Background The surgical management of benign prostatic hyperplasia (BPH) and upper urinary tract stones has remarkably evolved with technological advances. In this study, the trends in surgical techniques for these conditions in the San-in region of Japan were analyzed over a 10-year period. Methods A retrospective survey was conducted across 17 urological facilities in the San-in region (Tottori and Shimane prefectures) from 2014 to 2023. Data on the surgical procedures for BPH and upper urinary tract stones were collected, including the facility adoption rates and annual case volumes. Results For BPH treatment, HoLEP and bipolar TUR-P were the commonly performed procedures, with HoLEP accounting for approximately 50% of all cases. Minimally invasive surgical treatments, including water vapor energy (WAVE) and prostatic urethral lift (PUL), were introduced in 2022. For upper urinary tract stones, the utilization of TUL/URS equipped with holmium laser dramatically increased from 33.9% to 64.9% of all cases, whereas that of extracorporeal shock wave lithotripsy (ESWL) decreased from 59.9% to 32.1%. Conclusion This study shows the successful adoption of advanced urological techniques in rural Japan, with clear trends toward laser-based procedures for BPH and stone treatment. The observed decline in ESWL utilization is consistent with national and international trends, reflecting a global paradigm shift toward the endoscopic management of upper urinary tract stones.

Supplementary motor area (SMA) syndrome is a postoperative complication following SMA tumor resection, characterized by delayed movement initiation and impaired bimanual coordination. Although spontaneous recovery is common, rehabilitation strategies tailored to recovery stages remain unclear. We report a 38-year-old woman who presented with a right SMA tumor (isocitrate dehydrogenase-mutant oligodendroglioma). Preoperatively, she was independent in activities of daily living (ADLs) with no motor, sensory, or cognitive impairments. She underwent awake craniotomy with intraoperative monitoring confirming preservation of the primary motor cortex and corticospinal tract. On postoperative day (POD) 1, she developed left hemiparesis, delayed movement initiation, and impaired bimanual coordination, consistent with SMA syndrome. The patient received inpatient physical and occupational therapy (2 hours/day, 5 days/week) for 3 weeks. Balance and gait training were combined with progressively introduced bilateral, alternating, and rhythmic tasks emphasizing motor timing, sequencing, and coordination based on functional recovery stages. On POD 1, the Brunnstrom Recovery Stage (BRS) was III for the upper limb and II for the lower limb. By POD 14, BRS improved to VI and V, and she achieved independence in ward-based ADLs. Gait speed increased from 1.1 to 1.2 m/s, hand function improved from 91 to 98, and bimanual Purdue Pegboard Test performance improved from 7.3 to 10.3 pairs. By POD 22, gait speed reached 1.4 m/s and the Berg Balance Scale score was 56. This case demonstrates the stage-dependent evolution of SMA syndrome and suggests the potential utility of rehabilitation approaches emphasizing coordinated and sequential motor tasks aligned with functional recovery.

OBJECTIVE:To describe the surgical techniques and evaluate outcomes of laparoscopic hepatectomy using en bloc hilar pedicle control (EHPC) in dogs with hepatic masses. STUDY DESIGN:Prospective study. ANIMALS:A total of 10 client-owned dogs. METHODS:Dogs with hepatic masses not involving the hilar pedicle (portal vein, hepatic artery, and bile duct), hepatic veins at the hilus, and caudal vena cava (CVC) underwent laparoscopic hepatectomy using EHPC. Data on signalment, blood tests, imaging, intraoperative findings, histopathology, and clinical outcomes were collected. RESULTS:Masses were located in the right lateral, right medial, left medial, and left lateral lobes, or the caudate process of the caudate lobe. All dogs completed laparoscopic hepatectomy without conversion to laparotomy. Median operation time was 165 min (range: 90-230 min). Histopathology revealed hepatocellular carcinoma (n = 9) and adenoma (n = 1) and nodular hyperplasia (n = 2). Median hospital stay was 3 days (range: 2-4 days). One dog developed tension pneumothorax from an iatrogenic diaphragmatic injury, and three were diagnosed with bradycardia and hypotension following the Pringle maneuver. Disseminated hepatocellular carcinoma lesions were detected on the greater omentum in one dog 724 days post-surgery. All dogs were discharged. CONCLUSION:Laparoscopic hepatectomy using EHPC was safely performed in dogs with liver masses, with favorable short- and long-term outcomes. CLINICAL RELEVANCE:Laparoscopic hepatectomy using EHPC is a viable option for dogs with liver masses, provided there is no involvement of the hilar pedicle, hepatic veins at the hilus, and CVC.

The aim of this study was to determine the feasibility of intraoperative motor function monitoring using motor-evoked potential (MEP) in combination with low-concentration sevoflurane during propofol anesthesia. This study was a prospective, non-randomized trial that included 38 patients undergoing neurosurgery. MEP were performed under age-adjusted 0, 0.2, and 0.5 minimum alveolar concentrations (MACs) of additional sevoflurane inhalation on propofol anesthesia sequentially. MEP monitoring positive rate, amplitude, latency, and physiological variables were compared between the sections. The percentages of monitoring positive rate with additional 0.2 and 0.5 MACs of sevoflurane were 86.8

Cerebral amyloid angiopathy (CAA) is a disease in which amyloid beta (Aβ) is deposited in blood vessels and meninges in the brain. Cerebral amyloid angiopathy typically occurs in the elderly but is also known to occur in younger patients with a history of childhood head trauma or dura graft following neurosurgical procedures. The patient was a 39-year-old female who had undergone neurosurgery for an arachnoid cyst in the right temporal lobe at the age of two years. Severe headache, dizziness, and right leg weakness developed abruptly. The Aβ42/40 ratio had decreased in cerebrospinal fluid. Brain MRI showed multiple cerebral hemorrhages. Considering CAA, a brain biopsy was performed. Pathological examination showed severe CAA in many leptomeningeal and cortical vessels. We reported early-onset CAA after neurosurgery in childhood. In young patients with cerebral hemorrhages, it is necessary to consider early-onset CAA following childhood head trauma or neurosurgery.

OBJECTIVE Awake craniotomy is commonly used to resect lesions located near the language area during brain surgery. However, it is often difficult to perform language tasks due to several limitations such as difficulty in awakening during surgery and intraoperative seizures. This study investigated the clinical significance of bidirectional corticocortical evoked potential (CCEP) monitoring as a new approach to evaluate intraoperative language function. METHODS This study enrolled 12 patients who underwent awake brain tumor resection with intraoperative CCEP monitoring to assess language function. Electrodes were placed on the frontal and temporoparietal lobes based on the location of the arcuate fasciculus identified with preoperative diffusion tensor imaging to measure CCEPs intraoperatively in two directions: from the frontal lobe to the temporoparietal lobe of the language-dominant side, and vice versa. Correlations between CCEP amplitudes or latencies before and after tumor removal in each direction and postoperative language function assessed with the Western Aphasia Battery were analyzed. RESULTS Nine of the 12 patients showed language-related CCEP responses in both directions before, during, and after tumor removal. One patient who showed decreased CCEP amplitudes in both directions after tumor removal exhibited aphasia for as long as 1 month postoperatively. In contrast, of the 6 patients whose CCEP amplitude in only a single direction was reduced or disappeared, 4 had no deterioration of language function and the other 2 had temporary deterioration of language function during the 1st postoperative week, which improved by 1 month postoperatively. CONCLUSIONS This study indicated that bidirectional CCEP measurement may increase the precision of intraoperative language function monitoring.

Bladder cancer is a leading cause of cancer-related mortality worldwide, partly due to the absence of reliable biomarkers for the accurate prediction of patient prognosis. Amphoterin-induced gene and open reading frame 2 (AMIGO2) expression is a prognostic factor in several types of cancer. The present study aimed to clarify whether AMIGO2 expression can predict the prognosis of patients with bladder cancer. This retrospective study included patients with primary bladder cancer who underwent radical cystectomy at Tottori University Hospital (Yonago, Japan) and its affiliated hospitals between January 2010 and December 2017. Tumor tissues and data were collected from 100 patients and immunohistochemical analysis was performed. The independent predictors in multivariate analysis were lymph node metastasis for recurrence-free survival (RFS), and AMIGO2 expression and pathological T stage for overall survival (OS). Furthermore, AMIGO2 expression was evaluated at the invasive tumor front, and it was revealed that AMIGO2 expression was an independent prognostic factor for both RFS and OS, in addition to lymph node metastasis for RFS. Ki-67 expression, a marker of cell proliferation that is also associated with poor prognosis in several types of cancer, was examined, and Ki-67 expression and lymph node metastasis were identified as independent prognostic factors in RFS, but not in OS. However, the co-expression of AMIGO2 and Ki-67 was identified as an independent prognostic factor for OS. In conclusion, AMIGO2 expression may be considered a novel biomarker for the identification of the risk of recurrence and reduced survival in patients with bladder cancer, and could be used as a rationale for initiating treatment, such as radiation therapy, chemotherapy or immunotherapy, after radical cystectomy.

BACKGROUND/AIM:Few studies have verified the relationship between treatment outcomes of robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC). This study aimed to compare the perioperative and oncologic outcomes between RARC and LRC. PATIENTS AND METHODS:Medical records of 75 patients (45 RARC and 30 LRC) who underwent radical cystectomy and standard or higher lymph node dissection between April 2013 and December 2019 at the Tottori University and other satellite hospitals were reviewed. RESULTS:The operative time was shorter in the LRC group. Mean estimated blood loss was lower in the RARC group. No differences were noted in the complication rates. The mean number of lymph nodes removed was 23.1 in the RARC group and 13.9 in the LRC group (p<0.001). Cox proportional hazards regression analysis showed that the tumor variant of the transurethrally resected bladder tumor (TUR-BT) tissue (p=0.032) and lymph node metastasis (p= 0.041) were significantly associated with a higher risk of cancer-specific survival (CSS). No difference in the CSS (p= 0.337) and recurrence-free survival (p=0.448) was found in all patients having either RARC or LRC. However, the CSS of RARC was higher than that of LRC (p=0.032) in patients with locally advanced stages of bladder cancer such as pathological T stage ≥3 or pathological lymph node positivity. CONCLUSION:In patients with locally advanced bladder cancer pathological T stage ≥3 or pathological lymph node positivity, LRC appears to be associated with shorter CSS than RARC.

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP37)1 May 2024MP37-08 FIVE-YEAR QUALITY OF LIFE OUTCOMES FOLLOWING ROBOT-ASSISTED RADICAL PROSTATECTOMY VERSUS LOW-DOSE-RATE BRACHYTHERAPY MONOTHERAPY FOR LOW-INTERMEDIATE-RISK PROSTATE CANCER Masashi Honda, Hiroshi Yamane, Ryutaro Shimizu, Ryoma Nishikawa, Yusuke Kimura, Noriya Yamaguchi, Shuichi Morizane, Katsuya Hikita, and Atsushi Takenaka Masashi HondaMasashi Honda , Hiroshi YamaneHiroshi Yamane , Ryutaro ShimizuRyutaro Shimizu , Ryoma NishikawaRyoma Nishikawa , Yusuke KimuraYusuke Kimura , Noriya YamaguchiNoriya Yamaguchi , Shuichi MorizaneShuichi Morizane , Katsuya HikitaKatsuya Hikita , and Atsushi TakenakaAtsushi Takenaka View All Author Informationhttps://doi.org/10.1097/01.JU.0001008948.02935.01.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Evidence of long-term quality of life (QOL) in relation to treatment regimens is limited compared with that of oncological outcomes. This study aimed to evaluate 5-year QOL outcomes after robot-assisted radical prostatectomy (RARP) and low-dose-rate brachytherapy (LDR-BT) monotherapy for prostate cancer. METHODS: From April 2011 to September 2018, 264 patients who underwent RARP (n=162) or LDR-BT (n=102) for low-intermediate-risk prostate cancer participated in a longitudinal outcomes study. Male patients who received androgen deprivation therapy or radiation therapy for biochemical recurrence after treatment were excluded, and 139 RARP and 101 LDR-BT patients were included. A QOL survey using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire was completed at baseline, and at 3, 6, 12, 24, 36, 48, 60 months after treatment. RESULTS: At 3, 6, 12, 24, 36, 48, and 60 months after treatment, urinary function domain scores of RARP group were significantly lower than those of LDR-BT group (70.7±20.2 vs 82.8±19.4, p<0.01; 82.0±18.7 vs 87.5±16.9, p<0.05; 84.4±18.9 vs 92.8±13.2, p<0.01; 88.2±15.9 vs 93.4±12.1, p<0.05; 88.5±16.5 vs 94.8±11.1, p<0.01; 87.7±14.9 vs 93.5±13.7, p<0.05; 87.0±17.6 vs 92.9±13.8, p<0.05, respectively). While urinary function domain score of LDR-BT group had recovered to baseline value at 12 months, urinary function domain score of RARP group remained significantly lower than at baseline even at 60 months (87.0±17.6 vs 97.6±7.7, p<0.01). At 3 and 6 months, urinary irritation/obstruction domain scores of LDR-BT group were significantly lower than those of RARP group. At any observation period, urinary incontinence domain scores of RARP group were significantly lower than those of LDR-BT group. Moreover, urinary incontinence domain score of RARP group remained significantly lower than at baseline even at 60 months (80.9±24.6 vs 96.4±12.0, p<0.01). At 3 and 6 months, bowel function and bother domain scores of LDR-BT group were significantly lower than those of RARP group. At 3, 6, 12, 24, 36, 48, 60 months, sexual bother domain scores of RARP group were significantly lower than those of LDR-BT group. In the hormonal function and bother domain scores, no significant differences were observed between the two groups. CONCLUSIONS: Differences in 5-year QOL between patients with prostate cancer receiving RARP or LDR-BT monotherapy could aid in treatment selection in this setting. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e605 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Masashi Honda More articles by this author Hiroshi Yamane More articles by this author Ryutaro Shimizu More articles by this author Ryoma Nishikawa More articles by this author Yusuke Kimura More articles by this author Noriya Yamaguchi More articles by this author Shuichi Morizane More articles by this author Katsuya Hikita More articles by this author Atsushi Takenaka More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE The purpose of this study was to understand the anatomical and functional connections between the paracentral lobule (PCL) and the primary motor cortex (M1) of the human brain. METHODS This retrospective study included 16 patients who underwent resection of lesions located near M1. Nine patients had lesions in the dominant hemisphere. Tractography was performed to visualize the connectivity between two regions of interest (ROIs)—the convexity and the interhemispheric fissure—that were shown by functional MRI to be activated during a finger tapping task. The number, mean length, and fractional anisotropy (FA) of the fibers between the ROIs were estimated. During surgery, subdural electrodes were placed on the brain surface, including the ROIs, using a navigation system. Cortico-cortical evoked potentials (CCEPs) were evoked by applying electrical stimuli to the hand region of M1 using electrodes placed on the convexity and were measured with electrodes placed on the interhemispheric fissure. To verify CCEP bidirectionality, electrical stimuli were applied to electrodes on the interhemispheric fissure that showed CCEP responses. Correlations of CCEP amplitudes and latencies with the number, mean length, and mean FA value obtained from tractography were determined. The correlations between these parameters and perioperative motor functions were also analyzed. RESULTS Fibers of 14 patients were visualized by diffusion tensor imaging (DTI). Unidirectional CCEPs between the PCL and M1 were measurable in all 16 patients, and bidirectional CCEPs between them were measurable in 14 patients. There was no significant difference between the two directions in the maximum CCEP amplitude or latency (amplitude, p = 0.391; latency, p = 0.583). Neither the amplitude nor latency showed any apparent correlation with the number, mean length, or mean FA value of the fibers obtained from tractography. Pre- and postoperative motor function of the hands was not significantly correlated with CCEP amplitude or latency. The number and mean FA value of fibers obtained by DTI, as well as the maximum CCEP amplitude, varied between patients. CONCLUSIONS This study demonstrated an anatomical connection and a bidirectional functional connection between the PCL, including the supplementary motor area, and M1 of the human brain. The observed variability between patients suggests possible motor function plasticity. These findings may serve as a foundation for further studies.

Alcohol-associated liver disease (ALD) is a substantial cause of morbidity and mortality worldwide and represents a spectrum of liver injury beginning with hepatic steatosis (fatty liver) progressing to inflammation and culminating in cirrhosis. Multiple factors contribute to ALD progression and disease severity. Here, we overview several crucial mechanisms related to ALD end-stage outcome development, such as epigenetic changes, cell death, hemolysis, hepatic stellate cells activation, and hepatic fatty acid binding protein 4. Additionally, in this review, we also present two clinically relevant models using human precision-cut liver slices and hepatic organoids to examine ALD pathogenesis and progression.

Introduction and Hypothesis: Robot-assisted radical nephroureterectomy (RANU) has emerged as a valid alternative to open or laparoscopic nephroureterectomy in recent years. However, different types of robotic platforms can limit surgical maneuvers in various ways. This study aimed to describe the surgical procedure and demonstrate RANU's technical feasibility and safety using the Hugo robot-assisted surgery (RAS) system. Materials and Methods: Using the Hugo RAS system, we reported data from the first five consecutive patients who underwent RANU at Tottori University Hospital. We adjusted the docking angles of the four independent arm carts in each case and performed a complete RANU via a transperitoneal approach. We collected patients' sociodemographic and perioperative data, including complications, and compared them retrospectively with data obtained using the da Vinci surgical system. Results: Arms positions were modified after the first patient to be placed all at the back of the patient. Median overall operative time was 283 minutes (203-377) and the median time using the robotic system was 187 minutes (121-277). The median estimated blood loss was 20 mL (5-155). None of the patients required a blood transfusion and none suffered postoperative complications of Clavien-Dindo grade ≥3. These outcomes were similar to those obtained with the da Vinci Xi system. Conclusion: This series represents the first report of RANU executed using the novel Hugo RAS system. Our proposed arm-setup will assist other surgeons and help ensure safe implementation of RANU on the Hugo platform.

Extraventricular neurocytoma (EVN) is a rare neuronal tumor with a marked tendency towards ganglionic or glial differentiation. Although EVN commonly occurs in young adults, congenital cases are extremely rare, and standardized therapeutic strategies remain undetermined. The presence of atypical features such as increased mitotic activity on histological analysis is correlated with a higher rate of recurrence and poor prognosis. A 3-d-old infant with no abnormalities at birth presented with recurrent apnea and paroxysmal eye deviation on the upper right side. Magnetic resonance imaging revealed a large intracranial tumor located anterior to the brainstem. The patient underwent biopsy via craniotomy, leading to a histological diagnosis of EVN with atypical features. Despite the absence of adjuvant radiation therapy or chemotherapy, the lesion remained stable over 18 months, and the patient's growth was within normal limits. EVN is an important differential diagnosis of congenital brain tumors. Therapeutic strategies for congenital cases should be distinguished from those used for older children, and treatment decisions should be based on individual patient risks.

Neurosarcoidosis is a condition that is characterized by the occurrence of noncaseating epithelioid granulomas in various organs throughout the body, including the lungs, heart, and central nervous system. It is particularly prevalent in cases of noncommunicating hydrocephalus. While its clinical presentations may vary, neurological deficits such as hemiparesis are extremely uncommon. We herein present a case of unilateral hydrocephalus resulting from neurosarcoidosis presenting with hemiparesis. A 58-year-old woman exhibited right hemiparesis, altered mental status, and aphasia persisting for 1 month. Magnetic resonance imaging showed unilateral hydrocephalus of uncertain etiology. The patient underwent external ventricular drainage, endoscopic fenestration of the septum pellucidum (septostomy), and lesion biopsy, which led to a histopathological diagnosis. Hemiparesis can accompany unilateral hydrocephalus caused by neurosarcoidosis. Endoscopic procedures provide an effective option for the diagnosis and treatment of noncommunicating hydrocephalus caused by neurosarcoidosis.

Abstract Background Multiparametric MRI (mpMRI) is widely used for the diagnosis, surveillance, and staging of prostate cancer. However, it has several limitations, including higher costs, longer examination times, and the use of gadolinium-based contrast agents. This study aimed to investigate the accuracy of preoperatively assessed index tumors (ITs) using biparametric MRI (bpMRI)/transrectal ultrasound (TRUS) fusion biopsy compared with radical prostatectomy (RP) specimens. Methods We included 113 patients diagnosed with prostate cancer through bpMRI/TRUS fusion-guided biopsies of lesions with a Prostate Imaging Reporting and Data System (PI-RADS) category ≥ 3. These patients underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our institution between July 2017 and March 2023. We examined the localization of preoperative and postoperative ITs, the highest Gleason score (GS), and tumor diameter in these patients. Results The preoperative cT stage matched the postoperative pT stage in 53 cases (47%), while 31 cases (27%) were upstaged, and 29 cases (26%) were downstaged (Weighted Kappa = 0.21). The preoperative and postoperative IT localizations were consistent in 97 cases (86%). The concordance rate between Gleason groups in targeted biopsies and RP specimens was 51%, with an upgrade in 25 cases (23%) and a downgrade in 27 cases (25%) (Weighted Kappa = 0.42). The maximum diameter of the IT and the maximum cancer core length on biopsy were correlated with the RP tumor's maximum diameter (p < 0.001 for both). Conclusion The diagnostic accuracy of bpMRI/TRUS fusion biopsy is comparable to mpMRI, suggesting that it can be a cost-effective and time-saving alternative.

BACKGROUND AND PURPOSE:Elevated intracranial pressure (ICP) resulting from severe head injury or stroke poses a risk of secondary brain injury that requires neurosurgical intervention. However, currently available noninvasive monitoring techniques for predicting ICP are not sufficiently advanced. We aimed to develop a minimally invasive ICP prediction model using simple CT images to prevent secondary brain injury caused by elevated ICP. METHODS:We used the following three methods to determine the presence or absence of elevated ICP using midbrain-level CT images: (1) a deep learning model created using the Python (PY) programming language; (2) a model based on cistern narrowing and scaling of brainstem deformities and presence of hydrocephalus, analyzed using the statistical tool Prediction One (PO); and (3) identification of ICP by senior residents (SRs). We compared the accuracy of the validation and test data using fivefold cross-validation and visualized or quantified the areas of interest in the models. RESULTS:The accuracy of the validation data for the PY, PO, and SR methods was 83.68% (83.42%-85.13%), 85.71% (73.81%-88.10%), and 66.67% (55.96%-72.62%), respectively. Significant differences in accuracy were observed between the PY and SR methods. Test data accuracy was 77.27% (70.45%-77.2%), 84.09% (75.00%-85.23%), and 61.36% (56.82%-68.18%), respectively. CONCLUSIONS:Overall, the outcomes suggest that these newly developed models may be valuable tools for the rapid and accurate detection of elevated ICP in clinical practice. These models can easily be applied to other sites, as a single CT image at the midbrain level can provide a highly accurate diagnosis.