This study aimed to examine the impact of histological differences on positive surgical margins (PSM) and postoperative renal function in patients with renal cell carcinoma (RCC) who underwent robot-assisted partial nephrectomy (RAPN). This multicenter retrospective cohort study included patients with RCC who underwent RAPN at eight Japanese facilities between March 2016 and November 2023. The enrolled patients who underwent RAPN were divided into those with clear cell RCC (ccRCC group) and those with other histological subtypes (non-ccRCC group). The primary endpoint was to determine the differences in PSM rates according to histological type among patients who underwent RAPN. Secondary endpoint was the chronological assessment of renal function in patients undergoing RAPN, which was categorized according to histological type. To ensure a balance between the two groups with respect to variables that may influence perioperative outcomes, 3:1 propensity score matching was performed using logistic regression. Following propensity score matching at a 3:1 ratio, the analysis included 735 ccRCC and 245 non-ccRCC patients. No significant association was identified between the histological subtypes and PSM in multivariate analysis. Despite a decline in renal function of approximately 10% in both groups postoperatively, no significant difference was observed between the groups in the chronological changes in renal function over time. There was no statistically significant differences in the incidence of PSM based on histological type among the study groups nor substantial variations in postoperative renal function.

INTRODUCTION:We examined the impact of prostate-specific antigen (PSA) response, which is associated with survival, on patients with metastatic hormone-sensitive prostate cancer (mHSPC) treated with androgen receptor signal inhibitors (ARSIs). METHODS:We retrospectively reviewed 82 patients with mHSPC who received upfront ARSI treatment. The primary endpoint was PSA progression-free survival (PFS). Patients whose PSA levels decreased to ≤0.2 ng/mL at 3 months after ARSI initiation were classified as deep early, those with >0.2-≤1.0 ng/mL as early, and others as non-PSA responders. RESULTS:The median age of patients was 73 years old, and the median baseline PSA value was 361 ng/mL. Among 82 patients, 32 (39%), 16 (20%), and 34 (41%) were categorized into deep early, early, and non-early PSA responders, respectively. There was a significant association between PSA response status, hemoglobin, and PSA value. During follow-up (median, 23.0 months), 31 (37.8%) patients experienced PSA progression. The PSA progression rates of the deep early, early, and non-early PSA responders were 15.6%, 31.2%, and 61.8% (p < 0.001), and their 2-year PSA PFS rates were 90.5%, 70.7%, and 38.9%, respectively. CONCLUSION:An early PSA response within 3 months of ARSI initiation was associated with PSA progression in patients with mHSPC.

Introduction Transverse testicular ectopia is a rare anomaly in which both testes descend toward the same side of the hemiscrotum. Case presentation A 35‐year‐old man presented with right inguinal enlargement. Computed tomography showed a normal testis in the right hemiscrotum and a 58 mm heterogeneous mass in the right inguinal area. No testis was observed in the left hemiscrotum. The vascular structures extended from the right inguinal mass to the left renal vein. Consequently, the left testicular tumor was diagnosed as transverse testicular ectopia, and a left orchiectomy was performed. The histological diagnosis was seminoma stage pT2. Furthermore, left para‐aortic lymph node metastasis developed 10 months postoperatively. A complete response was obtained after systemic chemotherapy. Conclusion Awareness of seminomas in transverse testicular ectopia could facilitate appropriate diagnosis and treatment. Furthermore, the location of the lymph node metastasis indicated that the ectopic testis could have originated from the left side.

Renorrhaphy is often performed after tumor resection during robotic-assisted laparoscopic partial nephrectomy (RAPN). This study aimed to investigate the association between renorrhaphy performance and inflammatory markers. A retrospective cohort study was conducted including patients with renal cell carcinoma who underwent RAPN at eight institutions in Japan between April 2016 and November 2023. The primary endpoint was the association between the renorrhaphy performance in RAPN and the postoperative inflammatory markers. The secondary endpoints were perioperative outcomes in patients with and without renorrhaphy. The patients were divided into two groups at the time of RAPN: those who underwent renorrhaphy (renorrhaphy group) and those who did not (omitted group). In total, 934 patients were enrolled in this study. After propensity score matching, the rate of change in C-reactive protein and neutrophil-lymphocyte ratio on postoperative day 28 were not significant difference between the two groups. In contrast, the rate of change in platelet-lymphocyte ratio (PLR) on postoperative day 28 was significantly higher in renorrhaphy group than omitted group. Regarding surgical outcomes, the renorrhaphy group had a significantly longer hospital stay, operative time, and warm ischemia time (P = 0.038, P = 0.022, and P = 0.009, respectively) than the omitted group did. Furthermore, the omitted group had a significantly higher rate of Trifecta achievement than the renorrhaphy group did. This study demonstrated that renorrhaphy performance in RAPN was significantly associated with the higher value of postoperative PLR.

Background:The hinotoriTM surgical robot system (HSRS) is the first made-in-Japan robotic system used for radical prostatectomy. Here, we report initial results and describe our learning curve (skill development) implementing robot-assisted radical prostatectomy using HSRS (h-RARP).Methods:Between November 2021 and December 2022, 97 patients who underwent h-RARP at our institution were enrolled in this study. We retrospectively evaluated the surgical outcomes of the initial cases using h-RARP, comparing those of RARP using da Vinci surgical robot system (d-RARP) in our institution. Furthermore, the learning curves of two surgeons with the highest number of h-RARP were analyzed. Patients treated by each surgeon were categorized into two groups: 1-15 cases (earlier group) and >15 cases (later group). Preoperative patient characteristics, operation parameters, and complication rates were compared between the two groups.Results:In terms of surgical outcome, h-RARP was comparable to d-RARP. The procedures performed by the HSRS were successfully completed in all cases. There was no complication of grade 3 or higher. Comparing the two surgeons, surgeon 1, who had performed 40 d-RARP procedures, had time using robot system of the later group that was significantly shorter than that of the earlier group. However, for surgeon 2 with more than 100 d-RARP procedures, there was no statistically significant difference in time using robot system between groups. Other parameters showed no difference between earlier and later groups for the two surgeons.Conclusions:Our results show that surgical outcomes of h-RARP are comparable to those of d-RARP during the initial experience of clinical application. In addition, the surgeons' learning curves for the total RARP experience suggest that the experience of d-RARP can carry over to performance using the novel HSRS.

BACKGROUND:We compared the surgical outcomes of patients who underwent robot-assisted radical prostatectomy (RARP) using hinotori with those of patients who underwent RARP using da Vinci Xi through propensity score matching to evaluate the potential benefits and efficacy of hinotori. METHODS:Perioperative data of patients who underwent RARP between 2017 and 2023 were retrospectively evaluated. RESULTS:After adjusting for preoperative risk factors, each group comprised 118 propensity score-matched patients. Both median total operative time and median console time were significantly longer in the hinotori group (median differences, 26 and 23 min, respectively). Although the hinotori group had lower estimated blood loss, no significant differences were noted between the groups in postoperative complications, positive surgical margin rates, 12-month biochemical recurrence rates, and urinary continence recovery rates. CONCLUSIONS:Although RARP requires more time with hinotori, our study demonstrated that RARP can be performed safely and effectively immediately after the installation of hinotori.

Background: This study investigated the effect of mannitol administration on postoperative renal function during robot-assisted partial nephrectomy (RAPN) in patients with renal cell carcinoma (RCC). Methods: Patients with RCC who underwent RAPN at eight Japanese facilities between March 2016 and November 2023 were enrolled. In this study, patients were categorized into two groups according to those who received mannitol during RAPN (Group I) and those who did not receive mannitol (Group II). Differences in covariates between the two groups were adjusted using propensity score matching (PSM). Results: The study included 1530 patients with RCC who underwent RAPN. PSM was performed on 531 participants in each group. No difference was observed in perioperative outcomes between the two groups in terms of length of hospital stay, surgical outcomes, achievement ratio of Trifecta, and estimated glomerular filtration rate at 28 days, 90 days, and 1 year postoperatively. Conclusions: Intraoperative mannitol administration during RAPN for improving renal function may be unnecessary.

Background. Autosomal dominant polycystic kidney disease (ADPKD) is associated with several cardiovascular disorders, including aortic dissection, which preferentially occurs at the thoracic or abdominal level. Because there are few case reports describing surgical repair for aor-tic dissection followed by renal transplantation in patients with ADPKD, kidney transplantation performed after repair for aortic dissection remains challenging.Case presentation. A 34-year-old Japanese man with end-stage renal disease secondary to ADPKD underwent thoracic endovascular aortic repair for complicated acute type B aortic dis-section 12 months earlier. A contrast computed tomography scan before transplantation revealed an aortic dissection involving the descending aorta proximal to the common iliac arteries and confirmed multiple large bilateral renal cysts. After simultaneous right native nephrectomy, the patient underwent preemptive living-donor kidney transplantation obtained from his mother. Intraoperatively, we noted that dissection of the external iliac vessels was difficult because of dense adhesions. Arterial clamping was performed immediately below the bifurcation of the internal iliac artery to prevent further aortic dissection of the external iliac artery. After end-to-end anastomosis to the internal iliac artery was completed and the vascular clamp was released, the kidney began to produce urine immediately.Conclusion. This case suggests that kidney transplantation in patients undergoing endovascu-lar aortic repair for aortic dissection can be performed by adequately applying a vascular clamp proximal to the internal iliac artery during vascular anastomosis.

For chronic myeloid leukemia (CML), a Philadelphia chromosome-positive myeloproliferative neoplasm, the introduction of tyrosine kinase inhibitors has transformed CML from a lethal disease into a manageable chronic disease with a close-to-normal life expectancy. Active malignancy is an absolute contraindication to kidney transplantation. However, it is controversial whether kidney transplantation can be safely performed in patients with a history of CML who are in remission. We describe the clinical course of a 64-year-old male patient with chronic kidney disease from diabetic nephropathy (DMN) who underwent living donor kidney transplantation. The patient was diagnosed with CML 15 years ago and promptly achieved cytogenetic and molecular biological remission after starting imatinib. After that, he continued imatinib treatment for 15 years and was in remission, but his chronic kidney disease from DMN gradually worsened. A preemptive living donor kidney transplant was performed in July 2020. Imatinib for CML was discontinued because the patient maintained deep molecular remission (DMR) of major molecular response for more than 15 years before kidney transplantation. After kidney transplantation, the transplanted kidney function remained good at approximate serum creatinine levels of 1.1 mg/dL without histopathologic rejection, and the 3 monthly BCR-ABL1 measurement results were negative and are in progress. Thus, he continues to maintain treatment-free remission status without imatinib for 26 months after renal transplantation. In conclusion, this result suggests that CML with long-lasting DMR on imatinib therapy can be considered an inactive malignancy and therefore a relative indication for kidney transplantation.

BACKGROUND:Aortoiliac lesions can influence the results of kidney transplantation and increase technical difficulties during surgery. Aortic dissection (AD) is a rare and infrequently reported event before transplantation, whereas immediate optimal perfusion is paramount for kidney transplantation. Thus, adequate blood flow imposed by the flow from the true lumen must be considered when choosing a target inflow vessel.CASE PRESENTATION:A 67-year-old man on dialysis with end-stage renal disease caused by immunoglobulin A nephropathy was referred for kidney transplantation. He had successfully undergone conventional Stanford type A AD surgery 3 years ago. Pretransplant contrast-enhanced computed tomography angiography revealed termination of the distal intimal flaps within the common iliac arteries. Dilation of the descending aorta was also observed. Based on the meticulous vascular assessment, including consultation with the cardiovascular surgery department, the right internal iliac artery (IIA) was considered usable for anastomosis. He underwent living unrelated kidney transplantation from his 66-year-old wife. The patency and blood flow in the right IIA were also verified using intraoperative findings. Without any special procedure, we used a side-to-end arterial anastomosis between the donor renal artery and recipient IIA. After vascular clamp removal, the allograft was perfused homogeneously and immediately functioned.CONCLUSION:Patients receiving previous surgery for type A AD can successfully undergo kidney transplantation if the patency of the iliac arteries from the true lumen is confirmed by perioperative evaluation, and the artery can be carefully clamped to avoid possible further dissection.

A library of 27 murine monoclonal antibodies was obtained by using human liver and heart ferritins as immunogens. The specificity of the antibodies for the two ferritins and their subunits was studied with five different methods. The antibodies elicited by the liver ferritin bound preferentially the immunogen and were specific for the L subunit. Some antibodies elicited by the heart ferritin had characteristics similar to the anti-liver antibodies, other ones bound preferentially the heart over the liver ferritin and were specific for the H subunit. Only two antibodies were able to bind both ferritins and subunits. Some anti-H and anti-L chain antibodies were used to develop and compare four types of immunoassay to quantitate isoferritins. The results indicate the heart ferritin is immunologically more heterogeneous than liver, the H and L subunits having large immunological differences with few, if any, identical epitopes; and that that the architecture of the immunoassays have a strong influence on the crossreactivity of the antibodies with the two isoferritins, probably because H and L chains are not arranged randomly in the assembled protein.

International Journal of UrologyVolume 28, Issue 6 p. 681-682 Editorial Comment Editorial Comment from Dr Setoguchi and Dr Saito to Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis Kiyoshi Setoguchi M.D., Ph.D., Corresponding Author setoguch@dokkyomed.ac.jp Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, JapanSearch for more papers by this authorKazutaka Saito M.D., Ph.D., Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, JapanSearch for more papers by this author Kiyoshi Setoguchi M.D., Ph.D., Corresponding Author setoguch@dokkyomed.ac.jp Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, JapanSearch for more papers by this authorKazutaka Saito M.D., Ph.D., Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, JapanSearch for more papers by this author First published: 27 March 2021 https://doi.org/10.1111/iju.14561Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume28, Issue6June 2021Pages 681-682 RelatedInformation

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (MP78)1 Apr 2020MP78-13 SERUM TESTOSTERONE LEVEL RISES DRASTICALLY AT THE MOMENT OF EJACULATION Yoshitomo Kobori*, Akiyoshi Osaka, Hisamitsu Ide, Hiroshi Okada, Gaku Arai, Tadahiko Tokumoto, Kiyoshi Setoguchi, Yoji Hyodo, Akinori Nakayama, Yasuyuki Inoue, Yuka Yasuda, and Shigehiro Soh Yoshitomo Kobori*Yoshitomo Kobori* More articles by this author , Akiyoshi OsakaAkiyoshi Osaka More articles by this author , Hisamitsu IdeHisamitsu Ide More articles by this author , Hiroshi OkadaHiroshi Okada More articles by this author , Gaku AraiGaku Arai More articles by this author , Tadahiko TokumotoTadahiko Tokumoto More articles by this author , Kiyoshi SetoguchiKiyoshi Setoguchi More articles by this author , Yoji HyodoYoji Hyodo More articles by this author , Akinori NakayamaAkinori Nakayama More articles by this author , Yasuyuki InoueYasuyuki Inoue More articles by this author , Yuka YasudaYuka Yasuda More articles by this author , and Shigehiro SohShigehiro Soh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000964.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Testosterone is the major sex hormone in males and plays an important role in the development of the penis and testes, muscle size, bone growth, sex drive, and sperm production. Changes in serum testosterone levels at ejaculation are unclear, although the sexual function is influenced by testosterone. We measured pre- and post-ejaculatory testosterone levels over time and evaluated changes in these levels. We also measured levels of prolactin and cortisol, which are hormones that also affect sexual function. METHODS: We enrolled 7 men (age 32–41 years, mean 35.7 years) with normal sexual function, and collected blood samples before, during, and after masturbation. Testosterone, prolactin, and cortisol levels were evaluated before erection, after erection, just before ejaculation, at ejaculation, and 10 min after ejaculation. RESULTS: Serum testosterone level increased significantly over time from before erection to the moment of ejaculation, and decreased to the pre-erection level 10 min after ejaculation (pre-erection, 5.86±2.45ng/mL; at ejaculation, 7.01±3.61 ng/mL; 10 min after ejaculation, 6.22±2.89 ng/mL; p < 0.05). Cortisol increased significantly over time from before erection to after ejaculation (pre-erection, 5.63±3.82μg/dL; at ejaculation, 6.94±4.59 μg/dL; 10 min after ejaculation, 7.70±4.99 μg/dL; p < 0.05). And prolactin increased approximately 2-fold over time from before erection to after ejaculation (pre-erection, 12.83±2.36ng/mL; at ejaculation, 17.48±4.51 ng/mL; 10 min after ejaculation, 23.47±6.27 ng/mL; p < 0.05). CONCLUSIONS: All 3 hormones changed drastically with ejaculation. The increase in testosterone level may be due to prostate contraction and testicular secretion. In addition, prolactin and cortisol levels changed before and after ejaculation. Changes in hormone secretion due to ejaculation may affect daily health and sexual function. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1178-e1178 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yoshitomo Kobori* More articles by this author Akiyoshi Osaka More articles by this author Hisamitsu Ide More articles by this author Hiroshi Okada More articles by this author Gaku Arai More articles by this author Tadahiko Tokumoto More articles by this author Kiyoshi Setoguchi More articles by this author Yoji Hyodo More articles by this author Akinori Nakayama More articles by this author Yasuyuki Inoue More articles by this author Yuka Yasuda More articles by this author Shigehiro Soh More articles by this author Expand All Advertisement PDF downloadLoading ...

AIM:Transplant glomerulopathy (TG) is a feature of chronic antibody-mediated injury in the glomerular capillaries in renal transplant recipients. TG is generally associated with proteinuria; however, renal function at the diagnosis of TG varies. This study aimed to determine which morphological abnormalities are associated with renal function and proteinuria at the diagnosis of TG. METHODS:A total of 871 renal transplantations were performed at Tokyo Women's Medical University between 2005 and 2013. TG was diagnosed in 127 biopsies from 58 (6.7%) recipients. Renal function was evaluated by the estimated glomerular filtration rate (eGFR). Proteinuria was assessed by a dipstick test: positive for +1 and over. RESULTS:At diagnosis, of 127 biopsies, 72, 37, and 18 had mild, moderate, and severe TG (Banff cg). The severity of TG was not associated with decreased eGFR at the time of biopsy (cg1: 36.1 ± 14.8, cg2-3: 38.8 ± 14.5 mL/min per 1.73 m(2) , P = 0.25), whereas the severity of interstitial fibrosis (IF) (Banff ci) was significantly associated with decreased eGFR (ci0-1: 42.75 ± 13.32, ci2-3: 27.69 ± 11.94 mL/min per 1.73 m(2) , P < 0.0001). The multivariate analysis revealed that IF was the only independent risk factors for decreased eGFR (OR = 4.38, P = 0.0006). Meanwhile, TG was identified as the only independent risk factor for the incidence of proteinuria (OR = 2.67, P = 0.014). CONCLUSION:Interstitial fibrosis was a critical determinant of impaired renal function at the diagnosis of TG. The severity of TG was significantly associated with proteinuria, but did not contribute to renal dysfunction.

We herein describe the unique case of a 59‐year‐old man who underwent living kidney transplantation for IgA nephropathy ( IgAN ) and developed progressive kidney failure associated with the appearance of proliferative glomerulonephritis. An early protocol biopsy revealed recurrent IgAN with mesangial IgA2 deposits restricted to a single immunoglobulin λ light‐chain isotype. Despite treatment with tonsillectomy and rituximab, the patient eventually lost his allograft 31 months after transplantation. Serum electrophoresis showed a monoclonal IgA pattern. This case might share common pathological characteristics with the newly described entity referred to as proliferative glomerulonephritis with monoclonal IgG deposits.

Recipient CD4 T regulatory cells inhibit the acute T cell–mediated rejection of renal allografts in wild-type mice. The survival of single class II MHC–disparate H-2bm12 renal allografts was tested in B6.CCR5−/− recipients, which have defects in T regulatory cell activities that constrain alloimmune responses. In contrast to wild-type C57BL/6 recipients, B6.CCR5−/− recipients rejected the bm12 renal allografts. However, donor-reactive CD8 T cells rather than CD4 T cells were the primary effector T cells mediating rejection. The CD8 T cells induced to bm12 allografts in CCR5-deficient recipients were reactive to peptides spanning the 3 aa difference in the I-Abm12 versus I-Ab β-chains presented by Kb and Db class I MHC molecules. Allograft-primed CD8 T cells from CCR5-deficient allograft recipients were activated during culture either with proinflammatory cytokine–stimulated wild-type endothelial cells pulsed with the I-Abm12 peptides or with proinflammatory cytokine–simulated bm12 endothelial cells, indicating their presentation of the I-Abm12 β-chain peptide/class I MHC complexes. In addition to induction by bm12 renal allografts, the I-Abm12 β-chain–reactive CD8 T cells were induced in CCR5-deficient, but not wild-type C57BL/6, mice by immunization with the peptides. These results reveal novel alloreactive CD8 T cell specificities in CCR5-deficient recipients of single class II MHC renal allografts that mediate rejection of the allografts.

OBJECTIVES Interleukin-6, a pleiotropic cytokine that functions in both innate and adaptive immune responses, has been implicated in allograft rejection. We analyzed the efficacy of anti interleukin-6 receptor monoclonal antibody in delaying allograft rejection in a murine model of a heart. MATERIALS AND METHODS To investigate the role of interleukin-6 receptor signal transduction in acute and chronic allograft rejection, we blocked interleukin-6 receptor signaling to suppress the alloimmune response in C57BL/6 recipients of BALB/c cardiac allografts. RESULTS Administration of a high-dose α-interleukin-6 receptor monoclonal antibody prevented the intragraft infiltration of inflammatory cells and lymphocytes and prolonged allograft survival during the peritransplant period. However, all allografts were rejected by 23.5 days after transplant. In contrast, cardiac allograft recipients treated with a cytotoxic T-lymphocyte antigen 4-immunoglobulin plus continued administration of low-dose α-interleukin-6 receptor monoclonal antibody showed long-term graft survival compared with cytotoxic T-lymphocyte antigen 4-immunoglobulin monotherapy. A histologic analysis revealed that graft fibrosis was prevented in cytotoxic T-lymphocyte antigen 4-immunoglobulin plus high-dose α-interleukin-6 receptor monoclonal antibody group, but not in the cytotoxic T-lymphocyte antigen 4-immunoglobulin alone group. This suggests that deterioration of graft function associated with chronic rejection could be prevented by blocking interleukin-6 receptor signaling. CONCLUSIONS Disruption of interleukin-6 receptor signaling is an effective strategy for modulating proinflammatory immune responses and preventing chronic rejection.