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Annual Report 2022

Department of Urology

Hitoshi Masuda, Yasukazu Nakanishi, Shugo Yajima, Madoka Kataoka, Kohei Hirose, Naoya Okubo, Yosuke Umino, Rikuto Yasujima

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 primarily 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, while preserving the sexual and/or voiding functions in prostate cancer and organ function, especially in kidney cancer.

Table 1. Number of patients
Table 1. Number of patients

Table 1. Number of patients
Table 1. Number of patients

Table 2. Type of procedure
Table 2. Type of procedure

Table 2. Type of procedure
Table 2. Type of procedure

The Team and What We Do

 Outpatient activities: Our outpatient clinic is open four days a week, performing flexible cystoscopy, abdominal ultrasonography, retrograde pyelography and prostate biopsy. Superficial bladder cancer (G3, cis, or recurrent tumor) after TUR-Bt is treated by instillation of BCG into the bladder. Cases of advanced urogenital cancers including metastatic prostate cancer are referred to the medical oncology division for chemotherapy or hormonal therapy. Extrinsic upper urinary tract obstructions that directly result from invasion of an adjacent malignancy or peritoneal metastasis are also treated in our department. The selection of internal stenting or percutaneous nephrostomy depends on the malignancy type and degree of obstruction. In 2022, 116 patients newly received ureteral stents and 31 underwent nephrostomy for obstructive uropathy. Moreover, 331 patients newly received insertion of markers or spacers for radiation therapy for localized prostate cancer in 2022.

  • 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. This year, 979 surgeries were performed in the Department of Urology. Moreover, we performed 35 combination surgeries with colorectal surgeons in 2022.
  • 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.

Research Activities

  • We investigated the risk factors for the progression of high risk superficial bladder cancer. Additionally, we investigated the resistant mechanisms of BCG therapy for high-risk superficial bladder cancer.
  • We investigated the usefulness of novel techniques in robot surgeries including radical prostatectomy and radical cystectomy.
  • We evaluated the role of MRI-DWI in assessing the malignant potential of bladder and upper urinary tract cancers.
  • We are proceeding with clinical trials, including fat-derived stem cell therapy for urinary incontinence after radical prostatectomy and mobile health intervention for robot-assisted radical prostatectomy.
  • A total of 13 peer-reviewed papers are accepted.

Clinical Trials

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

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

3.  A phase III clinical study: Pembrolizumab in MIBC (MK-3475-866)

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

5.  A phase III clinical study: Enfortumab Vedotin and Pembrolizumab in MIBC (MK-3475-905)

6.  A phase III clinical study: Belzutifan and Pembrolizumab in ccRCC post nephrectomy (MK-6482-022)

7. A prospective observational study: QOL using a wearable device for SUI after radical prostatectomy

8. A prospective clinical study: Fat derived stem cell therapy for SUI after radical prostatectomy

Education

 We accepted four voluntary resident of urology in 2022 and taught urological surgery and clinical study.

Future Prospects

  • We will develop new and useful techniques for robot-assisted surgeries of the prostate, bladder and kidney.
  • We will start a clinical trial of stem cell therapy for urinary incontinence after radical prostatectomy.

List of papers published in 2022

Journal

1. Kuroe T, Watanabe R, Morisue R, Miyazaki S, Kojima M, Murata SC, Nakai T, Taki T, Sakashita S, Sakamoto N, Matsubara N, Masuda H, Ushiku T, Ishii G. Dirty necrosis in renal cell carcinoma is associated with NETosis and systemic inflammation. Cancer medicine, 12:4557-4567, 2023

2. Komai Y, Nakajima K, Saito K, Tomioka Y, Masuda H, Ogawa A, Yonese J, Kobayashi E, Ito M. Development of a New Two-Arm Transurethral Surgical System for En Bloc Resection of Bladder Tumor: A Preclinical Study. Journal of endourology, 37:165-170, 2023

3. Takeshita N, Sakamoto S, Kitaguchi D, Takeshita N, Yajima S, Koike T, Ishikawa Y, Matsuzaki H, Mori K, Masuda H, Ichikawa T, Ito M. Deep Learning-Based Seminal Vesicle and Vas Deferens Recognition in the Posterior Approach of Robot-Assisted Radical Prostatectomy. Urology, 173:98-103, 2023

4. Yajima S, Nakanishi Y, Yasujima R, Hirose K, Sekiya K, Umino Y, Okubo N, Kataoka M, Masuda H. Simultaneous robot-assisted nephroureterectomy and radical cystectomy. IJU case reports, 6:14-17, 2023

5. Yajima S, Nakanishi Y, Sugimoto M, Kobayashi S, Kudo M, Yasujima R, Hirose K, Sekiya K, Umino Y, Okubo N, Kataoka M, Gotohda N, Masuda H. A novel predictive model for postoperative delirium using multiple geriatric screening factors. Journal of surgical oncology, 127:1071-1078, 2023

6. Yajima S, Nakanishi Y, Yasujima R, Hirose K, Umino Y, Okubo N, Kataoka M, Masuda H. Rapid geriatric screening tools predict inability to manage stoma by oneself after urinary diversion: G8 and IADL-modified G8. Journal of geriatric oncology, 14:101468, 2023

7. 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

8. Yajima S, Nakanishi Y, Umino Y, Ookubo N, Tanabe K, Kataoka M, Masuda H. Value of Geriatric Assessment Using the G8 to Predict Postoperative Urinary Tract Infections in Patients Undergoing Radical Cystectomy. Turkish journal of urology, 48:278-286, 2022

9. Yajima S, Nakanishi Y, Yasujima R, Hirose K, Sekiya K, Umino Y, Ookubo N, Kataoka M, Masuda H. Predictive value of the G8 and the IADL-modified G8 screening tools for postoperative delirium following major urological cancer surgery. Journal of geriatric oncology, 13:1188-1193, 2022

10. Nakanishi Y, Matsumoto S, Okubo N, Tanabe K, Kataoka M, Yajima S, Masuda H. Significance of postoperative membranous urethral length and position of vesicourethral anastomosis for short-term continence recovery following robot-assisted laparoscopic radical prostatectomy. BMC urology, 22:145, 2022

11. Kaiho Y, Masuda H, Takei M, Hirayama T, Kitta T, Yokoyama M, Kawamorita N, Mitsui T, Nakagawa H, Iwamura M, Arai Y. Outcomes of artificial urinary sphincter implantation in patients with diabetes mellitus: A subgroup analysis. International journal of urology, 29:1498-1504, 2022

12. Tanabe K, Nakanishi Y, Umino Y, Okubo N, Kataoka M, Yajima S, Masuda H. Validity and Safety of Robot-Assisted Laparoscopic Radical Cystectomy for the Elderly: Results of Perioperative Outcomes in Patients Aged ≧80 Years. Turkish journal of urology, 48:322-330, 2022

13. Yajima S, Nakanishi Y, Umino Y, Ookubo N, Tanabe K, Kataoka M, Masuda H. Initial Experience of Hybrid Technique in Robot-Assisted Intracorporeal Ileal Conduit. Turkish journal of urology, 48:415-422, 2022

14. Yajima S, Nakanishi Y, Matsumoto S, Tanabe K, Masuda H. A Pitfall of the Androgen Deprivation Therapy for Salivary Duct Carcinoma: Hormonal Therapy-Induced Castrate-Resistant Prostate Cancer. Journal of maxillofacial and oral surgery, 21:1097-1100, 2022

15. Yajima S, Nakanishi Y, Umino Y, Okubo N, Tanabe K, Kataoka M, Masuda H. Salvage Robot-Assisted Radical Prostatectomy (sRARP) for Radiation-Recurrent Prostate Cancer: a Single-Center Experience. Indian J Surg Oncol, 2022

16. Yajima S, Nakanishi Y, Umino Y, Ookubo N, Tanabe K, Kataoka M, Masuda H . Clock drawing errors in the Mini-Cog test predict postoperative delirium following transurethral resection of bladder tumors while awake. Perioperative Care and Operating Room Management, 28:100260, 2022