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OBJECTIVES: There is an urgent need for more systematic investigations into how image inspection and primary treatment for low-risk prostate cancer vary by type of medical institution. To investigate disparities in imaging inspections and first-line treatment depending on the type of medical institution for low-risk prostate cancer using the Japan Study Group of Prostate Cancer database. METHODS: Data on patients with low-risk prostate cancer diagnosed between 2016 and 2018 from a nationwide database of the Japan Study Group of Prostate Cancer were used. Among these databases, patient and tumor characteristics, image inspections for diagnosis, and first-line treatment at clinics, community hospitals, and university hospitals were compared statistically. RESULTS: This analysis included patients with low-risk prostate cancer at clinics (n = 89), community hospitals (n = 1259), and university hospitals (n = 671). The three facilities had no significant differences in the performance of computed tomography scans, bone scintigraphy, and magnetic resonance imaging scans. Active surveillance was less performed in clinics and university hospitals, compared with community hospitals. Androgen deprivation therapy was significantly more common, but curative treatments, including radiation and prostatectomy, were less performed in clinics. Curative radiation was significantly more common, but androgen deprivation therapy was less performed in university hospitals. CONCLUSIONS: Our study analyzed data on low-risk prostate cancer obtained from a Japanese multi-institutional registry and showed differences in first-line treatment options by type of medical institution.

DOI： 10.1111/iju.70381

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Precise spatial understanding of the bronchovascular tree is essential for anatomical lung resection. Three-dimensional (3D) reconstruction and extended-reality (XR) technologies have emerged as tools for preoperative planning, navigation, and education. We aimed to assess the current use and efficacy of 3D and XR technologies in thoracic surgery in Japan and develop expert recommendations. METHODS: Two clinical survey questions on the usefulness of 3D imaging in thoracic surgery and that of VR, AR, and MR were sent to 125 certified thoracic surgical centers. PubMed searches targeted thoracic 3D and XR studies, including English-language randomized, prospective, and retrospective studies, systematic reviews, and meta-analyses. Draft statements were refined at the Anatomy on the Border Expert Consensus Meeting (Japan Society for Endoscopic Surgery 2024). RESULTS: Fifty of the 125 institutions (40%) responded. 3D imaging was used by 96% of the institutions, and 72% used it in all cases. "Very" or "moderately" useful was reported by 94% of the institutions. Main purposes for using 3D imaging were preoperative simulation (84%) and anatomical understanding (86%); 52% of the institutions used 3D imaging for intraoperative reference. For XR, awareness was moderate, but adoption remained limited (8%). Among respondents, 74% rated its usefulness as uncertain, while only a small proportion found it clearly useful for preoperative simulation, intraoperative localization, and education. Literature search showed that 3D-planning reduces blood loss, operative time, and complications in segmentectomy, whereas XR studies demonstrated improved nodule localization and workflow efficiency. CONCLUSIONS: 3D imaging should be the standard for complex thoracic resections, particularly segmentectomy. XR is a promising tool, with broader deployment expected as its usability improves and cost decreases.

DOI： 10.1111/ases.70196

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DOI： 10.1002/iju5.70111

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DOI： 10.1245/s10434-025-17840-6

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DOI： 10.1111/ases.70182

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DOI： 10.1111/ases.70189

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DOI： 10.1111/ases.70185

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DOI： 10.1111/ases.70184

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

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DOI： 10.1245/s10434-025-18003-3

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

ロボット支援腎部分切除術(RAPN)では,腫瘍の局在,形態,構造など様々なバリエーションを有する腎腫瘍に対応したオーダーメードな手術戦略が求められる.この対応において,腎癌3D画像を用いた手術ナビゲーションは,解剖情報を視覚的に理解でき,腎血管へのアプローチ方法や遮断部位,腫瘍切除範囲に関する術前シミュレーションを可能にする.また,腎癌3D画像を外部入力でコンソールに投影可能なため,術者は術野から視線を逸らさずに解剖情報を視認でき,ロボット支援手術と3D画像による仮想現実(VR)の活用は普及しつつある.近年ではVRに留まらず,人工知能(AI)や拡張現実(AR)が応用され,3D画像の自動作成や内視鏡画像への重畳表示も試みられている.こうした視覚的な画像支援が医療に応用される一方,現行の手術ナビゲーションには課題も多い.具体的には,RAPNでの腎癌3D画像の用途は,解剖情報の参照に留まり,細心の注意が必要な腎血管や腫瘍に対して術者の鉗子が術中どこにあるか位置情報をリアルタイムに可視化できていない.この情報がないことは術者がどこを剥離すべきか道標がないだけでなく,鉗子操作の深追いを招き組織損傷を引き起こしかねない.我々はこの課題に対し,光学式追跡システムで鉗子の動きを捉え,位置情報を腎癌3D画像のVR空間に統合するシステムを開発している.このシステムは,従来のナビゲーションに鉗子の位置情報を加えることでより直感的な解剖理解を可能にする術中ナビゲーションへのバージョンアップを目指しており,術者が目指す理想のRAPNの実現に近づけることができると考える.(著者抄録)

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DOI： 10.1002/cam4.71085

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Language：Japanese   Publisher：日本腎泌尿器疾患予防医学研究会  

Language：English   Publisher：シュプリンガー・ジャパン(株)  

症例は77歳男性で、48歳時に結腸癌と診断され、68歳時に左尿管癌に対する根治的腎尿管切除術を受けた。69歳と70歳の時に膀胱癌を発症し、経尿道的膀胱腫瘍切除術を受けた。75歳時には右腎癌に対して凍結療法を受けた。父親と男女の同胞も若年期に多発癌を発症していた。77歳で膀胱腫瘍の再発を認め、経尿道的切除術を施行した。病理診断は低悪性度尿路上皮癌(Grade 2>Grade 1)、Taであった。MRIでは膀胱腫瘍が前立腺および直腸へ浸潤していた。その後、高悪性度尿路上皮癌の前立腺浸潤を確認した。術前化学療法後、拡大骨盤内リンパ節郭清術を伴う骨盤内臓全摘術および右側尿管皮膚造瘻術を施行した。膀胱腫瘍の免疫組織化学染色により、MSH2とMSH6の発現喪失を認めた。さらに、MSI-HをPCRベースの方法で確認し、MSH2とMSH6における病原性変異を次世代シーケンシングで確認したことから、リンチ症候群が示唆された。骨盤内臓全摘術後の局所再発および上部尿路再発尿路上皮癌に対しペムブロリズマブを投与し、完全寛解が達成された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

Clinical evidence supporting the use of PD-1/PD-L1 inhibitors in treating urothelial carcinoma with microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) remains limited. We report a case of 77-year-old male with a history of multiple cancers. Immunohistochemical staining of bladder tumor revealed the loss of MSH2 and MSH6 expression, and MSI-H by PCR-based method and pathogenic alterations in MSH2 and MSH6 genes by next generation sequencing were confirmed, suggesting Lynch syndrome. He received pembrolizumab for local recurrence after total pelvic exenteration and recurrent upper tract urothelial carcinoma, and achieved complete remission. This case supports the potential of PD-1/PD-L1 inhibitors as a promising treatment option for MSI-H or dMMR urothelial carcinoma, similar to other solid tumors with MSI-H or dMMR.

DOI： 10.1007/s13691-025-00774-x

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Other Link： https://link.springer.com/article/10.1007/s13691-025-00774-x/fulltext.html

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

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DOI： 10.1097/01.JU.0001109904.25944.a0.35

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Objective: / This study aimed to develop an explainable radiomics model for stratifying prostate cancer (PCa) patients with high-risk disease via investigation of the association between cell density (CD) in the PCa region on histopathological images and multiparametric MR (mpMR) radiomics features. / Materials and methods: / 137,970 radiomic features were calculated from mpMR images (101 PCa regions of 44 patients), and joint histograms (JHs) were derived from dynamic contrast-enhanced (DCE) images for each PCa region. The association between CD on histopathological images and its corresponding mpMR radiomic features in PCa regions for various grade groups and the three risk groups was evaluated using Spearman’s correlation coefficient. To validate the potential of the radiomic-feature-CD association, we developed the radiomics model for stratifying patients into low/intermediate-risk and high-risk groups. / Results: / There were moderate correlations of the CD with a DCE-based texture feature (WV_HH_1st_GLSZM_ZP) (ρ = 0.609, p = 0.024) and DCE-JH feature (JH_WV_HL_1st versus 5th‐1st_Hist_STD) (ρ = 0.609, p = 0.024) in the high-risk group. The radiomics model had an accuracy of 0.920 for stratifying the patients of a test dataset into the low/intermediate-risk and high-risk groups. / Conclusion: / The association between CD and mpMR features can be leveraged to develop the explainable radiomics for the high-risk stratification of patients with PCa.

DOI： 10.1007/s10334-025-01250-6

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

脊椎動物は,心血管系と共にリンパ系を形成し体液を循環させるシステムを有しており,リンパ系は末梢組織から中枢の大静脈にリンパ液を輸送する.リンパ液には,蛋白質などの高分子物質,組織の代謝産物に加えてリンパ球に代表される免疫細胞が存在し,感染防御や癌免疫の観点からも重要なシステムである.癌は主に血行性やリンパ行性転移を来し,リンパ行性転移では原発巣からリンパ管に沿って癌細胞がリンパ節に転移するため,リンパ節転移の診断目的として,一部の癌では治療目的として,リンパ節郭清が行われる.副腎癌や腎癌,腎盂尿管癌,精巣癌において,腹部のリンパ節郭清が必要となる場合がある.しかし,リンパ節郭清により,リンパ液の滞留によるリンパ浮腫やリンパ液の溢流によるリンパ瘻,リンパ嚢腫などのリンパ管そのものの損傷による合併症に加え,リンパ管が伴走する動静脈や周囲神経の損傷に伴う合併症が惹起される可能性がある.したがって,泌尿器癌の診療において必要となる腹部リンパ節郭清には,リンパ管の走行とその周囲の血管,神経,そして膜構造に関する局所解剖に十分に通じておくことが必要である.本稿では,腹部リンパ節郭清に必要な知識について解剖学的事項を中心に概説する.(著者抄録)

Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

当院では,ロボット支援腎部分切除術における自動追尾型手術ナビゲーションシステムを開発,実装して手術を行なっており,そのシステムの臨床的有用性も明らかにしてきた.しかし,このシステムでは,赤外線を使用した光学式追跡システムで一時的に追跡できない術野の「死角」による追跡の「途絶」によって,ナビゲーションの安定性,精度が低下するという課題が依然解決されてこなかった.この課題によって,ナビゲーションを継続するために3Dモデル画像と内視鏡画像との間で複数回のレジストレーション(位置合わせ)が必要となるため,その結果,画像支援が中断されて手術進行が妨げられるリスクがあった.この術野の「死角」による追跡の「途絶」の解決に着目し,da Vinci Xi対応のアタッチメントを改良したため報告する.当院では,ロボット支援腎部分切除術における自動追尾型手術ナビゲーションシステムを開発,実装して手術を行なっており,そのシステムの臨床的有用性も明らかにしてきた.しかし,このシステムでは,赤外線を使用した光学式追跡システムで一時的に追跡できない術野の「死角」による追跡の「途絶」によって,ナビゲーションの安定性,精度が低下するという課題が依然解決されてこなかった.この課題によって,ナビゲーションを継続するために3Dモデル画像と内視鏡画像との間で複数回のレジストレーション(位置合わせ)が必要となるため,その結果,画像支援が中断されて手術進行が妨げられるリスクがあった.この術野の「死角」による追跡の「途絶」の解決に着目し,da Vinci Xi対応のアタッチメントを改良したため報告する.(著者抄録)

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DOI： 10.1097/CU9.0000000000000274

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

Language：Japanese   Publisher：The Japan Society of Computer Aided Surgery  

DOI： 10.5759/jscas.26.276

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

非セミノーマ性精巣胚細胞腫瘍に対する化学療法施行後の腹腔鏡下後腹膜リンパ節郭清(RPLND)の手術アウトカムについて検討した。当院で2016～2024年に化学療法後にRPLNDを受けた非セミノーマ性精巣胚細胞腫瘍患者13例(中央値32歳)を対象に、術前の臨床病理学的データ、周術期アウトカム、腫瘍アウトカムを評価した。BMI中央値は23.1kg/m2、ステージIが4例、ステージIIが5例、ステージIIIが4例、IGCCCリスク分類ではgoodが10例、intermediateが2例、poorが1例であり、最大腫瘍サイズ中央値は化学療法施行前が24mm、施行後が11mmで、化学療法後に血清中AFP、β-HCG、LDHといった腫瘍マーカーはいずれも正常範囲内にあった。RPLNDの手術時間中央値は272分、術中出血量は27mLで、開腹術への移行例はなかったが、1例のみ後腹膜腔の癒着に伴い後腹膜アプローチから経腹膜アプローチへ変更した。術中合併症の発症なく、経口摂取開始まで中央値1日、在院期間中央値は8日であった。腫瘍アウトカムに関して、腫瘍遺残を1例、奇形腫を7例に認め、術後観察期間中央値18.6ヵ月において再発例はみられなかった。非セミノーマ性精巣胚細胞腫瘍に対する化学療法後のRPLNDは安全に施行可能であることが示された。

Language：English   Publishing type：Research paper (scientific journal)   Publisher：The Biophysical Society of Japan  

<p>The malignancies of prostate tumour cells are assessed by pathologists as grade groups (GGs) from 1 (least aggressive) to 5 (most aggressive) on histopathology images. GGs are associated with the degree of tumour cell differentiation and may have different self-similarities depending on GG and tumour-related cell types, which are neoplastic epithelial, inflammatory, connective tissue, necrotic, and non-neoplastic epithelial cells. We investigated the associations between GGs and fractal dimensions (FDs) for five types of prostate tumour-related cells using a multiple-threshold box counting algorithm (MTBC). We showed the association of FDs of 9 channel images (eosin, hematoxylin, normalised images for red, green, and blue colour channels) with multiple threshold values on histopathology images (patch images) and the feasibility of FD-threshold images in an artificial intelligence model to classify patients into low (GG≤3) and high (GG≥4) GGs. We constructed FD-threshold images based on MTBC algorithm for characterizing prostate tumour cells. A shallow-convolutional neural network (sCNN) model to classify patients into low and high GGs was trained with input data of the FD-threshold images for all 9 channels and evaluated using the area under receiver operating characteristic curve (AUC). There were statistically significant correlations between the FD of non-neoplastic epithelial cells and GG [Pearson correlation coefficient=–0.849, p=0.001]. Significant correlations also existed for connective tissue and the original images. The AUC for the sCNN classification model into high and low GGs was 0.811. FD can characterise physical properties of prostate tumour-related cells for low and high GGs.</p>

DOI： 10.2142/biophysico.bppb-v22.0026

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Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>  Vertebrates have a system circulating body fluids that consists from lymphatic system and cardiovascular system. The lymphatic system transports lymph fluid from peripheral tissues to the central vena cava. In addition to proteins and tissue metabolites, lymph fluid contains immune cells represented by lymphocytes, and plays an important role in infection defense and cancer immunity. Cancer cells mainly metastasize via vascular and lymphatic systems. In lymphatic metastasis, cancer cells spread from the primary tumor to the lymph nodes along the lymphatic vessels. Then, lymph node dissection is recommended for the diagnosis of lymph node metastasis and for therapeutic intent in some cancers. Lymph node dissection in the abdomen is performed for adrenal cancer, renal cell carcinoma, upper tract urothelial carcinoma, and testicular cancer. However, lymph node dissection can cause complications by damaging the lymphatic vessels, such as lymphedema due to retention of lymph fluid, lymph fistula due to overflow of lymph fluid, and lymph cysts, as well as complications by damaging the arteriovenous vessels and surrounding nerves. Therefore, abdominal lymph node dissection in the management of urologic cancer requires a thorough understanding of the local anatomy of the lymphatic vessels and their surrounding vascular, nerve, and membrane structures. This article outlines the knowledge required for abdominal lymph node dissection, focusing on anatomy.</p>

DOI： 10.11302/jserjje.38.1_76

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Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>In our institution, we have developed and implemented an automated tracking surgical navigation system for RAPN (robot-assisted partial nephrectomy), and its clinical usefulness has been demonstrated. However, challenges have emerged with this system, precisely the blind spots in the surgical field and temporary interruptions of the optical tracking to chase the target. These issues compromise the stability and accuracy of navigation. As a result, multiple registrations (alignment) between the 3D images and endoscopic images were required to maintain navigation, potentially interrupting image guidance for the surgeon and hindering the progression of surgery. We report the improvement of a da Vinci Xi-compatible attachment designed to address these ‘blind spots’ and tracking ‘interruptions’ in the surgical field.</p>

DOI： 10.11302/jserjje.38.1_168

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Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>  In robot-assisted partial nephrectomy (RAPN), a tailored surgical strategy is essential to accommodate the wide variability in tumor location, morphology, and anatomical structure. Surgical navigation using three-dimensional (3D) kidney tumor images enables intuitive understanding of anatomical information, facilitates preoperative simulation of vascular access routes, clamping points, and tumor resection areas, and allows for effective information sharing among medical staff. These 3D images can also be externally input into the vision cart and projected onto the surgeon’s console, allowing the operator to visualize anatomical structures without diverting their gaze from the surgical field. This integration of 3D imaging with virtual reality (VR) is increasingly being adopted in robot-assisted surgeries.</p><p>  Recently, the scope of technological integration has expanded beyond VR to include artificial intelligence (AI) and augmented reality (AR), enabling automatic generation of 3D images and their overlay onto endoscopic views. While such visual image-based assistance has advanced, current navigation systems still present limitations. Specifically, in RAPN, 3D images are primarily used for anatomical reference, and there remains no system to visualize, in real time, the location of the surgeon’s forceps relative to critical structures such as renal vessels and the tumor, both of which require utmost care. The absence of this information deprives the surgeon of spatial guidance during dissection and increases the risk of excessive instrument manipulation, potentially leading to tissue injury. To address this issue, we are developing a novel system that tracks the motion of surgical forceps using an optical tracking system and integrates their positional data into the 3D-VR space of the kidney tumor model. By adding real-time instrument localization to conventional navigation, this system aims to evolve into a more intuitive intraoperative navigation tool, bringing us closer to realizing the ideal RAPN.</p>

DOI： 10.11302/jserjje.38.2_194

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Language：English   Publisher：(一社)日本生物物理学会  

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DOI： 10.1111/ases.13416

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BACKGROUND: Proton pump inhibitors (PPIs) are widely used due to their affordability and minimal severe side effects. However, their influence on the efficacy of cancer treatments, particularly androgen receptor signaling inhibitors (ARSIs), remains unclear. This study investigates the impact of PPI usage on the treatment outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC). METHODS: A total of 117 mCRPC patients were retrospectively analyzed and divided into two groups based on the concomitant use of PPI at the initiation of ARSI treatment: PPI+ (n = 38) and PPI- (n = 79). Patient characteristics, including age at ARSI treatment administered, prostate-specific antigen (PSA) value at ARSI treatment administered, International Society of Urological Pathology grade group at prostate biopsy, metastatic site at ARSI treatment administered, prior docetaxel (DTX) treatment, and type of ARSI (abiraterone acetate or enzalutamide) were recorded. Progression-free survival (PFS), overall survival (OS), and PSA response rates were compared between the two groups. Patients were further stratified by clinical background to compare PFS and OS between the two groups. RESULTS: The PPI- group exhibited significantly extended PFS and a trend toward improved OS. For PSA response (reduction of 50% or more from baseline), the rates were 62.3% and 45.9% in the PPI- group and the PPI+ group, respectively. For deep PSA response (reductions of 90% or more from baseline), the rates were 36.4% and 24.3% in the PPI- group and the PPI+ group, respectively. The effects were consistent across subgroups divided by prior DTX treatment and type of ARSI administered. CONCLUSIONS: The administration of PPIs appears to diminish the therapeutic efficacy of ARSIs in mCRPC patients. Further prospective studies are needed to confirm these findings and explore the biological mechanisms involved.

DOI： 10.1002/pros.24769

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BACKGROUND: This study aimed to show the association between tumor location and laterality of positive lymph nodes by evaluating biopsy and magnetic resonance imaging (MRI) findings, and to optimize the extended pelvic lymph node dissection (ePLND) side for prostate cancer. METHODS: The study enrolled patients who underwent robot-assisted radical prostatectomy with ePLND. Tumor locations were determined according to International Society of Urological Pathology grade group 4/5 in biopsies and Prostate Imaging-Reporting and Data System category 4/5 in MRI results. The concordance of tumor location lobe and positive lymph node side with the performance of tumor location-guided ePLND for positive lymph node detection was evaluated. RESULTS: For 301 patients who underwent ePLND at Kyushu University Hospital, tumor locations determined by biopsy and MRI findings showed no lesion in 8 (2.7%) patients, unilateral lobe in 223 (74.1%) patients, and bilateral lobe in 70 (23.3%) patients. The accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were 99.6% and 97.3%, respectively. Among the patients at St. Luke's International Hospital, the accuracies for detection of any and all positive lymph nodes by tumor location-guided unilateral ePLND were estimated to be 99.0% and 97.3%, respectively. CONCLUSIONS: This study proposed tumor location-guided ePLND according to biopsy and MRI findings. This novel strategy is expected to reduce the burden of bilateral ePLND at the cost of acceptable risk of failing to detect positive lymph nodes.

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Androgen receptor (AR)-targeting therapy induces oxidative stress in prostate cancer. However, the mechanism of oxidative stress induction by AR-targeting therapy remains unclear. This study investigated the mechanism of oxidative stress induction by AR-targeting therapy, with the aim to develop novel therapeutics targeting oxidative stress induced by AR-targeting therapy. Intracellular reactive oxygen species (ROS) was examined by fluorescence microscopy and flow cytometry analysis. The effects of silencing gene expression and small molecule inhibitors on gene expression and cytotoxic effects were examined by quantitative real-time PCR and cell proliferation assay. ROS induced by androgen depletion co-localized with peroxisomes in prostate cancer cells. Among peroxisome-related genes, PPARA was commonly induced by AR inhibition and involved in ROS production via PKC signaling. Inhibition of PPARα by specific siRNA and a small molecule inhibitor suppressed cell proliferation and increased cellular sensitivity to the antiandrogen enzalutamide in prostate cancer cells. This study revealed a novel pathway by which AR inhibition induced intracellular ROS mainly in peroxisomes through PPARα activation in prostate cancer. This pathway is a promising target for the development of novel therapeutics for prostate cancer in combination with AR-targeting therapy such as antiandrogen enzalutamide.

DOI： 10.1016/j.freeradbiomed.2024.05.030

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Journal of Robotic Surgery  

Our objective was to investigate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) combined with three-dimensional (3D) imaging. The 3D images, reconstructed using computed tomography, were introduced in RAPN procedures. The demographic, oncological, functional, and volumetric outcomes of 296 patients who underwent RAPN with and without 3D imaging between 2013 and 2021 were analyzed retrospectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. After matching, 71 patients were allocated to each group. In the 3D RAPN (3DRPN) group, functional outcomes significantly improved: the number of patients with over 90% estimated glomerular filtration rate (eGFR) preservation rate (40 vs. 43, P = 0.044), eGFR preservation rate (88.0% vs. 91.6%, P = 0.006), the number of patients with chronic kidney disease (CKD) upstaging (26 vs. 13, P = 0.023), and split renal function preservation rate (operated kidney: 84.9% vs. 88.5%, P = 0.015). The 3DRPN group showed superiority in terms of >90% eGFR preservation (P = 0.010), CKD upstaging-free survival rates (P < 0.001), and volumetric outcomes (excess parenchymal volume: 27.9 vs. 17.7 mL, P = 0.030; parenchyma volume preservation rate: 81.6% vs. 88.8%, P = 0.006). Three-dimensional imaging was positively associated with eGFR preservation (P = 0.023, odds ratio: 2.34) and prevention of CKD upstaging (P = 0.013, odds ratio: 2.90). In this study, RAPN combined with 3D imaging underscored the preservation of eGFR > 90% and the prevention of CKD upstaging by improving the preservation rate of renal parenchyma and split renal function.

DOI： 10.1007/s11701-024-02070-x

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In the last decade, the standard treatment for advanced renal cell carcinoma (RCC) has evolved, mainly driven by the development and approval of immune checkpoint inhibitors (ICIs). Currently, ICI monotherapy and ICI-based combinations with tyrosine kinase inhibitors and targeted therapies against mammalian target of rapamycin or vascular endothelial growth factor have become new standard treatments for first-line and subsequent-line therapies. ICIs play an important role as an adjuvant postoperative therapy, and this field is the subject of active research. Furthermore, ongoing randomized controlled trials are investigating the clinical value of more intense treatments by combining multiple effective treatments for RCC. Additionally, novel biomarkers for prognosis have been investigated. This study reviews the current evidence on immunotherapy as a treatment for RCC patients, randomized controlled trials, and ongoing studies including RCC patients and recent findings, and discusses future perspectives.

DOI： 10.1007/s10147-023-02446-3

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Androgen receptor signaling is crucial for the development of treatment resistance in prostate cancer. Among steroidogenic enzymes, 3β-hydroxysteroid dehydrogenases (3βHSDs) play critical roles in extragonadal androgen synthesis, especially 3βHSD1. Increased expression of 3βHSDs is observed in castration-resistant prostate cancer tumors compared with primary prostate tumors, indicating their involvement in castration resistance. Recent studies link 3βHSD1 to resistance to androgen receptor signaling inhibitors. The regulation of 3βHSD1 expression involves various factors, including transcription factors, microenvironmental influences, and post-transcriptional modifications. Additionally, the clinical significance of HSD3B1 genotypes, particularly the rs1047303 variant has been extensively studied. The impact of HSD3B1 genotypes on treatment outcomes varies according to the therapy administered, suggesting the potential of HSD3B1 genotyping for personalized medicine. Targeting 3βHSDs may be a promising strategy for prostate cancer management. Overall, understanding the roles of 3βHSDs and their genetic variations may enable the development and optimization of novel treatments for prostate cancer.

DOI： 10.1530/ERC-24-0023

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Language：English   Publisher：John Wiley & Sons Australia, Ltd  

転移性去勢抵抗性前立腺癌(mCRPC)に対するカバジタキセル後の治療パターンを評価し、生存への影響について検討した。2014～2023年にカバジタキセルによる治療を受けたmCRPC日本人患者を対象とした。全生存期間はカバジタキセル最終投与から死亡または最終追跡時点までとし、カプランマイヤー法により推定した。患者36例(カバジタキセル開始時、中央値72.5歳)を解析した。多くの患者がカバジタキセル治療前にアンドロゲン受容体シグナル伝達阻害薬(ARSI)やドセタキセルによる治療を受けた。36例中11例がカバジタキセル後に別の薬物治療を受けた。カバジタキセル後の追跡期間中央値4.27ヵ月に、33例(91.7%)が死亡した。12ヵ月全生存率は、カバジタキセル後に治療を受けた群で25.3%(95%CI:4.1～55.5)、受けなかった群で8%(同1.4～2.2)であった(p=0.0499)。カバジタキセル後に一次治療ARSI、オラパリブ、ラジウム223、またはドセタキセルを受けた患者と受けなかった患者の12ヵ月全生存率はそれぞれ50.0%(同11.1～80.4)と7%(同1.2～20.1)であった(p=0.0231)。以上より、mCRPCにおいてカバジタキセル後に治療を受けた患者では受けなかった患者よりも全生存期間が長いことが示された。

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

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

根治的前立腺摘除術(RP)後に行う前立腺特異抗原(PSA)モニタリングの4つのモデルの妥当性を検証し、生化学的再発(BCR)検出を改善する修正モデルを検討した。2009～2022年にロボット支援RPを受けた患者の臨床病理学的データを調べ、4つのモデルで仮想上経過観察時のPSA値を推定した。BCR検出に最適なPSA値は0.2～0.4ng/mLと定義した。患者896例(年齢中央値66歳)を解析した。追跡期間中央値21.4ヵ月の間に128例(14.3%)がBCRを認めた。BCRが検出されたPSA値0.4ng/mL超の患者は、慶應モデル、修正慶應モデル、国立がん研究センター中央病院(NCCH)モデル、および米国泌尿器科学会(AUA)/米国放射線腫瘍学会(ASTRO)モデルでそれぞれ14例(10.9%)、3例(2.3%)、12例(9.4%)、および11例(8.6%)であった。殆どの患者は、術後1年目にPSA値0.4ng/mL超でBCRが検出された。術後6ヵ月以内の間隔に変更すると、術後1年以内のPSA>0.4ng/mLのBCR検出は上記のモデルそれぞれで8/9例(88.9%)、1/2例(50.0%)、5/6(83.3%)、4/4例(100%)で回避された。以上より、RP後のBCR検出のためのPSAモニタリングを最適にするための修正案が示唆された。

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DOI： 10.1111/iju.15379

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Language：Japanese   Publisher：(一社)日本内分泌外科学会  

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DOI： 10.1111/ases.13279

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前立腺癌に対する炭素イオン線治療(CIRT)後のサルベージロボット支援前立腺全摘術(RARP)の手術アウトカムと腫瘍アウトカムについて検討した。2020～2023年に、CIRT後に局所再発をきたしてRARPを施行された前立腺癌患者10例(中央値69歳)を対象とした。拡大骨盤リンパ節郭清(PLND)によるサルベージRARPを行い、臨床病理学的特徴、周術期アウトカムおよび術後アウトカムを評価した。CIRT後の局所再発時のPSA中央値は4.02ng/mL、生検によるGleason分類ではグレードIIが1例、グレードIIIが2例、グレードIVが2例、グレードVが5例であり、術前の臨床的Tステージは9例がT2、1例のみT3a、初期診断から局所再発までは中央値58.5ヵ月であった。RARPに際して全例にPLND、1例に両側神経温存手術を行い、手術時間中央値は235分、コンソール時間中央値は171分、推定出血量中央値は150mLであった。直腸損傷といった周術期合併症や術後90日以内の再入院、尿道狭窄は認められなかった。腫瘍アウトカムに関して、1例が術後31.2ヵ月に生化学的再発を呈した。CIRT後に局所再発をきたした前立腺癌患者に対して、RARPは実行可能な手技であることが示された。

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

Language：Japanese   Publisher：(株)日本臨床社  

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

The novel technique of lateral pelvic fascia preservation (LPFP) in robot-assisted radical prostatectomy (RARP) has been reported to improve urinary continence recovery. We aimed to investigate surgical and oncological outcomes after RARP using the LPFP technique and compare them with conventional RARP. This study included patients who underwent RARP with and without the LPFP technique. Time to urinary continence recovery was compared between the LPFP and non-LPFP groups using univariate, multivariate, and propensity-score matched analysis. Perioperative and postoperative outcomes were compared between the two groups using univariate analysis. We included 139 patients who underwent RARP, 68 in the LPFP group and 71 in the non-LPFP group. The LPFP technique was associated with a shorter time to urinary continence recovery, a shorter operative time and lower estimated blood loss. Surgical and oncological outcomes, including complications, pathological T-stage, surgical margin status, and biochemical recurrence-free survival, were comparable between the two groups. This study demonstrated that the LPFP technique improves urinary continence recovery and operative times without compromising surgical and oncological outcomes. The use of this technique in patients with clinically localized prostate cancer is recommended.

DOI： 10.1007/s11701-023-01702-y

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This study investigated cellular mechanisms in steroidogenesis responsible for treatment resistance to the novel antiandrogen agent darolutamide in prostate cancer. HSD3B1 was overexpressed in darolutamide-resistant cells and induced by darolutamide treatment and AR knockdown. Inversely, HSD3B1 knockdown increased cellular sensitivity to darolutamide. Similarly, its upstream regulator NR5A2 was up-regulated in darolutamide-resistant cells and induced by darolutamide treatment and AR knockdown. Inversely, NR5A2 knockdown and NR5A2 inhibitor ML180 decreased expression of various steroidogenic enzymes including HSD3B1, leading to increased cellular sensitivity to darolutamide. The NR5A2/HSD3B1 pathway promoted cellular resistance to darolutamide and targeting NR5A2/HSD3B1 pathway is a promising therapeutic strategy to overcome darolutamide resistance.

DOI： 10.1016/j.drup.2023.100990

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Our objective was to evaluate the feasibility of a multi-section continuum robotic ureteroscope to address the difficulties with access into certain renal calyces during flexible ureteroscopy. First, the robotic ureteroscope developed in previous research, which utilizes three actuated bendable sections controlled by wires, was modified for use in this project. Second, using phantom models created from five randomly selected computer tomography urograms, the flexible ureteroscope and robotic ureteroscope were evaluated, focusing on several factors: time taken to access each renal calyx, time taken to aim at three targets on each renal calyx, the force generated in the renal pelvic wall associated with ureteroscope manipulation, and the distance and standard deviation between the ureteroscope and the target. As a result, the robotic ureteroscope utilized significantly less force during lower pole calyx access (flexible ureteroscope vs. robotic ureteroscope; 2.0 vs. 0.98 N, p = 0.03). When aiming at targets, the standard deviation of proper target access was smaller for each renal calyx (upper pole: 0.49 vs. 0.11 mm, middle: 0.84 vs. 0.12 mm, lower pole: 3.4 vs. 0.19 mm) in the robotic ureteroscope group, and the distance between the center point of the ureteroscope image and the target was significantly smaller in the robotic ureteroscope group (upper: 0.49 vs. 0.19 mm, p < 0.001, middle: 0.77 vs. 0.17 mm, p < 0.001, lower: 0.77 vs. 0.22 mm, p < 0.001). In conclusion, our robotic ureteroscope demonstrated improved maneuverability and facilitated accuracy and precision while reducing the force on the renal pelvic wall during access into each renal calyx.

DOI： 10.1007/s11701-023-01530-0

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PURPOSE: Understanding the three-dimensional anatomy of percutaneous intervention in prostate cancer is essential to avoid complications. Recently, attempts have been made to use machine learning to automate the segmentation of functional structures such as the prostate gland, rectum, and bladder. However, a paucity of material is available to segment extracapsular structures that are known to cause needle deflection during percutaneous interventions. This research aims to explore the feasibility of the automatic segmentation of prostate and extracapsular structures to predict needle deflection. METHODS: Using pelvic magnetic resonance imagings (MRIs), 3D U-Net was trained and optimized for the prostate and extracapsular structures (bladder, rectum, pubic bone, pelvic diaphragm muscle, bulbospongiosus muscle, bull of the penis, ischiocavernosus muscle, crus of the penis, transverse perineal muscle, obturator internus muscle, and seminal vesicle). The segmentation accuracy was validated by putting intra-procedural MRIs into the 3D U-Net to segment the prostate and extracapsular structures in the image. Then, the segmented structures were used to predict deflected needle path in in-bore MRI-guided biopsy using a model-based approach. RESULTS: The 3D U-Net yielded Dice scores to parenchymal organs (0.61-0.83), such as prostate, bladder, rectum, bulb of the penis, crus of the penis, but lower in muscle structures (0.03-0.31), except and obturator internus muscle (0.71). The 3D U-Net showed higher Dice scores for functional structures ([Formula: see text]0.001) and complication-related structures ([Formula: see text]0.001). The segmentation of extracapsular anatomies helped to predict the deflected needle path in MRI-guided prostate interventions of the prostate with the accuracy of 0.9 to 4.9 mm. CONCLUSION: Our segmentation method using 3D U-Net provided an accurate anatomical understanding of the prostate and extracapsular structures. In addition, our method was suitable for segmenting functional and complication-related structures. Finally, 3D images of the prostate and extracapsular structures could simulate the needle pathway to predict needle deflections.

DOI： 10.1007/s11548-022-02757-2

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

腎腫瘍は局在と形態は多岐にわたり,腎血管の数と形態にも個体差がある.従って,ロボット支援腎部分切除術(robot-assisted partial nephrectomy;RAPN)では多様な解剖学的特徴を踏まえ手術のアプローチ方法を術前に計画しておく必要がある.この術前計画において,医療画像から作成された腎癌3D画像は,腎腫瘍や腎血管の情報を視覚的に理解するのに役立ち,この画像を使った3次元的な解剖理解によって腎動脈の遮断予定部位,温存可能な血管の確認と腫瘍切除に伴う尿路の損傷範囲を予測することが可能となり,詳細な術前計画を立てることができる.しかし,3D画像を生成するためには,医用画像解析ワークステーションとソフトウエアが必要となり,これらを扱うための専門知識がユーザーには求められる.また,多様なソフトウエアをクラウドベースまたはサブスクライブされたアプリケーションの中から,ユーザーの用途に合わせて選択しなければならない.そして,ユーザーはソフトウエアを使って腎臓,腫瘍,腎血管や尿路をセグメンテーションしてラベルデータを作成し,このデータをレンダリングして3D画像を作成することになる.従って,ソフトウエアを使った腎癌3D画像の作成は,RAPNのナビゲーションを実施する上で重要でかつ最初のタスクである.しかし,このタスクを遂行する上で,多くの医療者は医療解析ソフトの特性からその操作方法に至るまでの知識と経験を持ち合わせていない場合があり,3D画像を使ったRAPNのナビゲーションの導入についてハードルが高く感じていることがある.本稿では,ナビゲーションを実践するために重要な腎癌3D画像の作成について,最新の知見を含め報告する.(著者抄録)

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

BACKGROUND: Early intravesical recurrence after transurethral resection of bladder tumors (TURBT) is often caused by overlooking of tumors during TURBT. Although narrow-band imaging and photodynamic diagnosis were developed to detect more tumors than conventional white-light imaging, the accuracy of these systems has been subjective, along with poor reproducibility due to their dependence on the physician's experience and skills. To create an objective and reproducible diagnosing system, we aimed to assess the utility of artificial intelligence (AI) with Dilated U-Net to reduce the risk of overlooked bladder tumors when compared with the conventional AI system, termed U-Net. MATERIAL AND METHODS: We retrospectively obtained cystoscopic images by converting videos obtained from 120 patients who underwent TURBT into 1,790 cystoscopic images. The Dilated U-Net, which is an extension of the conventional U-Net, analyzed these image datasets. The diagnostic accuracy of the Dilated U-Net and conventional U-Net were compared using the following four measurements: pixel-wise sensitivity (PWSe); pixel-wise specificity (PWSp); pixel-wise positive predictive value (PWPPV), representing the AI diagnostic accuracy per pixel; and dice similarity coefficient (DSC), representing the overlap area between the bladder tumors in the ground truth images and segmentation maps. RESULTS: The cystoscopic images were divided as follows, according to the pathological T-stage: 944, Ta; 412, T1; 329, T2; and 116, carcinoma in-situ. The PWSe, PWSp, PWPPV, and DSC of the Dilated U-Net were 84.9%, 88.5%, 86.7%, and 83.0%, respectively, which had improved when compared to that with the conventional U-Net by 1.7%, 1.3%, 2.1%, and 2.3%, respectively. The DSC values were high for elevated lesions and low for flat lesions for both Dilated and conventional U-Net. CONCLUSIONS: Dilated U-Net, with higher DSC values than conventional U-Net, might reduce the risk of overlooking bladder tumors during cystoscopy and TURBT.

DOI： 10.1089/end.2021.0483

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

ロボット支援腎部分切除術の術中超音波検査は,腎腫瘍を確実に切除するために必須である.術中超音波検査に用いられるL43Kプローブは,この術式に使用される超音波プローブの1つであり,術中はフェネストレイテッド鉗子でプローブのフィンを把持して使用する.RAPNは狭い後腹膜腔で鉗子を使ってプローブを操作しなければならず,プローブ先端からフィンを把持することが頻回にあった.このフィンはプローブ先端に向かって傾斜が低くなりかつ放射状に広がっている構造のため,プローブ先端から把持できない設計になっている.これが原因でプローブ先端からの把持は安定せず,プローブを頻回に落としていた.今回我々はプローブの先端から把持しづらい課題に対して,医工連携を通してプローブアタッチメントを開発して解決したので報告する.(著者抄録)

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

There are multiple reports on the value of complete blood count (CBC)-related parameters on prognosis in docetaxel-treated castration-resistant prostate cancer (CRPC) patients before the emergence of androgen receptor pathway inhibitors (ARPIs). We investigated the prognostic significance of CBC-related parameters in docetaxel-treated CRPC patients. Patients treated with docetaxel chemotherapy for CRPC between 2008 and 2018 were included. We analyzed the relevance of CBC-related parameters to oncological prognosis in docetaxel chemotherapy, associated with prior use of novel ARPIs. Among 144 Japanese men treated with docetaxel, 49 men (34.0%) had already received ARPI therapy. A high neutrophil-lymphocyte ratio (NLR) was a prognostic factor for poor progression-free survival and overall survival (OS) in both univariate and multivariate analyses. In addition, a low hemoglobin (Hb) level and a high systemic immune-inflammation index (SII) were prognostic factors of poor OS in univariate analysis. Hb level was a prognostic factor of OS in both ARPI-naive and ARPI-treated patients. However, a high NLR and SII were only associated with a poor prognosis in ARPI-naive but not in ARPI-treated patients. Hb, NLR, and SII have been suggested to be prognosticators in docetaxel-treated CRPC patients. The differential prognostic value of NLR and SII between ARPI-naive and ARPI-treated patients may require caution when using these markers in docetaxel-treated CRPC patients.

DOI： 10.1097/CAD.0000000000001170

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転移性去勢抵抗性前立腺癌(CRPC)の第一選択治療としてアンドロゲン受容体経路阻害剤(ARPI)やドセタキセルの臨床転帰に関する予測マーカーを検討した。2008年から2018年までにARPIまたはドセタキセルによる治療を受けた転移性CRPCの日本人患者254例(年齢中央値73歳)を対象とした。転移性CRPC患者254例のうち、119例と135例がそれぞれARPIとドセタキセルを受けた。多変量解析の結果、ARPIは、ドセタキセルと比較して、無増悪生存期間(PFS)(ハザード比0.62、95%CI 0.42～0.92、p=0.016)および全生存期間(OS)(ハザード比0.61、95%CI 0.41～0.93、p=0.021のより良い独立した予後因子であった。治療前の前立腺特異抗原レベルとCRPCになるまでの期間は、ARPIとドセタキセルでは、PFSやOSと異なる相関が認められた。CRPCを6ヵ月未満で発症した患者のうち、ARPIを受けた患者のPFS(中央値1.1ヵ月、95%CI 0.2～2.8ヵ月)は、ドセタキセルを受けた患者のPFS(中央値5.0ヵ月、95%CI 1.8～6.7ヵ月、p=0.014)よりも短かった。以上より、ARPIによる一次治療は、予後因子を調整した後でも、ドセタキセルと比較してより良い予後と関連していた。

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Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>  Intraoperative laparoscopic ultrasound in robot-assisted partial nephrectomy is essential to reliably remove a renal tumor. The L43K probe used for intraoperative laparoscopic ultrasound is one of the ultrasound probes used in this surgery, and the fins of the probe are grasped with fenestrated forceps during surgery. Surgeons must manipulate the robot in a narrow retroperitoneal cavity and often grip the fins from the probe’s tip. The conventional probe fin toward the probe tip has a structure in which the inclination becomes low grasp is not spread radially, and is designed not to be gripped from the probe tip. Therefore, the unstable while gripping the probe’s tip, and surgeons have frequently dropped the probe. In this study, we propose a solution to resolve this gripping difficulty by developing a probe attachment.</p>

DOI： 10.11302/jserjje.35.1_109

CiNii Research

Language：Japanese   Publisher：Japanese Society of Endourology and Robotics  

<p>　腎腫瘍は局在と形態は多岐にわたり, 腎血管の数と形態にも個体差がある. 従って, ロボット支援腎部分切除術 (robot-assisted partial nephrectomy ; RAPN) では多様な解剖学的特徴を踏まえ手術のアプローチ方法を術前に計画しておく必要がある. この術前計画において, 医療画像から作成された腎癌3D画像は, 腎腫瘍や腎血管の情報を視覚的に理解するのに役立ち, この画像を使った3次元的な解剖理解によって腎動脈の遮断予定部位, 温存可能な血管の確認と腫瘍切除に伴う尿路の損傷範囲を予測することが可能となり, 詳細な術前計画を立てることができる. しかし, 3D画像を生成するためには, 医用画像解析ワークステーションとソフトウエアが必要となり, これらを扱うための専門知識がユーザーには求められる. また, 多様なソフトウエアをクラウドベースまたはサブスクライブされたアプリケーションの中から, ユーザーの用途に合わせて選択しなければならない. そして, ユーザーはソフトウエアを使って腎臓, 腫瘍, 腎血管や尿路をセグメンテーションしてラベルデータを作成し, このデータをレンダリングして3D画像を作成することになる. 従って, ソフトウエアを使った腎癌3D画像の作成は, RAPNのナビゲーションを実施する上で重要でかつ最初のタスクである. しかし, このタスクを遂行する上で, 多くの医療者は医療解析ソフトの特性からその操作方法に至るまでの知識と経験を持ち合わせていない場合があり, 3D画像を使ったRAPNのナビゲーションの導入についてハードルが高く感じていることがある.</p><p>　本稿では, ナビゲーションを実践するために重要な腎癌3D画像の作成について, 最新の知見を含め報告する.</p>

DOI： 10.11302/jserjje.35.2_198

CiNii Research

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

2022, 35：1－5.

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Language：English  

DOI： 10.1002/iju5.12349

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

<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.</jats:p>
</jats:sec>

DOI： 10.1093/bjs/znab101

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

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

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

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

PURPOSE: The aim of this study was to determine the prevalence of collecting system invasion (CSI) on multiphasic CT, validate the pathological findings, and investigate the relationship between CSI and clinical outcomes in patients with renal cell carcinomas (RCC). METHODS: Patients pathologically diagnosed with RCC between January 2008 and December 2017 were retrospectively enrolled in this study. They were divided into two groups according to the presence of CSI on multiphasic CT images. Patients' clinical characteristics, radiological findings, and overall survival (OS) and recurrence-free survival (RFS) rates were analyzed and compared between the groups. In addition, the correlation of radiological findings with pathological findings was investigated. RESULTS: Among the included 347 kidneys of 340 patients, CSI was observed in 11 kidneys (3%; 95% confidence interval, 1.3-5.0%). In all the 11 kidneys, the tumors were pathologically diagnosed as clear cell RCC, and in one kidney, the tumor also had sarcomatoid features. When pathological CSI served as the standard of reference, the sensitivity, specificity, and accuracy of CSI on CT were 50%, 99.7%, and 97.1%, respectively. The OS and RFS rates were not significantly different between patients with CSI on CT and those without CSI. CONCLUSION: This study found that the prevalence of RCC-related CSI was 3%. Because of the low prevalence, we cannot exclude the possibility that CSI on CT would be associated with the OS and RFS. Further studies are needed to determine whether CSI on CT can be an independent prognostic factor for survival in patients with RCC.

DOI： 10.1007/s00261-020-02859-y

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

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

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

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

DOI： 10.1097/JU.0000000000000709.02

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

PURPOSE: We investigated the relationship between the surgical navigation system and postoperative parenchyma preservation volume, and assessed the feasibility of image guided surgery in robot-assisted partial nephrectomy. MATERIALS AND METHODS: We developed surgical navigation with registration between real-time endoscopic images using 3-dimensional virtual reality models for robot-assisted partial nephrectomy. Surgical outcomes of 44 (nonsurgical navigation group) and 102 (surgical navigation group) patients between June 2013 and December 2018 were retrospectively analyzed. To adjust for potential baseline confounders propensity score matching (1:1) was performed. Renal parenchymal preservation rate and extraparenchymal volume with a tumor including functional and oncological outcomes ("trifecta" defined as warm ischemia time of less than 25 minutes, no complications and negative surgical margins; "pentafecta" defined as trifecta plus greater than 90% preservation of estimated glomerular filtration rate at 12 months postoperatively and chronic kidney disease up staging) were evaluated using volumetric analysis and compared. RESULTS: After matching, 42 patients were allocated to each group. No significant differences in baseline characteristics; complications; and intraoperative, trifecta and pentafecta outcomes were observed between the 2 groups. Pathological T stages were significantly different between the groups (T1a/T1b/T2a or more 25/10/7 in the nonsurgical navigation group vs 35/7/0 in the surgical navigation group, p=0.003). Extraparenchymal volumes and parenchyma volume preservation rates were significantly higher in the surgical navigation group (21.4 vs 17.2 ml, p=0.041 and 83.5% vs 90.0%, p=0.042, respectively). Surgical navigation was positively associated with improved parenchyma preservation volume (p=0.003). CONCLUSIONS: Surgical navigation preserves renal parenchyma in robot-assisted partial nephrectomy and may contribute to improvement in postoperative renal function.

DOI： 10.1097/ju.0000000000000709

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

PURPOSE: To assess surgical skills in robot-assisted partial nephrectomy (RAPN) with and without surgical navigation (SN). METHODS: We employed an SN system that synchronizes the real-time endoscopic image with a virtual reality three-dimensional (3D) model for RAPN and evaluated the skills of two expert surgeons with regard to the identification and dissection of the renal artery (non-SN group, n = 21 [first surgeon n = 9, second surgeon n = 12]; SN group, n = 32 [first surgeon n = 11, second surgeon n = 21]). We converted all movements of the robotic forceps during RAPN into a dedicated vocabulary. Using RAPN videos, we classified all movements of the robotic forceps into direct action (defined as movements of the robotic forceps that directly affect tissues) and connected motion (defined as movements that link actions). In addition, we analyzed the frequency, duration, and occupancy rate of the connected motion. RESULTS: In the SN group, the R.E.N.A.L nephrometry score was lower (7 vs. 6, P = 0.019) and the time to identify and dissect the renal artery (16 vs. 9 min, P = 0.008) was significantly shorter. The connected motions of inefficient "insert," "pull," and "rotate" motions were significantly improved by SN. SN significantly improved the frequency, duration, and occupancy rate of connected motions of the right hand of the first surgeon and of both hands of the second surgeon. The improvements in connected motions were positively associated with SN for both surgeons. CONCLUSION: This is the first study to investigate SN for nephron-sparing surgery. SN with 3D models might help improve the connected motions of expert surgeons to ensure efficient RAPN.

DOI： 10.1007/s11548-019-01980-8

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

The rate of incidence of febrile infection and the antimicrobial drug used at the time of prostate needle biopsy was examined retrospectively. SPFX (sparfloxacin) 400 mg (January 2007 to March 2010) and LVFX (levofloxacin) 500 mg (April 2010, onward) were administered prophylactically in 1,034 patients undergoing transrectal or transperineal prostate biopsy. One febrile infection occurred and resolved in each group. A single dose of LVFX 500 mg before the procedure effectively prevented febrile infection in both transrectal and transperineal prostate needle biopsy.

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Advances in image navigation surgery

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Biomedical engineering for medical use

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Construction of an image conversion model that outputs 3D organ model images from robot-assisted surgery endoscopic images

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Research and development towards the feasibility of ureteroscopy-assisted robots

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Automatic segmentation of prostate and extracapsular structures in MRI to predict needle deflection in percutaneous prostate intervention.

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Automatic segmentation of prostate and extracapsular structures in MRI to predict needle deflection in percutaneous prostate intervention

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Development of automatic tracking surgical navigation using 3D images and an optical tracking system in the da Vinci Surgical System Xi -Toward standardization of navigation-

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Practice of RAPN using navigation system

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Resectoscope with micromanipulator

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Effectiveness of the navigation system in RAPN -How has navigation changed surgery-

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Surgical Strategy in RAPN: Introduction of 3D Imaging Intraoperative Navigation

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The preservation of more normal renal parenchyma improves the operated renal function decreased by partial nephrectomy.

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Surgical navigation in robot-assisted partial nephrectomy preserves the affected kidney.

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Trends in navigation development in robotic surgery at our hospital

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Investigation of artificial intelligence algorithm used for image support in cystoendoscopy

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Assessment of surgical skills by using surgical navigation in robot-assisted partial nephrectomy.

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Development of next-generation surgical navigation system in Robot-assisted partial nephrectomy

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Novel robotic navigation system

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Augmented Reality to RAPN Augmented Reality Surgical Navigation System Development

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Tumor detection from cystoscopic images by U-Net using Tri-Scan-enhanced images

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Robot-assisted partial nephrectomy ~Ingenuity for preserving renal function~

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Surgical navigation in robot-assisted partial nephrectomy preserves the affected kidney

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Surgical navigation in robot-assisted partial nephrectomy preserves the affected kidney

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Examination of the effectiveness of automatic tracking type surgical navigation in robot-assisted partial nephrectomy

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Ingenuity of renal hilum tumor in our hospital - Surgical navigation in RAPN -

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SURGICAL NAVIGATION USING INTUITIVE IMAGE-TO-PATIENT REGISTRATION FOR ROBOT-ASSISTED PARTIAL NEPHRECTOMY

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Surgical Navigation using Intuitive Image-to-Patient Registration for Robot-Assisted Partial Nephrectomy: Clinical Feasibility study.

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Surgical navigation using intuitive image-to-patient registration for robot-assisted partial nephrectomy: clinical feasibility study

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Expanding RAPN indications through navigation

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Robotic Surgical Navigation Development and Clinical Application at Kyushu University

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Challenge to develop robotic surgical navigation at Kyushu University

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Application of automatic tracking type surgical navigation system to robot-assisted partial nephrectomy and future prospects

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Presentation type：Symposium, workshop panel (nominated)  

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J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本泌尿器内視鏡・ロボティクス学会  

腎腫瘍は局在と形態は多岐にわたり,腎血管の数と形態にも個体差がある.従って,ロボット支援腎部分切除術(robot-assisted partial nephrectomy;RAPN)では多様な解剖学的特徴を踏まえ手術のアプローチ方法を術前に計画しておく必要がある.この術前計画において,医療画像から作成された腎癌3D画像は,腎腫瘍や腎血管の情報を視覚的に理解するのに役立ち,この画像を使った3次元的な解剖理解によって腎動脈の遮断予定部位,温存可能な血管の確認と腫瘍切除に伴う尿路の損傷範囲を予測することが可能となり,詳細な術前計画を立てることができる.しかし,3D画像を生成するためには,医用画像解析ワークステーションとソフトウエアが必要となり,これらを扱うための専門知識がユーザーには求められる.また,多様なソフトウエアをクラウドベースまたはサブスクライブされたアプリケーションの中から,ユーザーの用途に合わせて選択しなければならない.そして,ユーザーはソフトウエアを使って腎臓,腫瘍,腎血管や尿路をセグメンテーションしてラベルデータを作成し,このデータをレンダリングして3D画像を作成することになる.従って,ソフトウエアを使った腎癌3D画像の作成は,RAPNのナビゲーションを実施する上で重要でかつ最初のタスクである.しかし,このタスクを遂行する上で,多くの医療者は医療解析ソフトの特性からその操作方法に至るまでの知識と経験を持ち合わせていない場合があり,3D画像を使ったRAPNのナビゲーションの導入についてハードルが高く感じていることがある.本稿では,ナビゲーションを実践するために重要な腎癌3D画像の作成について,最新の知見を含め報告する.(著者抄録)

J-GLOBAL

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (scientific journal)  

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