Urological Surgery

Introduction
The urological department exists as a part of the pelvic surgery group in NCCHE. So urological surgery is actually the integration of surgical activities for colorectal, urogenital, and gynecological malignancies. The most important mission of the urological division is to contribute to the development of new surgical methods for treating pelvic malignancies. With that in mind, we each attend the daily clinical works as a member of a pelvic surgery team rather than as a conventional urological surgeon.

Routine Activities　
All of the urogenital malignant diseases are diagnosed at the clinics and those requiring pelvic surgery are referred to the ward for radical ope-rations. Those patients in an advanced stage are treated with chemo- and/or endocrine therapy or chemotherapy in cooperation with medical oncolo-gists. One more important job is consultation of other divisionis patient, who complaints of voiding disorder, urine retention, hydronephrosis caused by metastatic lesion and renal dysfunction.
2) Treatment system for inpatients:
Our pelvic surgery group consists of five consultants (four general surgeons and one urologist). Because the purpose of our pelvic surgery group is to create a new operation that preserves sexual and voiding function, we discuss the subjects at every opportunity.
3) Treatment modalities:
Major urological malignant diseases are treated according to the same strategies as employed at NCCH.

New Developments
Dysuria, incontinence and electile dysfunction after colorectal cancer surgery and prostatectomy are inevitable and important postoperative problems in patients with intrapelvic malignancies, particularly for those who have damage caused by intrapelvic autonomic nerve injury during the operation. Reduce the dysfunction, and improve patientis Quality of life following a radical operation of any of pelvic organs, we attempted some new trials.
For locally advanced colorectal carcinoma
1) Extended partial cystectomy:
In far advanced colorectal carcinoma cases with infection and abscess that seems to need total pelvic excenteration, we performed extended partial cystectomy to avoid TPE.We perform this procedure for 3 patientsin 2000-2001. Initial bladder capacities were 35ml, 40ml and 150 ml, but the capacity gained over 200 ml after 1year. All 3 patients can preserve normal voiding function, and they have no bladder recurrence. So we concluded that the extended partial cystectomy is feasible for far advanced cases.
2) Prostatectomy:
For the case of locally advanced colorectal carcinoma invading to the prostate we performed a newoperation. To perform prostatectomy and cyst-urthral anastomosis, we could avoid TPE. And in this case patient could avoid colostoma by performing colo-anal anastomosis. Patient can void spontaneously by this innovative operation. And local recurrence is not observed.
For prostate carcinoma
1) Cavernous nerve graft
We performed 4 cases of cavernous nerve graft after excision of cavernous nerve during prosta-tectomy for preserving electile function.We use sural nerve for graft. One case is bilateral nerve graft, and 3 cases are one nerve graft with ipsilateral nerve spare.
2) Minimal incision
For prostate cancer we tried retro-peritoneo-scopic radical prostatectomy for 10 patients. But we abandon this procedure, because it needs too long operation time and it is too difficult to do precise resection. We do operation with the minimal incision (8cm) for latest 15 cases. We think this minimal incision is appropriate.

K. KAWASHIMA

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