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Department of Urology

Yasuyuki Sakai, Yoshinobu Komai

Introduction

The Department of Urology has existed as part of the Department of Pelvic Surgery at the National Cancer Center Hospital East from 2003. This Department mainly treats diseases of the pelvic organs, including urogenital cancer, with the aim of preserving the sexual and/or voiding functions under minimally invasive surgery.

Routine activities

Outpatient activities: The outpatient clinic is open two days a week as a Urology Department. Flexible cystoscopy, abdominal ultrasonography, retrograde pyelography and some prostate biopsies are performed in the outpatient clinic. Superficial bladder cancer (G3, cis, or recurrent tumor) after TUR-Bt is treated by instillation of BCG into the bladder. Advanced urogenital cancers including metastatic prostate cancer are referred to the medical oncology division for chemotherapy or hormonal therapy. Extrinsic obstructions of the upper urinary tract that directly result from invasion of an adjacent malignancy or peritoneal metastasis are also treated. In most cases, internal stenting is better tolerated than percutaneous nephrostomy. 54 patients newly received ureteral stents and 18 underwent nephrostomy for obstructive uropathy in 2015. Inpatient activities: A daily conference is held with doctors of the Department of Pelvic Surgery on diagnosis and treatment of the patients with colorectal and urological cancer. We performedabout 28 combination surgeries with colorectal surgeons. In the department of urology, 103 general anaesthesia surgeries, 81 spinal anesthesia surgeries and 42 prostate biopsies were performed this year. 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 therapy of hormone and radiation for prostate cancer, treatment strategies for metastatic renal cell carcinoma and testicular cancer, and so on, are determined in the meeting.

Research activities

To facilitate laparoscopic off-clamp partial nephrectomy, we presented the “patient-specific 3D kidney image and 3D printed kidney model” at the 28th congress of the Japanese Society of Endourology, and this presentation was accepted as part of the content of the Audio-Visual Journal of the Japanese Urological Association. And at the 31st annual congress of the European Association of Urology, we presented a time-lapse movie as a novel informed consent tool. It was commended for the Best Poster Award. Total pelvic exenteration (TPE) is the standard procedure for locally advanced rectal cancer involving the prostate and seminal vesicles. We evaluated the feasibility of bladder-sparing surgery as an alternative to TPE. We performed concomitant prostatectomy and cysto-urethral anastomosis.

Clinical trials

  1. A retrospective study of perioperative results in partial nephrectomy for renal cell carcinoma
  2. An estimate of the prevalence of Lynch syndrome in upper urinary tract urothelial cancer
  3. Development and validation of a nomogram to predict recurrences of upper urinary tract urothelial cancer in Japanese patients
  4. A retrospective study of the utility and safety of Imidafenacin for overactive bladder, which occurs after urinary tract stenting for urinary obstruction by a progressive malignant tumor
  5. A phase II clinical study of robotic-assisted radical prostatectomy by the da Vinci S/Si Surgical System
  6. A phase III study: BCG instillation for high-grade T1 bladder cancer (JCOG1019)

Education

We accepted one voluntary resident of urology in 2015 and educated the resident on urological surgery.

Future prospects

New laparoscopic transurethral surgical devices for bladder cancer are being developed in cooperation with another institution. Also, we aim for the safe introduction of laparoscopic total cystectomy and the safe adaptation expansion of robot-assisted laparoscopic surgery.


Table 1. Number of patients Table 2. Type of procedure