Department of Urology

Hitoshi Masuda, Yasukazu Nakanishi, Shugo Yajima, Madoka Kataoka, Kenji Tanabe, Naoya Okubo, Yosuke Umino

Introduction

The Department of Urological Surgery has existed as part of the Department of Pelvic Surgery at the National Cancer Center Hospital East since 2003. This department mainly treats all urogenital malignant diseases, including kidney cancer, urothelial cancer, prostate cancer, testicular germ cell tumors, and retroperitoneal sarcomas. We usually perform minimally invasive surgeries such as robotic, laparoscopic and minimum incision endoscopic surgery, preserving the sexual and/or voiding functions in prostate cancer and organ function, especially in kidney cancer.

The Team and What We Do

Outpatient activities: An outpatient clinic is open four days a week in the Department of Urology. Flexible cystoscopy, abdominal ultrasonography, retrograde pyelography and prostate biopsy are performed in the outpatient clinic. Superficial bladder cancer (G3, cis, or recurrent tumor) after TUR-Bt is treated by instillation of BCG into the bladder. Advanced urogenital cancers including metastatic prostate cancer are referred to the medical oncology division for chemotherapy or hormonal therapy. Extrinsic obstructions of the upper urinary tract that directly result from invasion of an adjacent malignancy or peritoneal metastasis are also treated. Selection of internal stenting or percutaneous nephrostomy depends on malignancy type and degree of obstruction. 105 patients newly received ureteral stents and 58 underwent nephrostomy for obstructive uropathy in 2021. Moreover, 194 patients newly received insertion of markers or spacers for radiation therapy for localized prostate cancer in 2021.

• Inpatient activities: A daily conference is held for diagnosis and treatment of patients with urological cancer. Surgeries, especially all robotic surgeries, have consistently increased over time. In the Department of Urology, 780 surgeries were performed this year (Table 1). Also, we performed 20 combination surgeries with colorectal surgeons in 2021.
• Other: We have a conference on urogenital cancers every other week among medical oncologists, radiation oncologists, and pathologists. Neoadjuvant chemotherapy for muscle invasive bladder cancer, combination hormone and radiation therapy for prostate cancer, treatment strategies for metastatic renal cell carcinoma and testicular cancer, and so on are determined in the meeting.

Table 1. Number of patients


Table 2. Type of procedure

Research activities

1. We investigated the risk factors of progression of high-risk superficial bladder cancer. Also, we investigated the resistance mechanisms of BCG therapy for high-risk superficial bladder cancer.

2. We investigated the usefulness of novel robot surgery techniques, including radical prostatectomy and radical cystectomy.

3. We investigated the role of MRI-DWI in the evaluation of the malignant potential of bladder and upper urinary tract cancers.

4. We investigated the usefulness of stem cell therapy for urinary incontinence after radical prostatectomy in a rat model.

5. Nine peer-reviewed papers were accepted.

Clinical trials

1.  A phase III study: BCG instillation for high-grade T1 bladder cancer (JCOG1019)

2.  A phase III study: Pirarubicin instillation after nephroureterectomy for upper tract urothelial carcinoma (JCOG1403)

3.  A phase II clinical study: Penbrolizumab in high-risk NMIBC unresponsive to BCG (MK-3475-057)

4.  A phase III clinical study: Penbrolizumab in MIBC (MK-3475-866)

5.  A phase III clinical study: Adenovirus-mediated gene therapy in high-risk NMIBC unresponsive to BCG (CG0070)

Education

We accepted four voluntary residents of urology in 2021 and educated them on urological surgery and clinical studies.

Future prospects

1. We will develop new and useful techniques for robot-assisted surgeries of the prostate, bladder and kidneys.

2. We will start a clinical trial of stem cell therapy for urinary incontinence after radical prostatectomy.

List of papers published

Journal

1. Tanabe K, Nakanishi Y, Matsumoto S, Yajima S, Kuroe T, Watanabe R, Arai Y, Iwata S, Ito M, Masuda H. Utility of a multidisciplinary team approach with transanal total mesorectal excision for resection of a large pelvic solitary fibrous tumor. IJU case reports, 5:104-107, 2022

2. Yajima S, Nakanishi Y, Matsumoto S, Ookubo N, Tanabe K, Masuda H. Strangulated ileus from barbed suture following robot-assisted radical cystectomy: A case report. Urology case reports, 40:101916, 2022

3. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Tsuboi M, Masuda H. Prognostic significance of the postoperative/ preoperative serum CEA level ratio in patients with solitary adrenal metastasis from lung cancer. Molecular and clinical oncology, 16:10, 2022

4. Nishimura N, Miyake M, Iida K, Miyamoto T, Tomida R, Numakura K, Inokuchi J, Yoneyama T, Matsumura Y, Yajima S, Masuda H, Terada N, Taoka R, Kobayashi T, Kojima T, Matsui Y, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K. Prognostication in Japanese patients with bacillus CalmetteGuérin-unresponsive non-muscle-invasive bladder cancer undergoing early radical cystectomy. International journal of urology: official journal of the Japanese Urological Association, 29:242-249, 2022 2

5. Yajima S, Nakanishi Y, Matsumoto S, Ookubo N, Tanabe K, Kataoka M, Masuda H. The Mini-Cog: A simple screening tool for cognitive impairment useful in predicting the risk of delirium after major urological cancer surgery. Geriatrics & gerontology international, 22:319-324, 2022

6. Yajima S, Nakanishi Y, Wantanabe R, Matsumoto S, Tanabe K, Masuda H. Urothelial carcinoma of the bladder with cutaneous metastases after robot-assisted radical cystectomy. Case report. Urology case reports, 38:101709, 2021

7. Tanabe K, Nakanishi Y, Matsumoto S, Yajima S, Watanabe R, Masuda H. Rectal constriction due to metastasis of urothelial carcinoma of the bladder: A case report. Urology case reports, 39:101833, 2021

8. Yajima S, Nakanishi Y, Matsumoto S, Ookubo N, Tanabe K, Masuda H. Hyperchloremic Metabolic Acidosis with Hyperglycemic Hyperosmolar Syndrome after Robot-Assisted Radical Cystoprostatectomy with Ileal Conduit Urinary Diversion: A Case Report. Case reports in oncology, 14:1460- 1465, 2021

9. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Masuda H. Simultaneous laparoscopic nephroureterectomy and robotassisted radical cystectomy: Lessons learned from our initial experience. Current urology, 15:193-197, 2021

10. Kijima T, Yamamoto H, Saito K, Kusuhara S, Yoshida S, Yokoyama M, Matsuoka Y, Numao N, Sakai Y, Matsubara N, Yuasa T, Masuda H, Yonese j, Kageyama Y, Fujii Y. Early C-reactive protein kinetics predict survival of patients with advanced urothelial cancer treated with pembrolizumab. Cancer Immunol immunother 70,657-665, 2021

11. Kijima T, Fukushima H, Kusuhara S, Tanaka H, Yoshida S, Yokoyama M, Ishioka J, Matsuoka Y, Numao N, Sakai Y, Saito K, Matsubara N, Yuasa T, Masuda H, Yonese J, Kageyama Y, Fujii A. Association Between the Occurrence and Spectrum of Immune-Related Adverse Events and Efficacy of Pembrolizumab in Asian Patients With Advanced Urothelial Cancer: Multicenter Retrospective Analyses and Systematic Literature Review. Clin Genitourin Cancer.19(3):208-216, 2021

12. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Sugano M, Masuda H. Improvement of urinary symptoms after bladder biopsy: A case of pathologically proven allergy-related cystitis during administration of nivolumab. IJU Case Reports 4,213-215, 2021

13. Yajima S, Nakanishi Y, Matsumoto S, Ookubo N, Tanabe K, Kataoka M, Masuda H. Mini-Cog to Predict Postoperative Delirium in Patients Who Underwent Transurethral Resection of Bladder Tumor While Awake Turk J Urol 48(2):106-111, 2022

14. Kondo A, Nishizawa Y, Tsukada Y, Sasaki T, Inoue M, Masuda H, Suzuki Y, Ito M. Potential benefit of laparoscopic surgery for rectal cancer on postoperative male sexual function. Colorectal Disease.23(7):1745-1754, 2021

15. Kuroe T, Watanabe R, Kojima M, Morisue R, Sugano M, Kuwata T, Masuda H, Kusuhara S, Matsubara N, Oda S, Ushiku T, Ishii G. Evaluation of the morphological features and unfavorable prognostic impact of dirty necrosis in renal cell carcinoma. Journal of Cancer Research and Clinical Oncology. 147(4):1089-1100, 2021

16. Higashino T, Sakuraba M, Fukunaga Y, Oshima A, Masuda H, Ito M. Surgical outcome for colorectal or urinary tract-related fistula: Usefulness of vascularized tissue transfer-a retrospective study. J Plast Reconstr Aesthet Surg. 74(5):1041-1049, 2021