Publications by authors named "Hidetoshi Kokubun"
Dose compliance of estramustine phosphate in neoadjuvant chemohormonal therapy combined with degarelix acetate predicts the biochemical recurrence in patients with very high-risk prostate cancer who underwent robot-assisted radical prostatectomy.
Int J Urol
December 2024
Article Synopsis
- The study aimed to assess the safety and effectiveness of neoadjuvant treatment with degarelix acetate and low-dose estramustine phosphate in men with high-/very high-risk prostate cancer before surgery.
- A total of 187 patients participated, with 140 undergoing surgery after receiving 6 months of the treatment, highlighting adverse events, surgical outcomes, and rates of biochemical recurrence.
- Results showed that patients with very high-risk status and those who reduced the dose of estramustine phosphate had lower rates of biochemical recurrence, indicating that maintaining dose compliance may impact survival outcomes in this group.
Article Synopsis
- - The study aimed to assess the effectiveness and safety of a chemotherapy regimen, dose-dense gemcitabine and cisplatin (ddGC), in treating muscle-invasive bladder cancer (MIBC) before surgery.
- - Out of 45 patients treated, 92.7% completed the planned chemotherapy cycles, achieving a pathological complete response in 29.3% and an objective response in 41.5%.
- - The results indicated that ddGC was well-tolerated, with severe adverse effects in only 17.8% of patients, and showed promising 2-year disease-free and overall survival rates of 70.8% and 89.2%, respectively.
Article Synopsis
- Bladder diverticula in older adults usually result from bladder outlet obstruction and are commonly treated alongside prostate issues using bladder diverticulectomy.
- The reported study involved three patients who successfully underwent bladder diverticulectomy through a single cystotomy during robot-assisted laparoscopic radical prostatectomy, which minimizes complications and reduces surgery time.
- The technique utilized a transvesical approach via the bladder neck for diverticula that are easily visible, making it a practical option compared to other methods that might require more invasive surgery.
Introduction: In addition to reduced nectin-4 expression, the upregulation of ATP-binding cassette transporters has been suggested as a potential mechanism of resistance to enfortumab vedotin.
Case Presentation: A 76-year-old man previously treated with platinum-containing chemotherapy and pembrolizumab for metastatic bladder cancer was administered enfortumab vedotin because of disease progression. Subsequently, metastasectomy was performed for oligometastatic lesions (in the lung and adrenal gland) that exhibited growth during enfortumab vedotin therapy.
Introduction: Oligometastatic prostate cancer can be well-controlled through combined local and metastasis-directed therapies. However, the effects of cytoreductive radical prostatectomy and metastasectomy remain unclear.
Case Presentation: A 52-year-old man presented with prostate cancer and isolated bone metastasis to the thoracic spine.
Introduction: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC); however, validating body composition-related biomarkers for their efficacy remains incomplete. We evaluated the association between body composition-related markers and the prognosis of patients with mRCC who received ICI-based first-line therapies.
Patients And Methods: We retrospectively investigated 60 patients with mRCC who underwent ICI-based therapy as their first-line treatment between 2019 and 2023.
Introduction: Although undifferentiated pleomorphic sarcomas are aggressive, a subset of these tumors are immunogenic and may respond to immunotherapy.
Case Presentation: A 69-year-old man developed bilateral adrenal tumors and underwent bilateral adrenalectomy. Pathological examination revealed undifferentiated pleomorphic sarcoma harboring tertiary lymphoid structures and infiltration of CD8 T cells.
Article Synopsis
- The study aimed to evaluate how the shape of central tumours affects outcomes for patients undergoing robot-assisted partial nephrectomy (RAPN).
- A total of 186 patients were analyzed, categorizing tumour shapes into four types and assessing their impact on achieving the defined "trifecta," which indicates successful surgical outcomes.
- Results showed that tumours with complex-hump shapes had a significantly higher likelihood of failing the trifecta, highlighting the importance of preoperative morphology assessment in surgical planning.
Article Synopsis
- The study aimed to determine if placing prophylactic drains after laparoscopic nephroureterectomy for upper tract urothelial cancer is necessary.
- It analyzed outcomes of 164 patients from 2011 to 2021, comparing those with (D+) and without (D-) drain placement.
- Results showed no significant difference in complications between groups, but the D- group had a notably shorter hospital stay, indicating drains may not be needed.
Previous studies indicated the occurrence of compartment syndrome after testicular detorsion. In such cases, testicular blood flow may improve with tunica albuginea incision. A 14-year-old man presented with right-sided testicular torsion.
View Article and Find Full Text PDFArticle Synopsis
- After 4 years of hormone treatment, his PSA levels improved significantly, leading to a decision for salvage robot-assisted prostate surgery due to non-metastatic castration-resistant prostate cancer.
- Post-surgery, the patient's PSA dropped to undetectable levels, allowing him to stop hormone therapy, and he remained free of cancer recurrence for 3 years.
Article Synopsis
- The study compares robot-assisted (CRO-RAPN) and laparoscopic (CRO-LPN) techniques in partial nephrectomy for patients with localized renal masses from July 2012 to June 2020.! -
- Results showed that CRO-RAPN had significantly better outcomes, including shorter operation and warm ischemic times, less blood loss, and lower complication rates compared to CRO-LPN.! -
- Overall, CRO-RAPN also demonstrated a higher preservation rate of kidney function and a greater trifecta achievement rate, indicating its superiority in surgical performance and patient recovery.!
A retrocaval ureter (RCU) is a rare cause of congenital ureteral obstruction that often requires surgical repair. We report two cases of RCU in adults treated with robot-assisted laparoscopic surgery. In both cases, we performed robotic ureteroureterostomy with dissection of the entire length of the retrocaval portion of the right ureter without complications.
View Article and Find Full Text PDFArticle Synopsis
- The study assessed the effects of continuing antithrombotic therapy during surgery on bleeding and complications in patients undergoing laparoscopic radical nephrectomy and nephroureterectomy.
- It was conducted as a retrospective observational analysis, comparing outcomes between patients who continued their antithrombotic medications and those who did not, focusing on bleeding complications and other surgical markers.
- The findings suggest that perioperative antithrombotic therapy does not significantly increase bleeding risk, indicating it is safe to continue during these surgical procedures.
Article Synopsis
- Cytoreductive nephrectomy is a surgical technique used with systemic therapy to treat metastatic renal cell carcinoma, but its effectiveness alongside immune checkpoint inhibitors is debated.
- A 57-year-old woman with advanced renal cell carcinoma and lung metastases achieved complete response in her lungs following immunotherapy and underwent partial nephrectomy for the primary tumor after five months of treatment.
- One year after surgery, she remained free of cancer recurrence, suggesting that cytoreductive surgery may be a viable option in managing metastatic renal cell carcinoma.
Article Synopsis
- A study aimed to compare the effectiveness of two diagnostic methods, 5-ALA-mediated photodynamic diagnosis (PDD) and narrow-band imaging (NBI), for detecting bladder cancer during transurethral resection of bladder tumors (TURBT).
- In the study, 114 patients were given 5-ALA and their bladders were inspected using white light (WL), PDD, and NBI, with results compared to pathology outcomes.
- The findings revealed that PDD had a higher sensitivity for detecting cancerous lesions than NBI (89.6% vs. 76.2%), suggesting that adding PDD to conventional methods can improve cancer detection rates significantly, especially for carcinoma in situ (CIS
Article Synopsis
- The study analyzed 305 laparoscopic and 202 robot-assisted radical prostatectomies performed between April 2007 and April 2018, identifying 68 cases of positive lymph node metastasis (pN1).
- Among 62 cases that underwent extended lymph node dissection, the median number of lymph nodes removed was 25, with a median of 1 metastatic lymph node, and 40 patients experienced PSA recurrence within a median of 24 months.
- Key risk factors for PSA recurrence identified through analysis included initial PSA levels of 10 ng/ml or higher, Gleason scores of 8 or higher, and positive surgical margins, indicating that patients without these risk factors might avoid immediate adjuvant therapy despite having p
Article Synopsis
- The study aimed to evaluate how continuing anticoagulant medications during robot-assisted radical prostatectomy affects bleeding and complication rates in patients.
- A total of 606 patients were analyzed, with 31 continuing anticoagulant therapy, and their outcomes compared to those who were on different antithrombotic treatments or none at all.
- Results showed that continuing anticoagulants did not significantly increase bleeding complications or other adverse outcomes compared to other groups, suggesting these medications can be safely continued during surgery.
Article Synopsis
- * Out of 115 patients, 25% had oncological recurrences, with higher rates of atypical failures noted in those who had laparoscopic and robot-assisted procedures compared to the open procedure.
- * The findings suggest that patients with advanced disease (cT ≥ 3) and certain pathological variants may be at higher risk post-surgery and should be cautious about laparoscopic techniques in early experience.
Article Synopsis
- - The study evaluates the surgical outcomes and learning curve of laparoscopic intracorporeal urinary diversion (ICIC) in patients undergoing laparoscopic radical cystectomy (LRC) for bladder cancer at a single facility, comparing it to extracorporeal ileal conduit (ECIC) procedures.
- - Out of 38 patients, ICIC showed a lower rate of high-grade complications (3%) compared to ECIC (25%), with no wound infections in the ICIC group, while operative times and estimated blood loss were comparable.
- - The findings suggest that LRC with ICIC is safe and associated with fewer severe complications, and the learning curve indicated improved efficiency over time, as urinary diversion time significantly decreased with consecutive cases
Lymphovascular invasion (LVI) by urothelial carcinoma of the upper urinary tract (UC-UUT) is associated with an unfavorable prognosis. However, a high proportion of patients with UC-UUT are unable to receive the recommended doses of cisplatin-based adjuvant chemotherapy due to advanced age or renal dysfunction resulting from nephroureterectomy. Tegafur-uracil is an oral form of 5-fluorouracil whose efficacy is influenced by the activities of enzymes associated with its metabolism, such as dihydropyrimidine dehydrogenase (DPD), orotatephosphoribosyltransferase (OPRT) and thymidylate synthase (TS).
View Article and Find Full Text PDFBackground: Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI.
Materials And Methods: Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study.