Efficacy of Combination Use of Beta-Lactamase Inhibitor with Penicillin and Fluoroquinolones for Antibiotic Prophylaxis in Transrectal Prostate Biopsy

Katsumi Shigemura,Minori Matsumoto,Kazushi Tanaka,Masuo Yamashita,Soichi Arakawa,Masato Fujisawa 대한비뇨의학회 2011 Investigative and Clinical Urology Vol.52 No.4

Purpose: To investigate the efficacy of tazobactam/piperacillin (TAZ/PIPC) plus levofloxacin (LVFX) as a prophylactic administration in transrectal prostate biopsy (TPBX). Materials and Methods: We investigated 201 consecutive patients who underwent TPBX in one Japanese hospital during the period of 2009-2010. The patients received TAZ/PIPC 4.5 g i.v. once just before and 3 hours after TPBX, plus oral LVFX 300 mg or 500 mg daily for 3 days. We examined the infectious adverse events and laboratory data (serum white blood cell [WBC] count and C-reactive protein [CRP]) before and 1 day after TPBX. Results: Only one patient (0.50%) in 201 cases had febrile complications after TPBX. Serum WBC and CRP did not rise significantly on the day after TPBX compared with before TPBX (p>0.05). There was no significant difference in the rise of serum WBC and CRP before and after TPBX in the comparison of LVFX 500 mg with LVFX 300 mg in the TAZ/PIPC plus LVFX regimen. Conclusions: TAZ/PIPC plus LVFX can be considered as a prophylactic regimen for preventing infectious complications in TPBX. Purpose: To investigate the efficacy of tazobactam/piperacillin (TAZ/PIPC) plus levofloxacin (LVFX) as a prophylactic administration in transrectal prostate biopsy (TPBX). Materials and Methods: We investigated 201 consecutive patients who underwent TPBX in one Japanese hospital during the period of 2009-2010. The patients received TAZ/PIPC 4.5 g i.v. once just before and 3 hours after TPBX, plus oral LVFX 300 mg or 500 mg daily for 3 days. We examined the infectious adverse events and laboratory data (serum white blood cell [WBC] count and C-reactive protein [CRP]) before and 1 day after TPBX. Results: Only one patient (0.50%) in 201 cases had febrile complications after TPBX. Serum WBC and CRP did not rise significantly on the day after TPBX compared with before TPBX (p>0.05). There was no significant difference in the rise of serum WBC and CRP before and after TPBX in the comparison of LVFX 500 mg with LVFX 300 mg in the TAZ/PIPC plus LVFX regimen. Conclusions: TAZ/PIPC plus LVFX can be considered as a prophylactic regimen for preventing infectious complications in TPBX.

Postoperative Infectious Complications in Our Early Experience With Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

Katsumi Shigemura,Kazushi Tanaka,Takahiro Haraguchi,Fukashi Yamamichi,Mototsugu Muramaki,Hideaki Miyake,Masato Fujisawa 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.3

Purpose: The objective of this study was to retrospectively investigate postoperative infectious complications (PICs) in our early experience with holmium laser enucleation of the prostate (HoLEP) followed by mechanical morcellation for symptomatic benign prostatic hyperplasia. Materials and Methods: A retrospective review was performed of the clinical data for 90 consecutive patients who underwent HoLEP at our institution between February 2008 and March 2011. All patients were evaluated for the emergence of PICs, including prophylactic antibiotic administration (PAA) and the influence of the kind or duration of PAA on PIC. The details of cases with PICs were also examined. Results: The patients’ mean age was 71 years (range, 50 to 95 years), and their mean prostate volume was 60 mL (range, 2 to 250 mL). There were 7 cases (7.78%) with PICs;in detail, 3 patients were diagnosed with prostatitis, 2 with pyelonephritis, and 2 with epididymitis. Three patients had positive urine cultures: 1 had Serratia marcescens/Proteus mirabilis, 1 had S. marcescens, and 1 had Klebsiella pneumonia; only one case had urological sepsis. Our statistical data showed no significant differences between 2 or fewer days and 3 or more days of PAA and PIC occurrence. There was also no significant effect on PIC occurrence of sulbactam/ampicillin compared with other antibiotics. Conclusions: The results of this retrospective study showed that PIC occurrence did not depend on the duration or the kind of PAA. Further prospective study is necessary for the evaluation and establishment of prophylactic measures for PICs.

Can Diffusion-Weighted Magnetic Resonance Imaging Predict a High Gleason Score of Prostate Cancer?

Katsumi Shigemura,Nozomu Yamanaka,Masuo Yamashita 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.4

Purpose: To determine the relationship between cancer-positive findings on diffusion-weighted imaging (DWI) magnetic resonance imaging (MRI) and the Gleason score (GS) of radical prostatectomy specimens in prostate cancer (PC). Materials and Methods: We performed a retrospective study of 105 consecutive patients with PC who underwent radical prostatectomy between January 2009 and October 2011 with DWI MRI and full data available for analyses. Prostatectomy specimen pathology included GS, margin status, and capsule invasion, and the clinical factors investigated included age and serum prostate-specific antigen. We investigated the relationship between positive DWI MRI results and these pathological and clinical factors. Results: PC was diagnosed in 62 of 105 patients on DWI MRI. The prostatectomy specimens revealed that the number of cases with GS >4+3 was significantly greater in patients with PC-positive DWI MRI results (34/62, 54.80%) than in those with PC-negative results (2/43, 2.33%; p<0.0001). Positive surgical margins occurred significantly more often in cases with PC-positive DWI MRI results (31/62, 50.0%, compared with 9/43, 21.4%; p=0.0253), and patients with a single tumor lesion in DWI MRI had significantly higher GSs than did those with multiple tumor lesions (p=0.0301). Our statistical results with multiple regression analysis showed that PC-positive DWI MRI results are significantly associated with high GSs. Conclusions: DWI MRI may help to predict high GSs in prostatectomy specimens. Further studies assessing a greater number of patients will be necessary for a definitive evaluation of DWI MRI as a diagnostic tool for determining PC malignancy.

Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons’ Experience During Learning Curve

Katsumi Shigemura,Kazushi Tanaka,Fukashi Yamamichi,Koji Chiba,Masato Fujisawa 대한배뇨장애요실금학회 2016 International Neurourology Journal Vol.20 No.1

Purpose: To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (Ho- LEP) according to surgeon experience (beginner or experienced) and preoperative clinical data. Methods: Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO). We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (<21 cases) and experienced (≥21 cases). Results: Our statistical data showed DO was a significant predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000). Additionally, patient age, surgeon mentorship (inverse correlation), and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively). With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse) at the super-short period, and patient age and mentorship (inverse correlation) at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively) were significant predictive factors for beginners, and first desire to void (FDV) at 1 month after HoLEP (OR, 1.009; P=0.012) was a significant predictive factor for experienced surgeons in multivariate analysis. Conclusions: Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient’s quality of life with regards to urinary continence.

What are the differences between older and younger patients with epididymitis?

Fukashi Yamamichi,Katsumi Shigemura,Soichi Arakawa,Masato Fujisawa 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.3

Purpose: According to the aging of society and the spread of antibiotic-resistant strains, it is worth considering the different aspects of epididymitis (EP) in older and younger patients, even though the etiology and therapeutic strategies of this disease are considered to be established. Thus, we investigated how age affects EP-related symptoms. Materials and Methods: Data were gathered from 7 hospitals in Hyogo, Japan, and the correlations of age (older or younger) with urine findings such as pyuria or bacteriuria and EP-related symptoms such as fever were investigated. Results: In all 308 cases with full data for evaluation, there were 66 febrile (38℃ or higher) cases (21.4%) and bacteriuria was seen in 158 cases (51.3%). In the multivariate analysis, older age (65 years or older) was significantly correlated with the presence of pyuria (p=0.0156). Regarding the relationship between urine findings and EP-related symptoms, pyuria was significantly related to fever (37℃ or higher; p=0.0159). Conclusions: Our data showed that older patients with EP had pyuria significantly more often than did younger patients, which correlated with EP-related symptoms (fever). These data suggest that age-specific guidelines may be necessary.

Efficacy of Using Three-Tesla Magnetic Resonance Imaging Diagnosis of Capsule Invasion for Decision-Making About Neurovascular Bundle Preservation in Robotic-Assisted Radical Prostatectomy

Kazushi Tanaka,Katsumi Shigemura,Mototsugu Muramaki,Satoru Takahashi,Hideaki Miyake,Masato Fujisawa 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.7

Purpose: To evaluate the efficacy of using 3-tesla (T) magnetic resonance imaging (MRI) diagnosis of extracapsular extension (ECE) for decision-making about neurovascular bundle (NVB) preservation in robot-assisted radical prostatectomy (RARP) for prostate cancer (PC). Materials and Methods: We prospectively collected data on PC patients (n=67) who underwent preoperative 3-T MRI before RARP. The choice between nerve sparing or resection was based on 3-T MRI findings of ECE. We compared the MRI findings with the pathological data on surgical margins. Our clinical staging in this study was defined only by MRI. Results: When the data were divided by prostate lobe (right lobe or left lobe, n=134),3-T MRI showed 28 positive cases of ECE in 134 prostate lobes, allowing NVB preservation in 42 cases (31.3%). Nerve-sparing surgery was achieved in 38.7% of cases in which clinical T2 staging by MRI was reported. The pathological data revealed that 10 of 134 prostate lobes had positive ECE. The overall sensitivity, specificity, positive predictive value, and negative predictive value for predicting stage T3 (positive ECE) by side were 60.0% (12 of 20 sides), 86.0% (98 of 114 sides), 42.9% (12 of 28 sides), and 92.5% (98 of 106 sides), respectively. Conclusions: Three-T MRI prior to RARP enables the use of ECE diagnosis to guide decision-making about NVB preservation, with comparatively high specificity and negative predictive value. Further prospective studies are underway to reach more definitive conclusions.

Antimicrobial Prophylaxis in Urological Surgery

Shingo Yamamoto,Katsumi Shigemura,Hiroshi Kiyota,Soichi Arakawa,Japanese Research Group for UTI 대한요로생식기감염학회 2016 Urogenital Tract Infection Vol.11 No.3

Surgical site infection (SSI) is defined as an infection occurring within one month from surgery or intervention. SSIs are classified into three categories: Clean, clean-contaminated, and contaminated. They are defined as procedures that avoid entering the urinary tract, involve entry of the urinary tract, and involve the bowels, respectively. The purpose of antimicrobial prophylaxis (AMP) is to protect the surgical wound from contamination by normal bacterial flora. AMP should be based on penicillin with beta-lactamase inhibitors, or first- or second-generation cephalosporins. Broad-spectrum antimicrobials, such as third- and fourth- generation cephalosporins or carbapenems, should be used to treat postoperative infections but not AMP. AMP should be started no less than 30 minutes prior to the start of the operation. AMP should be administered by a single dose or be terminated within 24 hours in cases of transurethral, clean, or clean-contaminated surgery, and within 2 days in cases of bowl (contaminated) surgery. These guidelines are applicable preoperatively only for non-infected, low-risk patients. The risk of patients for infection should be evaluated preoperatively, such as with a urine culture test. In cases with preoperative infection or bacteriuria that can cause an SSI or urinary tract infection following surgery, patients must receive adequate preoperative treatment based on their individual situation.

Significance of Neoadjuvant Hormonal Therapy in Radical Retropubic Prostatectomy: A Retrospective Single-Surgeon Study

Fukashi Yamamichi,Katsumi Shigemura,Shinichi Morishita,Kunito Yamanaka,Kazushi Tanaka,Hideaki Miyake,Masato Fujisawa 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.2

Purpose: The purpose of this study was to evaluate whether neo-adjuvant hormonal therapy (NHT) prior to radical retropubic prostatectomy (RRP) for prostate cancer (PCa) is beneficial in terms of surgical outcomes and for preventing or delaying biochemical recurrence via single-surgeon case series study. Materials and Methods: Fifty-three men underwent RRP by a single surgeon. The patients were divided into two groups according to whether or not NHT was performed prior to RRP. The study was analyzed retrospectively. We evaluated clinical parameters,surgical parameters, and biochemical recurrence rate. Group 1 (n=34) was treated with RRP only, while Group 2 (n=19) underwent RRP along with NHT. Results: There were no significant differences in clinical, operation-related and pathological factors between the two groups (p>0.05). There was also no significant difference in biochemical recurrence rate between the two groups at the last follow-up, although Group 2 tended to have a lower PCa recurrence rate than Group 1 and the initial prostate-specific antigen (PSA) level was significantly higher in Group 2 than Group 1 (p=0.0496). Conclusion: The present single-surgeon case series study revealed a trend toward a lower rate of PCa recurrence in NHT+RRP treated patients compared to those treated with RRP alone, but this did not reach statistical significance, despite the fact that NHT+RRP patients exhibited higher serum PSA levels preoperatively. Prospective studies with a longer duration of observation and a greater number of patients would be helpful in evaluating NHT more definitively.

Possible Role of Sonic Hedgehog and Epithelial-Mesenchymal Transition in Renal Cell Cancer Progression

Hosny M. Behnsawy,Katsumi Shigemura,Fatma Y. Meligy,Fukashi Yamamichi,Masuo Yamashita,Wen-Chin Haung,Xiangyan Li,Hideaki Miyake,Kazushi Tanaka,Masato Kawabata,Toshiro Shirakawa,Masato Fujisawa 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.8

Purpose: Sonic hedgehog (Shh) signaling and epithelial-mesenchymal transition (EMT) are both known to relate to cancer progression. The purpose of this study was to investigate the role of Shh signaling and EMT in renal cell carcinoma (RCC). Materials and Methods: Cell proliferation was assayed in RCC cell lines in the presence or absence of a Shh signaling stimulator, recombinant Shh (r-Shh) protein, or a Shh signaling inhibitor, cyclopamine. Real-time reverse transcription-polymerase chain reaction (RT-PCR) was performed to study the expression of EMT markers (E-cadherin, N-cadherin, and vimentin) and osteonectin. The expression of Ki-67, Gli-1, osteonectin, and EMT markers in nephrectomy specimens from RCC patients was also measured by immunohistochemical (IHC) staining. Results: RCC cells showed enhanced cell proliferation by r-Shh protein, whereas cell proliferation was suppressed by the addition of cyclopamine in RenCa cells. Real-time RT-PCR showed that r-Shh suppressed the expression of E-cadherin and that this suppression was partly blocked by cyclopamine alone in RenCa cells. In the IHC results, osteonectin significantly correlated with vein sinus invasion (p=0.0218), and the expression of vimentin significantly correlated with lymphatic invasion (p=0.0392). Conclusions: Shh signaling and EMT play roles in RCC progression, and the Shh signaling inhibitor cyclopamine might be a possible molecular targeted therapeutic strategy for RCC.