Annual Report 2017
Department of Urology
Hitoshi Masuda, Masaharu Inoue, Motohiro Fujiwara, Takahiko Souma
Introduction
The Department of Urology has existed as part of the Medical Group of Pelvic Surgery at the National Cancer Center Hospital East (NCCHE) since 2003. Our 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 surgery with preserving the sexual and/or voiding functions in prostate cancer and organ function, especially in kidney cancer.
Our team and what we do
1. Outpatient activities
The outpatient clinic is open three days a week as 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 a malignancy type and degree of obstruction. Forty-five patients newly received ureteral stents and 53 underwent nephrostomy for obstructive uropathy in 2017.
2. Inpatient activities
A daily conference is held with doctors of the Medical Group of Pelvic Surgery on the diagnosis and treatment of patients with colorectal and urological cancers. We performed 15 combination surgeries with colorectal surgeons in 2017. In the Department of Urology, 143 general anesthesia surgeries, 121 spinal anesthesia surgeries, and 89 prostate biopsies were performed in this year (Tables 1 and 2).
3. Others
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 therapy of hormone and radiation for prostate cancer, treatment strategies for metastatic renal cell carcinoma and testicular cancer, and so on, are determined in the meeting.
Research activities
We reported initial experience with a novel style of three-dimensional printed kidney in minimally invasive off-clamp partial nephrectomy. We also reported risk factors for survival after placement of ureteral stents and a prognostic model for advanced gastrointestinal tract cancer patients.
We presented the treatment outcome of colorectal cancer infiltrating the ureter, the usefulness of ultrasound scalpels for robot-assisted radical prostatectomy, and the usefulness of kidney parenchymal ligation in laparoscopic off-clamp partial nephrectomy.
Clinical trials
1) A phase II clinical study of robot-assisted radical prostatectomy by the da Vinci S/Si Surgical System
2) A phase III study: BCG instillation for high grade T1 bladder cancer (JCOG1019)
3) A phase III study: Pirarubicin instillation after nephroureterectomy for upper tract urothelial carcinoma (JCOG1403)
4) Examination of the usefulness of the Resonance, the first metallic ureteral stent in Japan, to treat ureteral stricture due to extrinsic compression
5) A phase II clinical study: Pembrolizumab in high risk NMIBC unresponsive to BCG (MK-3475-057)
Education
We accepted two voluntary residents of urology in 2017 and educated urological surgery.
Future prospects
New transurethral surgical devices for bladder cancer are in the way of being developed in cooperation with other institutions. Also, we aim for the safe introduction of laparoscopic total cystectomy and the safe adaptation expansion of robot-assisted laparoscopic surgery.
List of papers published in January 2017 - March 2018
Journal
1. Tanaka H, Fujii Y, Ishioka J, Matsuoka Y, Saito K, Uehara S, Numao N, Yuasa T, Yamamoto S, Masuda H, Yonese J, Kihara K. Stepwise algorithm using computed tomography and magnetic resonance imaging for diagnosis of fat-poor angiomyolipoma in small renal masses: Development and external validation. Int J Urol, 24:511-517, 2017
2. Sakai Y, Komai Y, Saito N, Ito M, Sakuraba M. Analysis of a Surgical Treatment for Persistent Urorectal Fistulas after Radical Cancer Surgery: A Comparison of Prostate Cancer and Rectal Cancer. Urol Int, 99:56-62, 2017
3. Nakamura Y, Yoshida S, Tanaka H, Inoue M, Ito M, Kijima T, Yokoyama M, Ishioka J, Matsuoka Y, Saito K, Fujii Y, Kihara K. Potential Utility of Diffusion-Weighted Magnetic Resonance Imaging in Diagnosis of Residual Bladder Cancer before Second Transurethral Resection. Urol Int, 98:298-303, 2017
4. Noguchi K, Nishizawa Y, Komai Y, Sakai Y, Kobayasi A, Ito M, Saito N. Efficacy of an additional flap operation in bladder-preserving surgery with radical prostatectomy and cystourethral anastomosis for rectal cancer involving the prostate. Surg Today, 47:1119-1128, 2017
5. Yuasa T, Masuda H, Yamamoto S, Numao N, Yonese J. Biomarkers to predict prognosis and response to checkpoint inhibitors. Int J Clin Oncol, 22:629-634, 2017
6. Muto M, Inamura K, Ozawa N, Endo T, Masuda H, Yonese J, Ishikawa Y. Skene's gland adenocarcinoma with intestinal differentiation: A case report and literature review. Pathol Int, 67:575-579, 2017
7. Inamura K, Kobayashi M, Nagano H, Sugiura Y, Ogawa M, Masuda H, Yonese J, Ishikawa Y. A novel fusion of HNRNPA1-ALK in inflammatory myofibroblastic tumor of urinary bladder. Hum Pathol, 69:96-100, 2017
8. Kaiho Y, Masuda H, Takei M, Hirayama T, Mitsui T, Yokoyama M, Kitta T, Kawamorita N, Nakagawa H, Iwamura M, Arai Y. Surgical and Patient Reported Outcomes of Artificial Urinary Sphincter Implantation: A Multicenter, Prospective, Observational Study. J Urol, 199:245-250, 2018