Late-onset hypogonadism (LOH) syndrome is characterized by age-related testosterone deficiency and negatively affects the quality of life of older men. A promising therapeutic approach for LOH syndrome is transplantation of testosterone-producing Leydig-like cells (LLCs) derived from human induced pluripotent stem cells (hiPSCs). However, previous studies have encountered obstacles, such as limited cell longevity, insufficient testosterone production, and inefficiency of differentiation. To address these issues, we developed a novel protocol that includes forced NR5A1 expression, a cytokine cocktail promoting mesoderm differentiation, and a transitional shift from 3D to 2D cultures. The resultant cells survived on culture dishes for over 16 weeks, produced 22-fold more testosterone than the conventional method, and constituted a homogeneous population of LLCs with a differentiation efficiency exceeding 99% without purification. Furthermore, these LLCs were successfully engrafted subcutaneously into mice, resulting in increased serum testosterone levels. Our study will facilitate innovative therapeutic strategies for LOH syndrome.

BACKGROUND:This is a multicenter, open-label, single-arm clinical trial to evaluate the safety and efficacy of oral cancer vaccine B440 in patients with PD-1/PD-L1 inhibitor-resistant advanced urothelial cancer. METHODS:The trial will be performed at three university hospitals in Japan. The target number of patients will be 12. The patients will be treated orally with B440 once daily for 5 days followed by 2 days for four consecutive courses (4 weeks, 20 treatments). The low-dose group will receive 800 mg (4 capsules) per dose and the high-dose group will receive 1,600 mg (8 capsules) per dose. The primary outcome will be the number and incidence of DLT cases the start of treatment and Day 28. Secondary outcomes are the presence or absence of a response, the best overall response and PFS. DISCUSSION:If this trial shows B440 to be safe and effective, it may lead to a late phase randomized controlled trial in advanced urothelial cancer. Ultimately, we hope to provide a new treatment option for such patients. TRIAL REGISTRATION:Japan Registry of Clinical Trials (jRCT) identifier: jRCT2051220143. Registered on December 27, 2022.

PURPOSEAnti-PD-1 antibodies are widely used for cancer treatment, including in advanced renal cell carcinoma (RCC). However, the therapeutic response varies among patients. This study aimed to predict tumor response to nivolumab anti-PD-1 antibody treatment for advanced RCC by integrating genetic and clinical data using machine learning (ML).METHODSClinical and single-nucleotide polymorphism (SNP) data obtained in the SNPs in nivolumab PD-1 inhibitor for RCC study, which enrolled Japanese patients treated with nivolumab monotherapy for advanced clear cell RCC, were used. A point-wise linear (PWL) algorithm, logistic regression with elastic-net regularization, and eXtreme Gradient Boosting were used in this study. AUC values for objective response and C-indices for progression-free survival (PFS) were calculated to evaluate the utility of the models.RESULTSAmong the three ML algorithms, the AUC values to predict objective response were highest for the PWL algorithm among all the data sets. Three predictive models (clinical model, small SNP model, and large SNP model) were created by the PWL algorithm using the clinical data alone and using eight and 49 SNPs in addition to the clinical data. C-indices for PFS by the clinical model, small SNP model, and large SNP model were 0.522, 0.600, and 0.635, respectively.CONCLUSIONThe results demonstrated that the SNP models created by ML produced excellent predictions of tumor response to nivolumab monotherapy for advanced clear cell RCC and will be helpful in treatment decisions.

Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of advanced renal cell carcinoma (RCC). However, ICIs often induce immune-related adverse events (irAEs), which vary greatly among individuals and may influence treatment outcomes. This study aimed to identify genetic markers associated with the risk of severe treatment-related adverse events (trAEs) and assess their impact on patient prognosis. From August 19, 2019, to September 30, 2020, patient recruitment for nivolumab treatment in advanced clear cell RCC (ccRCC) was conducted across 23 institutions in Japan, with follow-up concluding on March 31, 2021 (protocol ID: UMIN000037739). A genome-wide association study (GWAS) was conducted in a development cohort to identify single nucleotide polymorphisms (SNPs) associated with severe trAEs following nivolumab. Sixteen SNPs were identified, and thirteen were genotyped in a validation cohort. Eight SNPs showed consistent trends with the development cohort, but they have not reached statistical significance in the validation cohort. Among them, rs2545737, corresponding to CHD1, was significantly linked to prolonged progression-free survival (PFS), highlighting its potential as a biomarker for both safety and efficacy. Further analysis indicated that high CHD1 expression in tumors correlated with improved overall survival in nivolumab-treated patients but not in those receiving everolimus. Given the failure to replicate the development set findings in our validation cohort, further re-validation within the RCC population is warranted. However, these results enhance our understanding of the genetic predisposition to trAEs and provide a significant step toward safer and more effective cancer treatment strategies. This study was registered on the University Hospital Medical Information Network (UMIN) in Japan on August 20, 2019 (protocol ID: UMIN000037739).

OBJECTIVES:The objective of this study is to evaluate our initial experience with contact laser vaporization of the prostate (CVP) using the new type of fiber for benign prostatic hyperplasia (BPH). METHODS:We retrospectively evaluated 43 patients in whom CVP was performed using the new type of fiber from October 2020 to December 2021 at our institution. Total International Prostate Symptom Score (IPSS), IPSS voiding, IPSS storage, IPSS postmicturition, quality of life (QOL) index, maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively. Prostate volume was assessed preoperatively and at 12 months postoperatively. Complications were also evaluated. RESULTS:Total IPSS, IPSS voiding, IPSS postmicturition, QOL index, and PVR showed significant improvement at 1 month postoperatively. IPSS storage showed significant improvement at 3 months postoperatively (p = 0.001), and Qmax showed significant improvement at 6 months postoperatively (p = 0.021). The preoperative prostate volume was 87.8 (65.0-116.7) ml and significantly decreased to 80.5 (42.6-97.4) ml at 12 months postoperatively (p = 0.002). The complications were acute prostatitis (9.3%) and temporary urinary retention (7.0%). CONCLUSION:CVP using the new type of fiber was found to be a minimally invasive surgical procedure. There were no severe complications, and the short-term outcomes were favorable.

TPS883 Background: B440, an oral cancer therapeutic vaccine, is based on an innovative oral vaccine platform utilizing gut microbiota ( B. longum; Bifidobacterium longum ) that can efficiently deliver the heterogeneous antigen protein to dendritic cells (DCs) in Peyer's patches in gut-associated lymphoid tissue (GALT). B440 is a lyophilized powder of inactivated B. longum 440, a recombinant B. longum expressing a partially modified human WT1 tumor-associated antigen protein (amino acids 117-419 with a single amino acid substitution at 236 from M to Y to enhance immunogenicity). In preclinical studies, B440 showed superior anti-tumor activity to the WT1 peptide vaccine (WT1 126-134 peptide, human HLA-A02 or mouse H-2Db restricted CD8 epitope) due to the large length of the WT1 117-419 protein, including multiple CD8 and CD4 epitopes without HLA restriction, and its ability to internalize into DCs (1, 2). Furthermore, our extensive preclinical studies showed that B440 alone or as an adjunct to an anti-PD1 antibody can induce potent WT1-specific cellular immunity and anti-tumor activity in several mouse syngeneic tumor models (urothelial cancer (3), prostate cancer (4), and renal cell carcinoma (5)). Methods: This first-in-human, multicenter, open-label, single-arm, investigator-initiated phase 1 study will evaluate the safety and initial efficacy of B440 monotherapy in patients with advanced urothelial cancer who are refractory to all standard therapies, including chemotherapeutic agents, PD-1/PD-L1 inhibitors and antibody-drug conjugates (ADCs). A total of 12 patients will receive B440 orally once daily for 5 consecutive days followed by a 2-day rest for a total of 20 doses for 4 weeks. The study consists of 2 escalating doses of 6 patients each; the low dose group will receive 800 mg (4 capsules) per dose and the high dose group will receive 1,600 mg (8 capsules) per dose. One enteric capsule contains 200 mg of B440, equivalent to 2X10 10 colony forming units (cfu) of B. longum 440. The primary endpoint is the determination of dose-limiting toxicity (DLT) with an assessment period of 4 weeks during treatment. Secondary endpoints are safety as assessed by adverse events (AEs) using CTCAE 5.0 and efficacy as assessed by best overall response and progression-free survival (PFS) using RECIST ver1.1. In addition, the immunological response to B440 will be evaluated by enzyme-linked immunosorbent assay (ELISPOT). The study was registered with the Japan Registry of Clinical Trials under the number jRCT2051220143 on December 27, 2022. Patient enrollment was completed in September 2024. Research Sponsor: Immunorock Co., Ltd., Grant: the Japan Agency for Medical Research and Development (AMED); 23ym0126081h0002. Clinical trial information: jRCT2051220143 .

Prostatitis is a major urological disease affecting 25%-50% of men over their lifetime. However, prostatitis is often overlooked in nonurologic departments due to its sometimes indeterminate symptoms. In this review, we describe how to recognize and treat acute bacterial prostatitis, which manifests as a clinical problem in other departments as well as urology, to help prevent this disease from being overlooked. There are several possible negative effects of not recognizing acute bacterial prostatitis (ABP). First, initial treatment can fail. In the hyperacute phase, common antibiotics are often effective, but in rare cases, such antibiotics may not be effective. In addition, once ABP progresses to form a prostate abscess, potentially avoidable surgical interventions are often needed. A second issue is the transition to chronic prostatitis. If chronic bacterial prostatitis progresses, treatment requires long-term antibiotic administration and the response rate is not high. Some patients may have to deal with urinary tract infections for the rest of their lives. Finally, there is the problem of overlooking the underlying disease. ABP is rare in healthy adult men without underlying disease, including sexually transmitted diseases as well as benign prostatic hyperplasia, urinary stones, and malignant tumors, and may not be obvious. When examining patients with fever of unknown origin, it is necessary to exclude not only infectious diseases but also collagen diseases and malignant tumors. If there are any doubts, we recommend a rectal exam and consultation with a urologist.

OBJECTIVES:To evaluate the safety, efficacy, and patient-reported outcomes of Aquablation therapy using the AQUABEAM Robotic System for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) in a Japanese population. METHODS:This post-market use-results survey included 103 Japanese men with BPH who underwent Aquablation across five centers with previously Aquablation naïve physicians. Data were collected at baseline, during the procedure, at discharge, and at 3 and 6 months post-procedure. Key outcomes included International Prostate Symptom Score (IPSS), quality of life (QoL), uroflowmetry parameters, and adverse events. RESULTS:The mean age of patients was 71.1 years, and the average prostate size was 82.3 mL. At 6 months, the mean IPSS significantly improved from 18.1 ± 9.0 to 6.1 ± 5.0 (p < 0.0001), and QoL scores improved from 4.9 ± 1.3 to 1.8 ± 1.3 (p < 0.0001). Uroflowmetry showed a significant increase in Qmax from 8.3 ± 4.4 to 15.5 ± 7.8 mL/s (p < 0.0001) and a decrease in post-void residual volume (PVR) from 85.6 ± 107.2 to 43.3 ± 60.0 mL (p = 0.0006). At the 30-day primary safety endpoint, there were no reported adverse events of pad-use incontinence, erectile dysfunction, or ejaculatory dysfunction reported, and no device-related serious adverse events were reported. One subject (0.97%) experienced a Clavien-Dindo grade 3 adverse event. CONCLUSIONS:Aquablation therapy using the AQUABEAM Robotic System is a reproducible, safe, and effective treatment for Japanese men with BPH, providing significant improvements in LUTS and QoL with a favorable safety profile.

In the field of urology, robotic surgery has gained rapid and wide acceptance as a standard surgical approach in the majority of major surgeries over the last decade. To date, the da Vinci surgical system has been the dominant platform in robotic surgery; however, several newly developed robotic systems have recently been introduced in routine clinical practice. Of these, hinotori, the first made-in-Japan robotic system, is characterized by various unique and attractive features different from the existing system, and the use of this system has gradually increased mainly in urologic cancer surgeries, including radical prostatectomy, partial nephrectomy, radical nephrectomy, and radical nephroureterectomy. This review initially describes detailed characteristics of hinotori, then summarizes the early experience with urologic cancer surgeries using hinotori at our institution, and finally discusses the future prospects of robotic surgery using hinotori, considering problems associated with the use of this robotic system.

Antibiotic resistance is currently an emergent global challenge. Urinary tract infection (UTI), one of the most commonly reported infections, are is becoming a difficult case to treat considering the increasing prevalence of antimicrobial resistance (AMR). The objective of this study was to assess the impact of a hospital antibiotic stewardship program on AMR in managing UTI at a tertiary referral hospital in Yogyakarta, Indonesia, while considering the absence of the program in lower-tier referral hospitals. A retrospective cross-sectional study was conducted from January 2017 to December 2020, classified into pediatric and adult samples. Urine samples were collected and cultured from all patients with UTI hospitalized in the Dr. Sardjito General Hospital, Yogyakarta. The UTI causative bacteria and antibiotic susceptibilities were investigated in the comparison of the first 2 years (2017-2018, prior to the hospital antibiotic stewardship program) and the last 2 years (2019-2020, following the implementation of the hospital antibiotic stewardship program). The isolates from 717 adult urine samples were cultured. Escherichia coli (39.1%), Acitenobacter baumanii (9.3%), and Pseudomonas aeruginosa (8.5%) were identified as the most common bacteria prior to the hospital antibiotic stewardship program. Extended-spectrum β-lactamase-producing E. coli and Burkholderia cepacia were still increasing in the following the implementation of the hospital antibiotic stewardship program. Our study indicated that the stewardship program does not exhibit a significant change during the first two years considering the absence of the program in lower-tier referral hospitals.

Small cell carcinoma (SCC) of the urinary bladder is a rare and highly aggressive subtype of bladder cancer. Most cases are diagnosed at advanced stages, and its therapeutic strategy remains unestablished. Here, we report a case of bladder SCC in which multidisciplinary treatment has resulted in relatively long-term survival. A 68-year-old man presented with gross hematuria. A cystoscopy revealed an invasive bladder tumor. A transurethral resection of bladder tumor (TURBT) was performed, and the pathological diagnosis was SCC. After systemic chemotherapy using etoposide and carboplatin and subsequent TURBT, a radical cystectomy and ileal conduit were performed. Three months postoperatively, the patient had a recurrence in the para-aortic lymph node. Systemic combination chemotherapy with carboplatin plus irinotecan (CBDCA + CPT-11) was administered, followed by amrubicin and an immune checkpoint inhibitor. In addition to this treatment, radiation therapy for the metastatic region led to the reduction of pain and shrinkage of the metastatic lesion. The patient survived for 2 years after the initial diagnosis. Our report indicates that multidisciplinary treatment can be effective for SCC of the bladder, and a therapeutic strategy including the identification of novel biomarkers should be established.

Immune checkpoint blockade therapies are widely used for cancer treatment, including advanced renal cell carcinoma (RCC). This study aimed to investigate the impact of zygosity in HLA genes and individual HLA genotypes on the efficacy of an anti-PD-1 Ab, nivolumab, in treating advanced RCC. Patient enrollment was conducted across 23 institutions in Japan from August 19, 2019, to September 30, 2020, with follow-up concluding on March 31, 2021. HLA genotype imputation of HLA-A, B, and C, DQB1, and DRB1 loci was performed. Among 222 patients, the presence of at least one homozygosity of the HLA-II allele significantly improved the best objective response (hazard ratio, 0.34; 95% confidence interval, 0.21-0.96; p = 0.042). The HLA evolutionary divergence (HED) of the HLA-A and HLA-B loci was higher than the HLA-C (p < 0.0001 and p < 0.0001, respectively), with high HED of the HLA-B locus correlating to clinical benefits in nivolumab treatment (hazard ratio, 0.44; 95% confidence interval, 0.21-0.90; p = 0.024) and improving cancer-specific survival compared with the low group (p = 0.0202). Additionally, high HED of the HLA-B locus was correlated with the number of infiltrated CD8+ cells in the tumor microenvironment (correlation coefficient, 0.4042). These findings indicate that the diversity of the HLA-B locus plays a significant role in the anti-tumor effect of nivolumab treatment in advanced RCC, potentially offering insights for improved risk stratification in nivolumab treatment and leading to better medical management of advanced RCC.

International Journal of UrologyEarly View Urological Note Clinical outcomes in patients with advanced urothelial carcinoma treated with enfortumab vedotin: A retrospective multicenter study in Japan Takuto Hara, Corresponding Author Takuto Hara [email protected] orcid.org/0000-0003-4524-2815 Department of Urology, Kobe University Graduate School of Medicine, Kobe, JapanSearch for more papers by this authorYuto Matsushita, Yuto Matsushita orcid.org/0000-0002-8159-9793 Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorKenichi Harada, Kenichi Harada orcid.org/0000-0002-0242-9674 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, JapanSearch for more papers by this authorNaohiro Fujimoto, Naohiro Fujimoto orcid.org/0000-0002-5256-6415 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, JapanSearch for more papers by this authorMasato Fujisawa, Masato Fujisawa Department of Urology, Kobe University Graduate School of Medicine, Kobe, JapanSearch for more papers by this authorHideaki Miyake, Hideaki Miyake Department of Urology, Kobe University Graduate School of Medicine, Kobe, JapanSearch for more papers by this author Takuto Hara, Corresponding Author Takuto Hara [email protected] orcid.org/0000-0003-4524-2815 Department of Urology, Kobe University Graduate School of Medicine, Kobe, JapanSearch for more papers by this authorYuto Matsushita, Yuto Matsushita orcid.org/0000-0002-8159-9793 Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, JapanSearch for more papers by this authorKenichi Harada, Kenichi Harada orcid.org/0000-0002-0242-9674 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, JapanSearch for more papers by this authorNaohiro Fujimoto, Naohiro Fujimoto orcid.org/0000-0002-5256-6415 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, JapanSearch for more papers by this authorMasato Fujisawa, Masato Fujisawa Department of Urology, Kobe University Graduate School of Medicine, Kobe, JapanSearch for more papers by this authorHideaki Miyake, Hideaki Miyake Department of Urology, Kobe University Graduate School of Medicine, Kobe, JapanSearch for more papers by this author First published: 29 February 2024 https://doi.org/10.1111/iju.15435Read 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 onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. CONFLICT OF INTEREST STATEMENT None declared. REFERENCES 1Powles T, Rosenberg JE, Sonpavde GP, Loriot Y, Durán I, Lee JL, et al. Enfortumab vedotin in previously treated advanced urothelial carcinoma. N Engl J Med. 2021; 384: 1125–1135. 10.1056/NEJMoa2035807 CASPubMedWeb of Science®Google Scholar 2Zschäbitz S, Biernath N, Hilser T, Höllein A, Zengerling F, Cascucelli J, et al. Enfortumab vedotin in metastatic urothelial carcinoma: survival and safety in a European multicenter real-world patient cohort. Eur Urol Open Sci. 2023; 53: 31–37. 10.1016/j.euros.2023.04.018 PubMedGoogle Scholar 3Jindal T, Zhu X, Bose R, Kumar V, Maldonado E, Deshmukh P, et al. Somatic alterations of TP53 and MDM2 associated with response to enfortumab vedotin in patients with advanced urothelial cancer. Front Oncol. 2023; 13:1161089. 10.3389/fonc.2023.1161089 CASPubMedWeb of Science®Google Scholar 4Bellmunt J, Choueiri TK, Fougeray R, Schutz FAB, Salhi Y, Winquist E, et al. Prognostic factors in patients with advanced transitional cell carcinoma of the urothelial tract experiencing treatment failure with platinum-containing regimens. J Clin Oncol. 2010; 28: 1850–1855. 10.1200/JCO.2009.25.4599 PubMedWeb of Science®Google Scholar 5Maas M, Stühler V, Walz S, Stenzl A, Bedke J. Enfortumab vedotin—next game-changer in urothelial cancer. Expert Opin Biol Ther. 2021; 21: 801–809. 10.1080/14712598.2021.1865910 CASPubMedWeb of Science®Google Scholar 6McGregor BA, Sonpavde G. Enfortumab vedotin, a fully human monoclonal antibody against Nectin 4 conjugated to monomethyl auristatin E for metastatic urothelial carcinoma. Expert Opin Investig Drugs. 2019; 28: 821–826. 10.1080/13543784.2019.1667332 CASPubMedWeb of Science®Google Scholar 7Matsubara N, Yonese J, Kojima T, Azuma H, Matsumoto H, Powles T, et al. Japanese subgroup analysis of EV-301: an open-label, randomized phase 3 study to evaluate enfortumab vedotin versus chemotherapy in subjects with previously treated locally advanced or metastatic urothelial carcinoma. Cancer Med. 2023; 12: 2761–2771. 10.1002/cam4.5165 CASPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Antimicrobial agents are administered to humans and livestock, and bacterial antimicrobial resistance (AMR) and antimicrobial agents are released into the environment. In this study, to investigate the trend of AMR in humans, livestock, and the environment, we performed a metagenomic analysis of multidrug-resistant bacteria with CHROMagar ESBL in environmental river water samples, which were collected using syringe filter units from waters near hospitals, downtown areas, residential areas, and water treatment plants in Surabaya, Indonesia. Our results showed that Acinetobacter, Pseudomonas, Aeromonas, Enterobacter, Escherichia, and Klebsiella grew in CHROMagar ESBL; they were most frequently detected in water samples from rivers surrounding hospitals contaminated with various AMR genes (ARGs) in high levels. These results identified bacteria as ARG reservoirs and revealed that hospitals could be sources for various ARGs disseminated into the environment. In conclusion, this study details a novel metagenomic analysis of collected bacteria in environmental water samples using a syringe filter unit for an AMR epidemiological study based on the One Health approach.

INTRODUCTION: We aimed to clarify the therapeutic outcome of combination therapy using immune -checkpoint inhibitors (ICIs) and/or tyrosine kinase inhibitors (TKIs) for metastatic non -clear -cell renal cell carcinoma (nccRCC). METHODS: We have been retrospectively investigating the therapeutic efficacy and prognosis in 36 patients with metastatic nccRCC undergoing combination therapy using two ICIs, ipilimumab plus nivolumab (ICI -ICI), and ICI plus TKI (ICI-TKI), at Kobe University and affiliated institutions since 2018. Progression -free survival (PFS), overall survival (OS), objective response rate (ORR), and adverse event (AE) were compared. RESULTS: The first -line regimen was ICI -ICI in 26 cases and ICI-TKI in 10 cases. The ORRs in the ICI -ICI and ICI-TKI groups were 34.6 and 30.0%, respectively (p=0.9433). The 50% PFS for the ICI-TKI group was 9.7 months, significantly longer than that for the ICI -ICI group (4.6 months, p=0.0499), and there was no significant difference in OS between groups (p=0.3984). There was no significant difference in the occurrence rate of AE for below grade 2 (p=0.8535), nor above grade 3 (p=0.3786) between the ICI -ICI and ICI-TKI groups. CONCLUSIONS: From our analysis of real -world data, a better outcome of PFS was expected in the ICI-TKI group compared with that in the ICI -ICI group, while there was no significant difference in OS or ORR.

This study aimed to compare the efficacy of robot-assisted partial nephrectomy for completely endophytic renal tumors with the reported outcomes of conventional laparoscopic partial nephrectomy and investigate the transition of renal function after robot-assisted partial nephrectomy. We conducted a prospective, multicenter, single-arm, open-label trial across 17 academic centers in Japan. Patients with endophytic renal tumors classified as cT1, cN0, cM0 were included and underwent robot-assisted partial nephrectomy. We defined two primary outcomes to assess functional and oncological aspects of the procedure, which were represented by the warm ischemic time and positive surgical margin, respectively. Comparisons were made using control values previously reported in laparoscopic partial nephrectomy studies. In the historical control group, the warm ischemia time was 25.2, and the positive surgical margin was 13

The current study aimed to establish an experimental model in vitro and in vivo of urinary crystal deposition on the surface of ureteral stents, to evaluate the ability to prevent crystal adhesion. Non-treated ureteral stents were placed in artificial urine under various conditions in vitro. In vivo, ethylene glycol and hydroxyproline were administered orally to rats and pigs, and urinary crystals and urinary Ca were investigated by Inductively Coupled Plasma-Optical Emission Spectrometer. in vitro, during the 3- and 4-week immersion periods, more crystals adhered to the ureteral stent in artificial urine model 1 than the other artificial urine models (p < 0.01). Comparing the presence or absence of urea in the composition of the artificial urine, the artificial urine without urea showed less variability in pH change and more crystal adhesion (p < 0.05). Starting the experiment at pH 6.3 resulted in the highest amount of crystal adhesion to the ureteral stent (p < 0.05). In vivo, urinary crystals and urinary Ca increased in rat and pig experimental models. This experimental model in vitro and in vivo can be used to evaluate the ability to prevent crystal adhesion and deposition in the development of new ureteral stents to reduce ureteral stent-related side effects in patients.

Surgeons’ adaptability to robotic manipulation remains underexplored. This study evaluated the participants’ first-touch robotic training skills using the hinotori surgical robot system and its simulator (hi-Sim) to assess adaptability. We enrolled 11 robotic surgeons (RS), 13 laparoscopic surgeons (LS), and 15 novices (N). After tutorial and training, participants performed pegboard tasks, camera and clutch operations, energizing operations, and suture sponge tasks on hi-Sim. They also completed a suture ligation task using the hinotori surgical robot system on a suture simulator. Median scores and task completion times were compared. Pegboard task scores were 95.0

Introduction: A prolonged operative time of lithotripsy with ureteroscopy for urolithiasis increases the risk of infectious complications; however, few reports have investigated the factors prolonging the operative time for ureteral stones. We investigated the factors associated with longer operative time in ureteroscopy for ureteral stones. Methods: This retrospective cohort study analyzed patients who underwent retrograde ureteroscopic lithotripsy for ureteral stones and achieved an endoscopic stone-free status between April 2019 and July 2022. Patients were classified into two groups based on an operative time of ≥90 minutes or <90 minutes. We compared the patient and stone characteristics and surgical outcomes, and investigated the factors associated with a prolonged operative time. Results: The cohort comprised 519 patients, with 58 patients in the group with an operative time of ≥90 minutes. Compared to the shorter operative time group, the longer operative time group had a significantly greater proportion of males, stone diameter, stone volume, and Hounsfield units of stone; additionally, the longer operative time group had higher prevalences of endoscopic findings of edema, polyps, and mucosa-stone adherence. Multivariable analysis showed that stone size >10 mm (odds ratio 4.05), polyps (odds ratio 2.40), and mucosal adherence (odds ratio 3.51) were significantly associated with an operative time exceeding 90 minutes. There were no significant differences between the two groups in the incidences of postoperative fever and systemic inflammatory response syndrome. Conclusions: Stone size, endoscopic findings of polyps, and mucosa-stone adherence were independent factors associated with a longer operative time.