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医学部 医学科 発達泌尿生殖医学講座泌尿器科学分野 |
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宮崎泌尿器癌データベース（MUCD）を用いた尿路上皮癌患者の予後に関する後ろ向きコホート研究 査読あり
寺田 直樹, 木村 翔一, 大塚 武, 岡部 洸, 木村 友哉, 秋岡 貴弘, 藤崎 友基也, 藤井 将人, 向井 尚一郎, 山崎 丈嗣, 黒岩 顕太郎, 賀本 敏行, 鬼塚 千衣
泌尿器科紀要 67 ( 9 ) 407 - 412 2021年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：泌尿器科紀要刊行会
Miyazaki Urological Cancer Database (MUCD) is a web-based database containing background, treatment, and prognosis of patients with prostate, renal, and urothelial cancers diagnosed in Miyazaki. We entered information on patients diagnosed with urothelial carcinoma from 2014 to 2018 at 4 of the 17 facilities that diagnose urothelial carcinoma in Miyazaki Prefecture. We analyzed the overall survival for bladder cancer and upper urinary tract cancer, and examined its correlation with the presence of symptoms, urine cytology, and clinical TNM classification. There were 487 patients with urothelial carcinoma, comprising 372 (76%) with bladder cancer and 115 (24%) with upper tract urinary cancer. In the bladder cancer group, 301 (81%) patients had symptomatic disease and 119 (32%) had positive urine cytology. The stage according to the TNM classification was Ta-1N0, T2-4N0, N1-2M0 and M1 in 248 (67%), 94 (26%), 19 (5%) and 11 (3%) patients, respectively. In the upper urinary tract cancers group, 89 (76%) had symptomatic disease and 41 (36%) had positive urine cytology. The stage according to the TNM classification was Ta-1N0, T2-4N0, N1-2M0 and M1 in 45 (39%), 37 (32%), 11 (10%) and 22 (19%) patients, respectively. The 3-year survival rates for bladder and upper urinary tract cancer were 83.4% and 67.8%, respectively. TNM classification (≤T1 vs ≥T2≥) was significantly associated with overall survival (bladder cancer : HR＝7.07, 95% CI＝3.13-16.0, p＜0.0001 ; upper tract urinary cancer : HR＝6.33, 95% CI＝2.13-18.8, p＝0.0009). The prognosis of patients with urothelial carcinoma diagnosed in multiple institutions could be evaluated using MUCD. The clinical T stage was significantly associated with overall survival in patients with bladder cancer and patients with upper urinary tract cancer.
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前立腺癌治療中の前立腺再生検で診断した神経内分泌癌に対して集学的治療が奏効した1例 査読あり
木村 翔一, 寺田 直樹, 長野 正史, 山本 昇士, 秋山 裕, 佐藤 勇一郎, 大塚 武, 秋岡 貴弘, 木村 友哉, 飛田 卓哉, 岡部 洸, 中原 智子, 高森 大樹, 木田 和貴, 上村 敏雄, 賀本 敏行, 向井 尚一郎
泌尿器科紀要 66 ( 3 ) 91 - 96 2020年3月
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：泌尿器科紀要刊行会
A 73-year-old Japanese man visited the urology clinic with the chief complaint of gross hematuria in June 2015. His prostate specific antigen (PSA) level was 146.7 ng/ml and he was diagnosed with prostate adenocarcinoma with a Gleason Score of 5+4. With bone metastasis in the right femur (cT3aN0M1), he was treated by orchiectomy and bicalutamide. He had gross hematuria in October 2017 and a prostate tumor was detected by computed tomography (CT) and magnetic resonance imaging without increasing PSA levels. Prostate re-biopsy showed prostate neuroendocrine carcinoma and local radiation therapy (74 Gy) was performed. Follow-up CT revealed a left adrenal tumor with a positive positron emission tomographic scan in October 2018. Under the diagnosis of metastatic neuroendocrine carcinoma, chemotherapy using cisplatinum and etoposide was performed. The tumor shrunk after five courses of treatment, followed by regrowth in April 2019. Radiation therapy (50 Gy) was added to the left adrenal tumor and it shrunk again. However, a left retroperitoneal tumor was detected in July 2019 and it was resected under laparoscopic surgery and diagnosed as metastatic neuroendocrine carcinoma. Since then, no recurrence has been observed.
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HoLEPにおける術後腹圧性尿失禁を防ぐための手技の工夫 査読あり
小林 隆彦, 岩本 秀安, 伊藤 歌織, 藤崎 友基也, 木村 友哉, 寺田 直樹, 賀本 敏行
Japanese Journal of Endourology 33 ( 2 ) 244 - 247 2020年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：日本泌尿器内視鏡・ロボティクス学会
HoLEP (holmium laser enucleation of prostate) における周術期合併症の1つである一過性の腹圧性尿失禁 (stress urinary incontinence; SUI) を予防する工夫として, 前立腺部尿道12時にある腺組織を有しない前葉線維筋性間質 (anterior fibromuscular stroma ; AFS) を温存するHoLEP術式を紹介した. この術式は, 前立腺部尿道の11時から1時の粘膜を帯状に残るように切開し, AFSを温存する方法である. 膀胱頸部から尖部まで核出する境界線が明確になることで, 術式が簡略化して初心者でもオリエンテーションを付けやすいという利点があり, また尖部剝離操作の際に愛護的操作を意識するようになり, SUI発生率が低下した.