Prognostic significance of thymidylate synthase expression in patients with prostate cancer undergoing radical prostatectomy.

Objectives: Thymidylate synthase (TS), a key enzyme in DNA synthesis, is overexpressed in a variety of cancer cells. 5-Fluorouracil (5-FU), an anticancer agent used clinically against various cancers, including prostate cancer, inhibits DNA synthesis by binding TS. In this study, we investigated the expression of TS in prostate cancer and its prognostic significance.

Upregulation of heme oxygenase and collagen type III in the rat bladder after partial bladder outlet obstruction.

The objective of the study was to evaluate possible changes of the gene expression and localization of the enzymes, heme oxygenase and nitric oxide synthase (NOS), with reference to increase of collagen type III in response to the partial obstruction of the bladder. Following initial obstruction, whole rat bladders were removed for real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Real-time RT-PCR demonstrated significantly enhanced expression of HO (p < 0.

Overexpression of XIAP expression in renal cell carcinoma predicts a worse prognosis.

X-linked inhibitor of apoptosis protein (XIAP) is the most potent caspase-inhibitory IAP family member and a negative regulator of various apoptotic stimuli. Thus, XIAP overexpression in cancer cells may select for tumor cell survival following various cytotoxic therapeutic modalities. The anatomical staging system in renal cell carcinoma (RCC) currently provides good prognostic information, albeit insufficient.

Clinical efficacy of alternative antiandrogen therapy in Japanese men with relapsed prostate cancer after first-line hormonal therapy.

Background: To confirm the effectiveness of alternative antiandrogen therapy (AAT) in Japanese patients with prostate cancer relapse after first-line hormonal therapy.

Methods: A total of 80 patients who had successive serum prostate-specific antigen (PSA) progression after first-line hormonal therapy (luteinizing hormone-releasing hormone agonist alone: 21 cases; combined antiandrogen blockade therapy: 59 cases) were enrolled. We evaluated the positive ratio of antiandrogen withdrawal syndrome (AWS), the PSA responses with second- and third-line AAT, and cause-specific survival in terms of the effectiveness of AAT.

Laparoscopic partial nephrectomy for incidental stage pT2 or worse tumors.

Objectives: To present our experience with laparoscopic partial nephrectomy (LPN) in patients with an incidentally detected Stage pT2, pT3a, or pT3b renal mass.

Methods: Of 525 patients undergoing LPN, 21 (4%) had pT2 or worse disease. LPN routinely involved en bloc excision of the overlying perirenal fat, along with the tumor and a healthy parenchymal margin.

Nerve-sparing laparoscopic radical cystectomy: technique and initial outcomes.

Objectives: To report the technique and early outcomes of nerve-sparing laparoscopic radical cystectomy with continent orthotopic ileal neobladder in selected male and female patients with bladder cancer.

Methods: Since 2000, 52 patients have undergone laparoscopic radical cystectomy at our institution, with nerve-sparing laparoscopic radical cystectomy performed in 5 patients. In the nerve-sparing technique, transection of the lateral vascular pedicle and the posterior dissection proceeds closer to the bladder, at some distance from the rectum.

Significant relationship of time-dependent uroflowmetric parameters to lower urinary tract symptoms as measured by the International Prostate Symptom Score.

Aims: The aim of the present paper is to elucidate the possible involvement of time-dependent parameters as obtained by uroflowmetry in the manifestation of lower urinary tract symptoms (LUTS) in elderly patients.

Methods: Using simple and multiple regression analyses, the correlation of the International Prostate Symptom Score (IPSS) with objective parameters including age, postvoid residual, uroflowmetry and transrectal ultrasonic measurements of the prostate was analyzed in 206 male patients (average age of 68.0 +/- 7.

Visual analog scale questionnaire to assess quality of life specific to each symptom of the International Prostate Symptom Score.

Purpose: We assessed patient quality of life specific to each of the 7 items on the International Prostate Symptom Score, as evaluated with a novel visual analog scale questionnaire.

Materials And Methods: A total of 246 male patients with a chief complaint of lower urinary tract symptom were asked to complete the International Prostate Symptom Score and visual analog scale questionnaires to assess bother or satisfaction regarding patient quality of life specific to each of the 7 items on the International Prostate Symptom Score.

Results: An item with the maximum visual analog scale measure matched the chief complaint in 169 patients (69%).

Real-time transrectal ultrasound guidance during nerve sparing laparoscopic radical prostatectomy: pictorial essay.

Purpose: We report that real-time TRUS can visualize prostate/periprostatic anatomy and provide intraoperative navigation during nerve sparing LRP. Real-time TRUS navigation during radical prostatectomy, whether open or laparoscopic, is a novel application about which little is known.

Materials And Methods: Transperitoneal LRP with TRUS guidance has been performed in 77 consecutive men since March 2003.

Real-time transrectal ultrasound guidance during laparoscopic radical prostatectomy: impact on surgical margins.

Purpose: We evaluated whether intraoperative real-time TRUS navigation during LRP can decrease the incidence of positive surgical margins.

Materials And Methods: Since March 2001, 294 patients with clinically organ confined prostate cancer undergoing LRP have been retrospectively divided into 2 groups, including group 1-217 who underwent LRP without TRUS from March 2001 to February 2003 and group 2-77 who have undergone LRP with TRUS since March 2003. Various baseline parameters were similar between the groups.

Four-dimensional ultrasonography for dynamic bladder shape visualization and analysis during voiding.

Objective: The purpose of this study was to describe initial applications of 4-dimensional ultrasonography (4DUS) for visualizing dynamic change in 3-dimensional (3D) bladder shape as well as for analyzing intravesical volume and diameters during voiding.

Methods: In 15 healthy volunteers and 5 patients with lower urinary tract symptoms, 4DUS images of the bladder during voiding were obtained by transabdominal 4DUS and compared with the outcome of uroflowmetry. Changes of intravesical volume as well as diameters in axial, coronal, and sagittal planes were measured and analyzed in comparison with uroflow data.

Running suture for vesicourethral anastomosis in minilaparotomy radical retropubic prostatectomy.

Introduction: We used a running suture method for vesicourethral anastomosis in patients undergoing minilaparotomy radical retropubic prostatectomy.

Technical Considerations: The vesicourethral anastomosis using a single knot at the 6:30-o'clock position is created with two steps of semicircular running suture. A total of 21 consecutive patients underwent this running suture method using the Endostitch in the hands of a single surgeon (T.

Complexed PSA improves prostate cancer detection: results from a multicenter Japanese clinical trial.

Objectives: To compare the distribution of total and complexed prostate-specific antigen (cPSA) in men with and without prostate cancer with another studied population and to ascertain whether cPSA could enhance the detection of prostate cancer in Japanese men.

Methods: A total of 760 men whose serum total PSA (tPSA) values ranged from 1.0 to 100 ng/mL were enrolled.

Laparoscopic partial nephrectomy in solitary kidney.

Purpose: We report our experience with LPN for tumor in a solitary kidney.

Materials And Methods: Of 430 patients undergoing LPN since February 1999 at our institution 22 (5%) underwent LPN for tumor in a solitary kidney, as performed by a single surgeon. The laparoscopic technique that we used duplicated open principles, including hilar clamping, cold cut tumor excision and sutured renal reconstruction.

[Radio-frequency ablation of T1a renal cell carcinoma].

We report the efficacy of radio-frequency ablation (RFA) for T1a renal cell carcinoma (RCC). RFA was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in seven patients with Tla RCC, who were at significant operative or anesthetic risk for invasive surgery. At a median follow-up of 17.

Potassium-titanyl-phosphate laser laparoscopic partial nephrectomy without hilar clamping in the survival calf model.

Purpose: Laparoscopic partial nephrectomy (LPN) with hilar clamping represents the various challenges associated with warm ischemia. We tested the feasibility, and acute and chronic outcomes of LPN using a potassium-titanyl-phosphate (KTP) laser without vascular hilar clamping in the survival calf model.

Materials And Methods: Six Jersey calves weighing 76 to 94 kg underwent a total of 12 staged bilateral transperitoneal laser LPNs of the mid/lower pole using an 80 W KTP laser, including left kidney chronic LPN with 1-month followup in 6 and right kidney acute LPN with immediate sacrifice in 6.

Prospective, randomized comparison of transperitoneal versus retroperitoneal laparoscopic adrenalectomy.

Purpose: We report a prospective, randomized comparison of transperitoneal laparoscopic adrenalectomy (TLA) vs retroperitoneal laparoscopic adrenalectomy (RLA) for adrenal lesions with long-term followup.

Materials And Methods: Between December 1997 and November 1999, 57 consecutive eligible patients with surgical adrenal disease were prospectively randomized to undergo TLA (25) or RLA (32). Study exclusion criteria were patient age greater than 80 years, body mass index greater than 40, bilateral adrenalectomy and significant prior abdominal surgery in the quadrant of interest.

Outpatient laparoscopic pyeloplasty.

Objectives: To assess the feasibility of ambulatory laparoscopic pyeloplasty. Laparoscopic pyeloplasty aims to reproduce the excellent functional outcomes of open pyeloplasty while diminishing procedural morbidity.

Methods: Six patients fulfilled specific inclusion criteria for outpatient laparoscopic pyeloplasty: informed consent, body mass index of 40 kg/m2 or less, primary ureteropelvic junction obstruction, uncomplicated laparoscopic surgery completed by 12:00 pm, and postoperative pain control by oral analgesics.

Preoperative administration of chlormadinone acetate reduces blood loss associated with transurethral resection of the prostate: a prospective randomized study.

Objectives: To assess the effects of giving chlormadinone acetate (CMA) before surgery on blood loss associated with transurethral resection of the prostate (TURP), in a prospective randomized controlled study.

Patients And Methods: Candidates for TURP among patients with benign prostatic hyperplasia were randomized to either treatment with CMA (CMA+) or not (CMA-). In principle, CMA was started at least 28 days before TURP and continued until just before surgery.

Laparoscopic radical cystectomy and urinary diversion.

Most of the publications regarding laparoscopic radical cystectomy (LRC) have reported the institutions' initial experience focusing on technique and perioperative results. Increasing experience from major medical centers worldwide indicates increasing interest and expertise with LRC. In this manuscript, initial laboratory experience, contemporary series, current controversies, and future directions of the procedure are discussed.

Lateral pedicle control during laparoscopic radical prostatectomy: refined technique.

Objectives: To report a technique of lateral pedicle control during laparoscopic radical prostatectomy that completely eliminates any form of electrocautery, ultrasonic thermal energy, clips, or bioadhesives.

Methods: The technique was used in 25 men undergoing nerve-sparing laparoscopic radical prostatectomy. Our antegrade technique involves transient control of the lateral prostate pedicles with an atraumatic vascular bulldog clamp.

Radio-frequency ablation of renal cell carcinoma in patients who were at significant risk.

Objective: Although radio-frequency ablation (RFA) has been recently applied as a minimally invasive treatment option for renal cell carcinoma (RCC), indication of this modality remains a critical issue due to the lack of complete tumor destruction as well as the uncertainty of its long-term efficacy. We report the efficacy of RFA for nine carefully selected patients with RCC who had significant reason to avoid invasive surgical treatment under general anesthesia.

Methods: Radio-frequency ablation was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in nine patients with biopsy proven RCC (mean diameter, 38 mm; range, 20-53 mm), who were at significant operative or anesthetic risk for invasive surgery.

Learning curve of hand-assisted retroperitoneoscopic nephrectomy in less-experienced laparoscopic surgeons.

Aim: To evaluate the learning curve of hand-assisted retroperitoneoscopic nephrectomy (HALS) performed by less-experienced surgeons.

Methods: The operative records of 166 patients, including 103 with renal tumors and 63 with renal pelvic or ureteral tumors, who underwent HALS performed by 18 less-experienced urologists were reviewed.

Results: The insufflation time in the first four cases was significantly longer than that in the sixteenth and later cases.

Effects of acupuncture for chronic pelvic pain syndrome with intrapelvic venous congestion: preliminary results.

Background: The present study was designed to reveal the usefulness of acupuncture for chronic pelvic pain syndrome with intrapelvic venous congestion as evaluated by symptom scores, transrectal ultrasonography (TRUS) and magnetic resonance (MR) venography.

Methods: Ten male patients suffering from non-inflammatory chronic pelvic pain syndrome (NIH category IIIB) with intrapelvic venous congestion were treated using acupuncture. Eight patients had previously received pharmacotherapy, which was unsuccessful.

Hand-assisted retroperitoneoscopic radical nephrectomy and nephroureterectomy.

In laparoscopic operations for renal tumor and upper urinary-tract transitional-cell carcinoma (TCC), three approaches - the transperitoneal, retroperitoneal, and transperitoneal hand-assisted - have been reported. We have performed hand-assisted retroperitoneoscopic radical nephrectomy (RN) since 1999 and nephroureterectomy (NU) since 2000. The surgical techniques and the operative results of 95 cases of RN and 54 cases of NU are described and analyzed.