the right ureterocutaneous fistula were observed, necessitating retroperitoneoscopic nephroureterectomy and peristomal skin resection. Pathology revealed urothelial carcinoma with T2 disease at the lower ureter, plus spreading cytokeratin 7+ and cytokeratin 20+ pagetoid cells clustered within the epidermis indicative of secondary Paget's disease. CONCLUSION: In cases of recurrent upper urothelial carcinoma after urinary diversion, patients may develop secondary extramammary Paget's disease of the skin.

DOI： 10.1002/iju5.70021

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Bladder preservation therapy in combination with atezolizumab and radiation therapy (BPT-ART) trial, which was a multicenter, open-label, single-arm phase II study, showed a promisingly high interim clinical complete response (cCR) rate of 84.4% (38/45). In the present study, we aimed to identify potential tissue biomarkers for achieving cCR via BPT-ART. METHODS AND MATERIALS: We used tumor tissue samples of the bladder and blood samples collected from patients at baseline to analyze the tumor immune microenvironment at baseline using an integrated approach of immunophenotyping, genomic, and tumor-infiltrating lymphocyte (TIL) profiling. RESULTS: Immune phenotype analysis revealed that cCR rates of patients with the desert phenotype were as similarly high as patients with excluded/inflamed phenotypes (73.3% [11/15] vs. 93.3% [14/15], p=0.33) despite lower PD-L1 expression levels in the desert phenotype. Genomic and TIL profiling then revealed that increased CD8+ and CD204+ TIL infiltration, high CD8/FOXP3 ratios in the stroma of the excluded/inflamed phenotypes, and gene alterations, such as CDK12, GNAS, NOTCH2, and AR1D1A, were associated with a high cCR rate (93.3%). Furthermore, the characteristics of these dual TILs, CD8/FOXP3 ratios, and gene alterations (especially FGFR3) bifurcated the desert phenotype into two subgroups with different cCR rates (100% [11/11] and 0% [0/4]). CONCLUSIONS: These potential subgroups, defined by combined molecular subclass and immune phenotype, could lead to identification of good responders to atezolizumab plus radiation therapy for invasive bladder cancer. However, given the small cohort size and limited number of tumor samples, these findings should be viewed as hypothesis-generating and require further validation in larger studies.

DOI： 10.1016/j.ijrobp.2024.12.019

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: To investigate whether seminal plasma (SP)/serum ratios of multiple trace elements (TEs) can classify patients with male subfertility. METHODS: SP/serum ratios of 20 TEs (lithium, sodium, magnesium, phosphorus, sulfur, potassium, calcium, manganese, iron, cobalt, copper, zinc, arsenic, selenium, rubidium, strontium, molybdenum, cesium, barium, and thallium) were calculated for healthy volunteers (n = 4) and those consulting for male subfertility (n = 245). Volunteer semen samples were collected by split ejaculation into early and subsequent fractions, and SP/serum ratio data were compared between fractions. The patients' SP/serum ratio data were used in an unsupervised clustering analysis and qualitatively compared with the data from the fractions of ejaculation from the volunteers. Semen quality parameters and pregnancy outcomes were compared between patient clusters. RESULTS: The early fraction of volunteers was characterized by lower phosphorus and arsenic and 18 other higher TEs than the subsequent fraction. Cluster analysis classified patients into four distinct clusters, one sharing characteristics with the early fraction and another with the subsequent fraction. One cluster with the early fraction characteristics had significantly lower semen volume and higher pregnancy rates from spontaneous pregnancies or intrauterine insemination. CONCLUSIONS: Classification of patients based on SP/serum ratios of multiple TEs represents the dominance of fractions of ejaculation samples.

DOI： 10.1002/rmb2.12584

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Language：English   Publishing type：Research paper (scientific journal)  

Bladder cancer is one of the most common cancers among men worldwide. Although multiple genomic mutations and epigenetic alterations have been identified, an efficacious molecularly targeted therapy has yet to be established. Therefore, a novel approach is anticipated. Glycoprotein nonmetastatic melanoma protein B (GPNMB) is a type I transmembrane glycoprotein that is highly expressed in various cancers. In this study, we evaluated bladder cancer patient samples and found that GPNMB protein abundance is associated with high-grade tumors, and both univariate and multivariate analyses showed that GPNMB is a prognostic factor. Furthermore, the prognosis of patients with high GPNMB levels was significantly poorer in those with nonmuscle invasive bladder cancer (NMIBC) than in those with muscle invasive bladder cancer (MIBC). We then demonstrated that knockdown of GPNMB in MIBC cell lines with high GPNMB inhibits cellular migration and invasion, whereas overexpression of GPNMB further enhances cellular migration and invasion in MIBC cell lines with originally low GPNMB. Therefore, we propose that GPNMB is one of multiple driver molecules in the acquisition of cellular migratory and invasive potential in bladder cancers. Moreover, we revealed that the tyrosine residue in the hemi-immunoreceptor tyrosine-based activation motif (hemITAM) is required for GPNMB-induced cellular motility.

DOI： 10.1111/pin.13419

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Language：Japanese  

Case 1 : A 75-year-old man was emergently admitted to our hospital with a complaint of continuous bleeding from the ileal conduit. The conduit was constructed by a total pelvic resection for sigmoid colon cancer that invaded the urinary bladder 24 years ago. Swollen cutaneous mucosa was seen around the ileal conduit, but no obvious bleeding spot was observed. The contrast-enhanced computed tomographic (CT) scan and 3D visualization revealed varices extending to the abdominal wall. Percutaneous transhepatic embolization successfully stopped the bleeding, but it was needed again after two years. Case 2 : A 72-yearold man with a history of open cystectomy and ileal conduit for bladder cancer came to our hospital two years after the surgery, complaining of continuous bleeding from the conduit. The skin around the stoma site was discolored purple, but no obvious bleeding site or bloody urine was observed. The CT scan similar to Case 1 revealed varices in the ileal conduit, and percutaneous transhepatic embolization successfully stopped the bleeding, but it was needed again after five months. After that, three months passed without recurrence.

DOI： 10.14989/actauroljap_70_4_101

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Language：Japanese   Publisher：医学図書出版(株)  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Genitourinary sarcomas are rare in adults and few large-scale studies on adult genitourinary sarcoma are reported. We aimed to elucidate the clinical characteristics, survival outcomes, and prognostic factors for overall survival of adult genitourinary sarcoma in Japan. METHODS: A hospital-based cancer registry data in Japan was used to identify and enroll patients diagnosed with genitourinary sarcoma in 2013. The datasets were registered from 121 institutions. RESULTS: A total of 116 men and 39 women were included, with a median age of 66 years. The most common primary site was the kidney in 47 patients, followed by the paratestis in 36 patients. The most common histological type was liposarcoma in 54 patients, followed by leiomyosarcoma in 25 patients. The 5-year overall survival rates were 57.6%. On univariate analysis, male gender, paratestis as primary organ, and histological subtype of liposarcoma were predictive of favorable survival while primary kidney, bladder, or prostate gland location were predictive of unfavorable survival. On multivariate analysis, primary paratestis was an independent predictor of favorable survival while primary kidney, bladder, or prostate gland were independent predictors of unfavorable survival. CONCLUSIONS: This is the first report showing the clinical characteristics and survival outcomes of adult genitourinary sarcoma in Japan using a real-world large cohort database.

DOI： 10.1186/s12885-024-11952-0

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Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>本邦の2010年～2020年における腎移植レシピエントの死亡原因として悪性腫瘍は第1位(16.6%)であり、免疫抑制下におかれる腎移植患者は悪性腫瘍発生の高リスクとされ、悪性腫瘍の発生状況や対策は重要な課題である。2002年より2022年12月までに当院で施行した腎移植179例を対象としレトロスペクティブに検討した。悪性腫瘍は15例（8.4%）に１７種の癌が発生した。内訳は腎癌5例、大腸癌3例、膵癌2例、子宮体癌１例、前立腺癌1例、膀胱癌1例、胃癌1例、肝細胞癌1例、慢性骨髄性白血病1例、甲状腺癌1例であった。癌発症群は発症なし群と比較して、レシピエント年齢が高く、献腎移植、急性拒絶反応が多く、観察期間が長かった。また癌発症群では生存率が低かったが、生着率（death-censored）には差がなかった。癌発症例のうち癌死は4例（26.7%）であった。全例death with functioning graftであった。腎移植後は悪性腫瘍の発生率が上がり、また死亡率も高く注意が必要である。定期的な健診や予防が推奨される。当院における腎移植後悪性腫瘍の発生状況につき若干の文献的考察を加え報告する。</p>

DOI： 10.11386/jst.59.supplement_s326_2

Open Access

CiNii Research

Language：Japanese   Publisher：株式会社医学書院  

DOI： 10.11477/mf.1413207898

CiNii Research

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01561&link_issn=&doc_id=20230803040008&doc_link_id=10.11477%2Fmf.1413207898&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1413207898&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

Language：English   Publisher：Prostate  

Background: In recent years, the usefulness of androgen receptor axis-targeted agents (ARATs) such as abiraterone, enzalutamide, and apalutamide for the upfront treatment of metastatic hormone-sensitive prostate cancer (mHSPC) has been demonstrated. However, it remains unclear which patients would truly benefit from these treatments. Furthermore, intraductal carcinoma of the prostate (IDC-P) is a known poor prognostic factor in patients with prostate cancer. We investigated the association between the presence of IDC-P and response to therapy in patients with mHSPC. Methods: This retrospective analysis included 318 patients with mHSPC who received treatment at Nagoya University and its 12 affiliated institutions between 2014 and 2021. Their biopsy specimens were evaluated for the presence of IDC-P. The patients were classified according to their first-line treatment into the ARAT (n = 100, receiving a combination of androgen-deprivation therapy [ADT] and ARAT) or conventional therapy (n = 218, receiving ADT with or without standard antiandrogen agents) group. We compared the overall survival (OS) and second progression-free survival (PFS2) between the ARAT and conventional groups according to the presence of IDC-P to evaluate whether presence of IDC-P predicts the response to each treatment. PFS2 was defined as the period from mHSPC diagnosis to disease progression on second-line treatment or death. Propensity score matching with one-to-one nearest-neighbor matching was used to minimize the potential effects of selection bias and confounding factors. The clinicopathological variables of the patients were well-balanced after propensity score matching. Results: Most patients in the ARAT (79%) and conventional therapy (71%) groups were ICD-P positive. In the propensity score-matched cohort, the OS and PFS2 of IDC-P-positive patients were significantly longer in the ARAT group than in the conventional group (OS: hazard ratio [HR], 0.36; p = 0.047; PFS2: HR, 0.30; p < 0.001). In contrast, no difference in OS and PFS2 was observed between the ARAT and conventional groups in IDC-P-negative patients (OS: HR, 1.09; p = 0.920; PFS2: HR, 0.40; p = 0.264). Conclusions: The findings highlight a high prevalence of IDC-P among patients with mHSPC and suggest that IDC-P positivity may be a reliable indicator that ARAT should be implemented as first-line treatment.

DOI： 10.1002/pros.24462

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PubMed

Language：Japanese   Publishing type：Research paper (scientific journal)  

Postoperative femoral nerve palsy (FNP) is a rare complication associated with urologic surgery. Inappropriate use of retractors, use of lithotomy position, and prolonged surgery that lead to the femoral nerve compression have been reported as risk factors for FNP. Here, we report two cases of FNP after pelvic surgery. Case 1: A 47-year-old woman underwent ureterocystoneostomy for a giant ureterocele. On the first postoperative day, she developed muscle weakness and paresthesia in the left lower leg. An orthopedic surgeon diagnosed her with FNP associated with the surgery. Case 2: An 82-year-old woman underwent radical cystectomy for invasive bladder cancer. On the second postoperative day, she developed extension deficit in the left lower leg and was diagnosed with an iatrogenic FNP. Although this complication is infrequent, at onset, it leads to difficulty in walking and gait disturbance in the patient. As a result, it greatly reduces the patient's postoperative quality of life. Therefore, preventive measures should be taken to reduce the risk of this postsurgical nerve injury, such as appropriate placement of retractors and proper patient positioning during the operation.

DOI： 10.14989/actauroljap_69_1_25

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J-GLOBAL

Language：English   Publishing type：Research paper (scientific journal)  

Enfortumab vedotin (EV) is an antibody-drug conjugate and a promising agent for metastatic urothelial carcinoma (mUC). However, evaluations in end-stage renal disease patients undergoing hemodialysis are unreported. Here, we report such a case. A 74-year-old woman with mUC, on hemodialysis for complete urinary tract extirpation, was diagnosed with multiple pulmonary metastases after treatment with gemcitabine-carboplatin followed by pembrolizumab. As third-line therapy, she received a standard dose of EV. She achieved complete response after 2 cycles without grade 3 or higher adverse events, demonstrating the utility of EV in this setting.

DOI： 10.1159/000530780

Open Access

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PubMed

Language：Japanese   Publisher：一般社団法人 日本移植学会  

<p>【背景】生体腎移植後早期腎機能は、グラフトの「nephron mass」に依存する。近年、CT撮影装置の発展とCT-volumetryの改良により、正確的に「nephron mass」を測定できるようになった。本研究では、CT-volumetryを用いてグラフト「nephron mass」を定量化し、これを用いたcortex/recipient weight ratio(CRWR)が、他パラメータと比較し、術後早期腎機能予測が可能か検証した。【方法】2014年1月～2022年12月までに生体腎移植を受けた107人を対象とし、開発コホート（n=79）と検証コホート（n=28）に分けた。開発コホートを用い、CRWRを含むパラメーターと術後eGFRとの相関係数を算出した。重回帰分析より、術後1ヶ月eGFR予測式を作成した。検証コホートを用いて、その妥当性を検討した。【結果】相関係数はCRWRが最も高かった（1ヶ月r=0.66 ）。CRWRは術後1と6ヶ月で、尿蛋白と弱い逆相関を示した（r=-0.27と r=-0.34）。重回帰分析により、1ヶ月後のeGFRは線形モデルで予測された： 0.23 x ドナー術前eGFR + 17.03 x CRWR + 8.96 x 先行的腎移植 + 5.10. 検証コホートの大部分の患者において、観察されたeGFRは予測されたeGFRから±10 ml/min/1.73 m2の範囲内にあった。【結論】CRWRは、初期の移植片機能を予測するための正確なパラメータであった。この式を用いた腎機能の予測は、適切なドナーを選択し、不必要な術後医療介入を回避するために有用であると考えられる。</p>

DOI： 10.11386/jst.58.supplement_s188_1

Open Access

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Language：Japanese   Publisher：(一社)西日本泌尿器科学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本性機能学会  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：Japanese   Publisher：医学図書出版(株)  

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Language：English   Publisher：(一社)日本泌尿器科学会総会事務局  

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Language：Japanese   Publisher：泌尿器科紀要刊行会  

症例1(47歳女性)。左尿管瘤に合併した巨大尿管症に対する左尿管形成術、尿管膀胱新吻合術から1日で左大腿神経麻痺が出現した。症例2(82歳女性)。膀胱癌に対する開腹根治的膀胱全摘除術、回腸導管造設術、骨盤内リンパ節郭清術が行われたが、術後10日で左大腿神経麻痺が認められた。両症例ともリハビリテーションを行うことで、下肢筋力や知覚障害の改善が認められた。それぞれ、症例1は術後12ヵ月で杖歩行が可能となり、症例2は術後5年で自力歩行が可能となった。

Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01269&link_issn=&doc_id=20230209350005&doc_link_id=1390857977632823424&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390857977632823424&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

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Event date： 2022.10

Event date： 2022.6

Event date： 2022.6

Event date： 2022.5

Event date： 2020.2

17歳男性、慢性腎不全に対してCAPDカテーテル挿入。挿入後より大網巻絡による灌流障害あり、単孔式腹腔鏡下に解除を行った。

Event date： 2019.11

【背景】筋層非浸潤性膀胱癌（NMIBC）の再発抑制のためには、微小な尿路上皮癌（UC）や前癌病変（atypia）を残さず切除することが重要とされる。さらに筋層浸潤性膀胱癌（MIBC）においても、当院では膀胱温存療法の適応を決定するため、上皮内癌の有無とその局在を確認する必要がある。5-ALAによる光力学診断（PDD）は、これら病変の検出率を高めることが期待される。今回当院における初期成績について報告する。
【対象と方法】2018年3月1日から2019年9月30日までに筑波大学附属病院において5-ALAを用いたPDD補助TURBTを施行した症例を対象とした。2018年3月のみSBIファーマ社D-light(r)、2018年4月以降、Olympas社Aladuck(r)を使用した。
【結果】PDD補助TURBTを試みた症例は92例あった。患者背景は、男:女 76:16、年齢(歳) 46-87(中央値 74.5)、初発:再発 50:42。術前膀胱鏡の所見は、NMIBC疑い(所見なし含む) 75例、MIBC疑い 17例であった。腎盂尿管癌が疑われる14例は尿管鏡を併用した。5-ALA内服直前に肝機能障害があった1例と5-ALA内服後に一過性の血圧低下をきたした1例はPDD使用を見合わせた。その他周術期にCTCAEおよびClavien分類でGrade3以上の有害事象はみられなかった。病理評価可能かつPDD評価可能な平坦型病変は合計565検体採取され、うちUCは62検体、atypia 71検体であった。UCにおける感度は白色光で54%、PDDで69%、atypiaにおける感度は白色光で30%、PDDで52%、UC+atypiaにおける特異度は白色光の89%、PDDで84%であった。
【考察】自験例の検討でもPDDは早期病変の検出に有用と考えられた。一方でPDDの国内第III相試験（感度 80%、特異度 81%）と比較して、自験例では偽陰性がやや多かった。原因として5-ALAの内服から手術開始までの時間が遅れたり、PDDの判定が術者によって異なっていたりすることが挙げられる。PDDを実施する際のクリニカルパスや手術時のプロトコルには改良の余地があると考えられた。

Event date： 2019.10

28 歳男性。13cm の左副腎腫瘍を指摘。副腎癌も否定できないことから左副腎、腎合併切除術を施行したところ、副腎 oncocytoma の診断であった。

Event date： 2017.11

Event date： 2017.10

Event date： 2017.10

筑波大学では2013年に生体腎移植を再開し、移植件数は年々増えてきている。現在では、ABO不適合腎移植やクロスマッチ陽性腎移植を開始し、グラフト生着率および患者生存率も良好である。一方、症例が蓄積することで、長期フォローに伴う合併症や医療者側の負担などが問題となってきている。今回、国内の腎移植の動向を踏まえ、当院での腎移植医療の現状と方向について報告する。

Event date： 2017.9

Event date： 2017.9

Event date： 2017.8

Event date： 2017.6

Event date： 2017.4

Event date： 2017.4

Event date： 2017.4

Event date： 2017.4

Event date： 2017.2

Event date： 2017.2

Event date： 2017.1

Event date： 2016.2

Event date： 2016

Event date： 2016

Event date： 2015.10

Event date： 2015.10

Event date： 2015.3