Keiko Asakawa, Koki Idehara, Atsushi Saito, Takeshi Mitomi, Ataru Igarashi
{"title":"[Cost-Effectiveness Analysis and Budget Impact Analysis of Enzalutamide for the Treatment of Metastatic Hormone-Sensitive Prostate Cancer].","authors":"Keiko Asakawa, Koki Idehara, Atsushi Saito, Takeshi Mitomi, Ataru Igarashi","doi":"10.14989/ActaUrolJap_69_12_337","DOIUrl":"10.14989/ActaUrolJap_69_12_337","url":null,"abstract":"<p><p>We conducted cost-effectiveness analysis and budget impact analysis for androgen deprivation therapy (ADT) plus enzalutamide (ENZ) on patients with metastatic hormone-sensitive prostate cancer (mHSPC) from the publicly-funded healthcare system perspective. Using a partitioned survival model, lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) of ADT+ENZ were estimated against ADT alone, ADT plus abiraterone (ADT+ABI), and ADT plus apalutamide (ADT+APA). Total healthcare cost differences with and without ENZ in mHSPC therapy were estimated for the period from 2022 to 2026. Based on cost-effectiveness analysis, the ICER of ADT+ENZ versus ADT alone was estimated as ¥7.18 million/QALY gained. ADT+ABI and ADT+APA were dominated options (extended dominance). Budget impact analysis showed that incorporation of ENZ had a net budget impact of ¥57.19 billion, an 8.4% increase, over these 5 years. This amounted to a budgetary impact of ¥16,000 per patient per month at year 5. However, the number of patients with disease progressed to metastatic castration-resistant prostate cancer (mCRPC) would be reduced from 79,000 (without ENZ) to 65,000 (with ENZ), resulting in a 17% cost reduction within the mCRPC phase. In conclusion, ADT+ENZ would be a cost-effective option, at the willingness to pay threshold of ¥7.5 million/QALY gained. Introduction of ENZ in the mHSPC treatment would result in a marginal increase in the total budget. However, ENZ is also expected to provide clinical benefits in reducing the number of patients with disease that would otherwise progress to mCRPC during these 5 years, resulting in cost savings in this phase.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 12","pages":"337-361"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[A Case of Metanephric Adenoma Treated with Robotic-Assisted Laparoscopic Partial Nephrectomy].","authors":"Kohei Segawa, Koichi Tsutahara, Kenji Tsutsui, Airi Miki, Teppei Wakita, Yuki Horibe, Masaru Tani, Yoichi Kakuta, Tetsuya Takao","doi":"10.14989/ActaUrolJap_69_12_369","DOIUrl":"10.14989/ActaUrolJap_69_12_369","url":null,"abstract":"<p><p>A 53-year-old female patient was diagnosed with a left renal mass incidentally detected on an abdominal computed tomography (CT) scan. Further examination revealed a slightly contrast-enhancing mass 2.0 cm in diameter, in the left kidney on a contrast-enhanced CT scan. A diagnosis of left renal cell carcinoma (cT1aN0M0) was made and a robotic-assisted laparoscopic partial nephrectomy was performed. The excised tissue specimen exhibited a clearly circumscribed tumor. On hematoxylin eosin staining, the small uniform tumor cells appeared organized in glandular luminal arrangements, with lacking nuclear atypia and any malignant features. Immunostaining confirmed the diagnosis as metanephric adenoma, as indicated by positive results for WT1 and negative results for alpha-methylacyl-CoA race mase. Metanephric adenoma is an uncommon benign epithelial tumor of the kidney, which frequently poses a challenge in differential diagnosis with renal carcinoma on preoperative imaging. Pathologically, it can be challenging to differentiate from papillary renal cell carcinoma, and immunostaining can be used to effectively differentiate between the two entities.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 12","pages":"369-372"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Ureteral Access Sheath Assisted Percutaneous Antegrade Ureteroscopic Lithotripsy for Impacted Ureteral Calculus].","authors":"Tetsuo Fukuda, Ryo Kawahata, Hironao Tajirika, Tatsuro Ishikawa, Junichi Matsuzaki","doi":"10.14989/ActaUrolJap_69_12_363","DOIUrl":"10.14989/ActaUrolJap_69_12_363","url":null,"abstract":"<p><p>We retrospectively evaluated the safety and effectiveness of ureteral access sheath-assisted percutaneous antegrade ureteroscopic lithotripsy in treating ureteral calculus. Between January 2016 and April 2022, 28 patients with ureteral calculus received ureteral access sheath-assisted percutaneous antegrade ureteroscopic lithotripsy. At postoperative 1 month, a plain computed tomography (CT) and kidney ureter bladder X-ray (KUB) were performed to assess stone fragmentation and hydronephrosis. According to postoperative imaging, stone-free was defined as residual fragments 4 mm or less on KUB and 2 mm or less on CT. The mean stone size was 16.3 mm (3-43 mm). The mean stone volume was 1.91 ml (0.13-6.1 ml). The mean operative time was 140 min (60-222 min). Stone-free rate (SFR) was 89.3% on KUB, and 82.1% on CT. Three patients (10.7%) had postoperative fever greater than 38.5°C. There were no complications of grade III or higher according to the modified Clavien-Dindo classification. In the Ellenbogen classification, improvement was observed in hydronephrosis of Grade II or lower. Improvement was also observed in cases with Grade III hydronephrosis. However, due to the presence of residual renal atrophy, there was no change in the classification. The preoperative eGFR was 63 ml/min/1.73 m² (36-101 ml/min/1.73 m²) and the postoperative eGFR was not improved. We conclude that ureteral access sheath-assisted percutaneous antegrade ureteroscopic lithotripsy is effective for treating impacted ureteral calculus.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 12","pages":"363-368"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Akira Tachibana, Kota Iida, Yoshitaka Itami, Masaya Hashimura, Yuta Toyoshima, Yukinari Hosokawa, Kiyohide Fujimoto
{"title":"[Efficacy of Recombinant Thrombomodulin for Sepsis-Associated Disseminated Intravascular Coagulation Caused by Urinary Tract Infections].","authors":"Akira Tachibana, Kota Iida, Yoshitaka Itami, Masaya Hashimura, Yuta Toyoshima, Yukinari Hosokawa, Kiyohide Fujimoto","doi":"10.14989/ActaUrolJap_69_11_309","DOIUrl":"10.14989/ActaUrolJap_69_11_309","url":null,"abstract":"<p><p>Severe urinary tract infections occasionally cause sepsis and disseminated intravascular coagulation (DIC). We examined the efficacy of recombinant thrombomodulin (rTM) for treating DIC caused by urosepsis. We enrolled 40 patients who were diagnosed with DIC caused by urosepsis at our hospital between April 2018 and May 2022. Twenty-six patients were treated with rTM (rTM group), while 14 patients did not receive rTM (non-rTM group). The DIC score before treatment in the rTM group was significantly higher than that in the non-rTM group (P<0.01). There was no significant difference in disease-specific survival between the two groups. There was a significant improvement in DIC scores on days 1-3 after administering rTM. However, the duration of DIC in the rTM group was significantly longer than that in the non-rTM group (P=0.038). The administration of rTM may have benefits in patients with DIC caused by urosepsis.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 11","pages":"309-314"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Testicular Malignant Sertoli Cell Tumor with Long-Term Survival After Pulmonary Metastasectomy: A Case Report].","authors":"Noriyuki Makita, Kazuma Hiramatsu, Yuki Kamiyama, Naofumi Tsutsumi, Toru Yoshida, Yoko Iwasa, Yoji Urata, Takehiko Segawa","doi":"10.14989/ActaUrolJap_69_10_295","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_69_10_295","url":null,"abstract":"<p><p>A 45-year-old man was referred to our hospital with a complaint of right scrotal discomfort. With a diagnosis of testicular tumor, right orchiectomy was performed. The tumor was histologically diagnosed as malignant Sertoli cell tumor pT1N0M0. A pulmonary nodule appeared, 53 months after the operation, and increased in size there after. Thoracoscopic left upper lobectomy was performed 64 months after the operation, and the pathological diagnosis was metastasis of malignant Sertoli cell tumor. No recurrence has been observed for 94 months after the resection of the metastatic lesion.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 10","pages":"295-298"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[The Relationship Between Prognosis and Duration of Drug Holidays after Docetaxel Therapy for Castration-Resistant Prostate Cancer].","authors":"Kenta Onishi, Nobumichi Tanaka, Yasushi Nakai, Norimi Takamatsu, Tatsuki Miyamoto, Mitsuru Tomizawa, Takuto Shimizu, Shunta Hori, Makito Miyake, Kiyohide Fujimoto","doi":"10.14989/ActaUrolJap_69_10_269","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_69_10_269","url":null,"abstract":"<p><p>The next treatment strategy after drug holidays following docetaxel (DTX) therapy for patients with castration-resistant prostate cancer (CRPC) is unclear. This study investigated the relationship between the duration of drug holidays and prognosis after DTX therapy. This study retrospectively assessed 26 patients treated with DTX in our hospital. Overall survival duration was significantly longer in the long-term withdrawal group (duration of drug holidays ≥6 months) than in the short-term withdrawal group (duration of drug holidays <6 months) (P=0.015). Similarly, progression-free survival duration was significantly longer in the long-term withdrawal group than in the short-term withdrawal group (P=0.008). The short-term withdrawal group had a significantly lower body mass index (P=0.009) and higher prostate-specific antigen (PSA) (P=0.017) at the initiation of DTX therapy, higher PSA nadir during DTX therapy (P=0.009), and higher PSA at the end of DTX therapy (P=0.022), compared to the long-term withdrawal group. This study suggests that the optimal opportunity to introduce DXT therapy is when the patients with CRPC are physically able to tolerate chemotherapy and their tumor volume remains a lower burden. This may provide a clinical benefit, longer drug holidays, and a better prognosis.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 10","pages":"269-277"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Evaluation of the Effects of Long-Term Indwelling Ureteral Stents on Preserving Renal Parenchyma and Function in Patients with Ureteral Stenosis].","authors":"Tomohiro Toyota, Tomohiro Yoshikawa, Toshiaki Tanaka, Kohei Hashimoto, Ko Kobayashi, Naoya Masumori","doi":"10.14989/ActaUrolJap_69_10_279","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_69_10_279","url":null,"abstract":"<p><p>Although ureteral stenting is a common conservative treatment for ureteral stricture, it is unclear whether a long-term indwelling ureteral stent protects the kidney against parenchymal atrophy and functional deterioration. In this study, we evaluated the changes in renal parenchymal thickness (RPT) and estimated the glomerular filtration rates (eGFR) in patients with indwelling ureteral stents for one year or more. As a control, we also evaluated changes in RPT associated with indwelling percutaneous nephrostomy (PNS) for one year or more. Polymer ureteral stents were used and replaced every three months. RPT was measured using computed tomography (CT). Totally, 69 renal units in 55 patients with baseline and follow up CT scans available were enrolled. The median follow-up period was 29 months. The etiologies of ureteral obstruction were malignant and benign disease in 27 and 28, respectively. RPT was reduced obviously in most cases. At 1 year, the median reduction rate of RPT was 17.3% in unilateral cases, which was significantly higher than that in the healthy contralateral kidney. There was a strong correlation between eGFR and total RPT including the contralateral kidney. The reduction rate of RPT in kidneys with ureteral stents including bilateral cases was also significantly higher than that in 39 renal units of 35 patients with PNS. The results of this study suggest that the long-term efficacy of indwelling ureteral stents in preserving renal function is limited. Regular imaging may be essential to evaluate the residual renal function.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 10","pages":"279-287"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[A Case of Left Renal Cell Carcinoma with Renal Arteriovenous Fistula and Multiple Vascular Malformation Undergoing Nephrectomy].","authors":"Takanori Hayase, Satoshi Washino, Hiroki Yagi, Shozaburo Mayumi, Kai Yazaki, Yuki Nakamura, Kimitoshi Saito, Akihiro Sawada, Masahiro Hiruta, Koichi Tamai, Tomoaki Miyagawa","doi":"10.14989/ActaUrolJap_69_10_289","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_69_10_289","url":null,"abstract":"<p><p>A 69-year-old woman was referred to our hospital for the treatment of a left renal tumor found by computed tomography (CT) during examination for microscopic hematuria. Contrast-enhanced CT showed a 5 cm tumor in the inferior pole of the left kidney. Left renal cell carcinoma (RCC) (cT1bN0M0) was suspected. In addition, the left renal and gonadal veins were dilated and enhanced in an arterial phase; renal arteriovenous fistula (RAVF) was suspected. Moreover, there were multiple focal arterial dilatations, suggesting the presence of multiple vascular malformation. Hereditary aortic disease, including vascular Ehlers-Danlos syndrome (vEDS), was a concern. In general, surgery is not recommended for patients with vEDS, due to vascular fragility. As such, a panel analysis of genes for hereditary aortic diseases, including vEDS, was performed; no pathogenic variants in candidate genes including COL3A1 were identified. After detailed discussions with the patient, she underwent a left nephrectomy, following transcatheter arterial embolization (TAE) of the left renal artery. We prepared a balloon catheter for aortic occlusion as a preventative measure for massive bleeding; this was not the case, as only a small amount of intraoperative bleeding occurred. Thus, the nephrectomy was performed successfully without using the balloon catheter. The patient recovered uneventfully and was discharged on day 8. Pathological examination showed clear-cell RCC (pT1a) and a RAVF near the tumor. Herein we report this case of left RCC with RAVF and multiple arterial malformation, which was successfully managed by evaluating preoperative risks with a genetic test, followed by TAE of the renal artery and open nephrectomy.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 10","pages":"289-294"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Urological Comorbidities in an HIV-Infected Patient: A Case Report].","authors":"Yohei Ueki, Ko Kobayashi, Kohei Hashimoto, Toshiaki Tanaka, Hiromi Fujita, Naoya Masumori","doi":"10.14989/ActaUrolJap_69_10_299","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_69_10_299","url":null,"abstract":"<p><p>We report a case of a patient who developed several urological comorbidities associated with HIV infection. A 53-year-old male was diagnosed with HIV infection and AIDS. After 13 years, microhematuria was found and computed tomography (CT) revealed urolithiasis and a left renal tumor suspected of being renal cell carcinoma. Initially, he underwent transurethral lithotripsy. Stone analysis indicated that the stone was made of atazanavir. Then he received laparoscopic left partial nephrectomy. The pathological diagnosis was papillary type 2 renal cell carcinoma. Three years later, follow-up CT revealed a right renal pelvic tumor. Since right ureteroscopy showed that the tumor was papillary we diagnosed it as renal pelvic cancer and decided to perform laparoscopic right radical nephroureterectomy. His renal pelvic tumor was determined to be urothelial carcinoma by the pathological diagnosis. Intravesical recurrence occurred twice after the nephroureterectomy. His renal function gradually deteriorated during follow-up and we suspected that HIV nephrosis was one of the reasons for the deterioration. Hemodialysis was initiated at the age of 71.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 10","pages":"299-303"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71427656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[A Case of Testicular Cancer with Solitary Iliac Bone Metastasis].","authors":"Hajime Miyata, Takashige Abe, Naoya Iwahara, Hiroshi Kikuchi, Hiroki Chiba, Ryuji Matsumoto, Takahiro Osawa, Hiroshi Tanaka, Ken Morita, Tomoko Mitsuhashi, Nobuo Shinohara","doi":"10.14989/ActaUrolJap_69_9_259","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_69_9_259","url":null,"abstract":"<p><p>A 23-year-old male was aware of pain around his left hip joint and visited a nearby orthopedic clinic. Swelling of the right testis was pointed out, and a testicular tumor was suspected. He was referred to the urology department of a local hospital. Blood analysis showed an increase of α-fetoprotein (AFP) (3,620 ng/ml). Computed tomographic (CT) -scan revealed a left iliac bone metastasis and morbid fracture. Right radical inguinal orchiectomy was performed. The pathological examination revealed mixed germ cell tumor (embryonic carcinoma and immature teratoma: 70%, seminoma: 30%). The diagnosis was non-seminomatous germ cell tumor, stage IIIc, and poor risk on the International Germ Cell Consensus Classification. After one cycle of a bleomycin, etoposide and cisplatinum (BEP) regimen, he was referred to our hospital. After a total of 4 cycles of BEP, AFP was normalized. Denosumab was also administered monthly. The CT-scan showed a reduction of bone metastasis and recovery of ossification. Bone biopsy did not show viable tumor cells. Because extirpation of the remaining mass would require resection of the left part of the pelvic bone with significant functional loss of the left limb, we performed close follow-up after an additional 2 courses of the etoposide and cisplatin regimen. The patient is currently alive without recurrence at 45 months after the last systemic chemotherapy.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"69 9","pages":"259-264"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41137292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}