The 6th CJUA annual meeting
2012

China-Japan urological association

PROGRAM ＆ABSTRACTS

Date
Apr. 23, 2012
Venue
Pan Pacific Yokohama Bay Hotel Tokyu

CJUA

Home-page

URL: http://www.uro.jp/nichu/index.html

PROGRAM of the 6th CJUA annual meeting( 2012.4.23

Yokohama

Japan )

Meeting address: Room Prince，Pan Pacific Yokohama Bay Hotel Tokyu

16:00 - 16:10 Opening Address
Prof. Yanqun Na, President of CJUA (China)

16:10 - 16:25 Special lecture
Chairmen:

Prof. Kakehi Y , Japan

From Chinese Urologist to a Doctor of Japan: A Journey through Education andResearch.
Xiuxian Wu,

Kagawa University ,Japan

16:25 - 17:05 Session I (7 minutes presentation following 3minutes discussion)
Chairmen:

A.Prof. Shinohara N , Japan
Prof. Xianghua Zhang , China

1）Androgen Ablation Therapy Increases Prostate Cancer Stem Cells via Hedgehog
Pathway.
ZHANG Yu-xi,

China Medical University, China

2）Oncolytic herpes simplex virus type 1 (HSV-1) armed with IL-12 for treating bladdercancer.
Jiangang Hou,
3)

The University of Tokyo ,JapanThe fuctional and transcriptional regulation mechanism of UCA1, a novel

bladder-cancer specific long noncoding RNA.
Zhang Zheng , The First Affiliated Hospital of Peking University, China
4)

Association Analysis of 14 Single Nucleotide Polymorphisms with Prostate Cancer

1

Risk in Chinese Subjects.
Lei Wang, Peking University Wujieping Urology Center, China

17:05 - 17:55 Session
Chairmen:

II (7 minutes presentation following 3minutes discussion)

Prof. Nagai A, Japan
Prof. Xu Kexing, China

5)

Clinical Research of Holmium Laser Therapy of Scrotum Paget Disease.

Jianbo Wang, Dalian Medical University, China
6)

Ureteral stent retrieval and ureteral stent exchange using crochet hook techniquefor female patients.
Takashi Kawahara, Yokohama City University, Japan
7)

Endoscopic treatment for obstructive complications after urinary diversion.

Cao ming, Renji Hospital, Shanghai, China
8)

A novel endourological strategy in complete staghorn calculus patient withcomorbidity: 2-staged TUL -assisted PCNL (TAP).
Noritaka Ishito,

Kurashiki Medical Center, Japan

9） Impact of Right-sided Nephrectomy on Long-term Outcomes in Retroperitoneoscopic
Live Donor Nephrectomy: Based on 533 Consecutive Cases at Single Center.
Takafumi Yagisawa,

Tokyo Women’s Medical University, Japan

17:55 - 18:35 Session
Chairmen:

Prof. Ichikawa T, Japan
Prof.

10)

Gang Zhu , China

Clinical practice for BPH medical treatment in China.

Xianghua Zhang,11)

III (7 minutes presentation following 3minutes discussion)

Peking University Wujieping Urology Center, China

IMPROVEMENT OF SEXUAL FUNCTIONS IN PATIENTS WITH BENIGNPROSTATIC HYPERPLASIA TREATED BY HOLMIUM LASER ENUCLEATION OF

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THE PROSTATE (HoLEP).
Kazuhiko Fukumoto, Kawasaki Medical School, Japan12）Early outcomes and safety analysis of the Beijing LESS Laparoscopic Radical
Prostatectomy Technique.
Gang Zhu, Beijing Hospital, China
13)

Predictive factors for acute and late urinary toxicities after permanent prostatebrachytherapy.
Ryuta Tanimoto, Okayama University, Japan
18:35- 18:40 Closing Address
Prof. Hiromi Kumon, President of CJUA (Japan)3

[ Abstracts ]Special lecture
From Chinese Urologist to a Doctor of Japan: A Journey through Education andResearch.
Xiuxian Wu（Department of Urology, Faculty of Medicine, Kagawa University ,Japan）
In this symposium, I will introduce my presentation as From Chinese Urologist to a
Doctor of Japan: A Journey through Education and Research. Our department accepted
one Chinese urologist, supported by the Japanese Urological Association International
Foundation in 2009 and 2010, respectively. I will also introduce their current active
progress in China.
Prior to visit to Japan, I had carried out clinical work such as kidney cancer, bladdercancer, and renal transplantation as an urologist for 12 years at the Qiqihar Medical
University Hospital in China. I came to Japan in October 1996 and studied in the
Department of Urology, Kyoto University for one year as a Sasakawa Medical
Scholarship trainee. Afterwards, I re-visited Japan and enrolled in the graduate schoolof Kyoto University. At my graduate school, I was engaged with research projects suchas exploring molecular markers of early diagnosis of bladder cancer and developing
molecular targeted therapeutic agents using primary cultured cells isolated from renal
cancer tissue obtained at the time of surgery.
For foreign doctors, in order to get Medical License, they have to pass a preliminary
qualification test that consists of three components: basic medicine, clinical medicine,and a skill test. The preliminary qualification test is in essay format. Pass rate isabout 3%, most foreign medical school graduates took the exam 3-5 times and did
not pass it. Unfortunately, most of them give up at that step. Then, they should join aclinical training for one year after passing the preliminary qualification test. Finally,
they will be qualified to take the Japanese national medical license board. As I
graduated from Medical School in China 26 years ago, it was challenging to get a
medical license in Japan. Fortunately, I passed the Japanese national medical license
board in March 2011. I just now finished 8 months initiated clinical training which
provided by the Ministry of Health, Labour and Welfare of Japan and the ClinicalTraining Center of Kagawa University, and started my career again as an urologist in

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Japan. In the future, I will strive to develop new therapeutics for cancer and makecontributions to local communities through medical care services. Furthermore, I wantto contribute toward the medical and cultural exchange between China andJapan.

１ . And rogen Ab lation The rapy Inc rease s Prostate Can cer Stem Ce ll s
via He dgehog Pathway
ZHANG Yu-xi, BI Jian-bin, KONG Chui-ze（Department of Urology,The First Hospital, China Medical University, China ）Ab str ac t
O bjec tiv e

Prostate cancer is the most commonly diagnosed malignancy in older men

in the west world. At initial stages, prostate cancer cells depend on androgens for
growth, and therefore androgen ablation therapy (ADT) is the standard therapy for thetreatment of prostate cancers. However, androgen-independent disease will ultimatelyintervene in most patients.We investigate the mechanismof ADT affecting prostatecancer stem cells (PrCSCs) and the gene relative to stem cells.
M ethodsAn

androgen-independent

subline(LNCaPAI)

wasestablishedbycontinuously culturing the LNCaP cells in the medium without androgen. After the
LNCaP

cells

were

ablatedofandrogen,the

proportionof

PrCSC(CD44+/CD24-subpopulation) was assessed by flow cytometry analysis and theexpressions of BMI-1, ABCG2, NANOG,Gli-1, andSMOwere assessed by western blot
and real-time RT-PCR. After the prostate cancer cells were treated with 10
μMcyclopamine for one week, the proportion of CD44+/CD24- in prostate cancer cells
were assessedby flow cytometry analysis.
Result s The LNCaPAIsubline were established from androgen-dependent LNCaP cells.
CCK-8 assay illustrated that LNCaP-AI cells showed stronger proliferative ability than
LNCaP cells in androgen depriviation culture medium. PSA secretion was stimulatedwith increasing concentration of DHT in both LNCaP and LNCaP-AI cells, but the PSA
secretion was much higher for LNCaP cells than for LNCaP-AI cells. In the LNCaP cell5

line, the CD44+/CD24- subpopulation (PrCSC) was rare (0.04%), whereas the LNCaPAI
cell line had a more prevalent CD44+/CD24- population (0.74%). After the LNCaP cells
were cultured in an androgen deprivation condition, the CD44+/CD24- subpopulation
increased. The expressions of BMI-1, ABCG2, NANOG,Gli-1, andSMO increased after
the LNCaP cells cultured in an androgen deprivation condition. The expressions of

BMI-1, ABCG-2, NANOG, GLI-1, and SMO in LNCaP-AI were more than those in
LNCaP cells.We further investigated the role of Hedgehog pathway in prostate cancer.
After the LNCaP and LNCaP-AI cells have been treated with 10 μMcyclopamine for one
week, the CD44+/CD24-subpopulation significantlydrcreased. Inhibition Hedgehog
pathway also prevents the increase of CD44+/CD24- subpopulation induced by ADT.
Conc lusion

It was found for the first time in our study that the CD44+/CD24-

subpopulation increased in androgen-dependent prostate cancer after androgendeprivation. The expressions of BMI-1, ABCG-2, NANOG, GLI-1, and SMOincreased
after

longerandrogendeprivation

invitro.ADT

increased

the

PrCSCsinandrogen-dependent prostate cancer might via Hedgehog pathway.

２．Oncolytic herpes simplex virus type 1 (HSV-1) armed with IL-12 for treating
bladder cancer.
Jiangang Hou1, Hiroshi Fukuhara1, Yuzuri Tsurumaki Sato1, Yuta Takeshima1, Yukio
Homma1, Yasushi Ino2, Tomoki Todo2（1Department of Urology, Graduate School of Medicine, The University of Tokyo,
2Division of Innovative Cancer Therapy, the Advanced Clinical Research Center, The

Institute of Medical Science, The University of Tokyo, Japan）
Oncolytic herpes simplex viruses type 1 (HSV-1) that replicate selectively in cancer cells
are promising therapeutic agents for cancer.

G47∆ is a third-generation oncolytic

HSV-1 that has triple mutations in the gamma34.5, alpha47 and ICP6 genes, and thefirst recombinant oncolytic virus to be used in a clinical trial in Japan. Using the G47∆
backbone, we constructed T-mfIL12, an HSV-1 armed with fusion-type murineinterleukin 12 (IL-12).

We have previously shown that, when inoculated

intraneoplastically at 1 x 106 pfu, T-mfIL12 was significantly better at inhibiting the
growth of subcutaneous MB-49 tumors (murine bladder cancer) in syngeneic C57BL/6
mice compared with T-01, a control virus.

6

From a clinical standpoint, we further

sought various applications of IL-12-expressing oncolytic HSV-1 for treating bladdercancer.
A lung metastases model was generated by injecting MB-49 cells intravenously in
C57BL/6 mice, and viruses were repeatedly administered into the tail vein. Both T-01
and T-mfIL12 (5 x 106 pfu) significantly prolonged the survival compared with mock,with T-mfIL12 being more efficacious than T-01. In an orthotopic bladder cancer model,
intravesical inoculations with T-mfIL12 (1 x 106 pfu) prolonged the survival of C57BL/6
mice with MB-49 bladder cancer compared with T-01. Further, using the orthotopic
model, cancer-bearing mice were treated with intravesical administration of T-mfIL12(1 x 106 pfu) or mock in combination with BCG (1.35mg) or PBS.

The combination of

T-mfIL12 and BCG prolonged the survival of the mice with MB-49 bladder cancer
compared with T-mfIL12 alone or BCG alone.

When athymic mice bearing

subcutaneous human RT-4 bladder cancer were treated with intraneoplastic inoculationof G47∆ (4 x 104 pfu) or mock in combination with intraperitoneal injection of Gefitinib,
an epidermal growth factor receptor inhibitor, or PBS, the combination therapy wassignificantly more efficacious than G47∆ alone or Gefitinib alone.
Results indicate that the G47∆-derived oncolytic HSV-1’s are useful for treating bladdercancer in a variety of ways.

The efficacy of G47∆ may be greatly enhanced by arming

the virus with IL-12.

３. The fuctional and transcriptional regulation mechanism of UCA1, a novel

bladder-cancer specific long noncoding RNA.
Zhang Zheng（Department of Urology, The First Affiliated Hospital of Peking University, China）
Bladder cancer is the most common urinary malignant tumor in China and theincidence is increasing in recent years. The prognosis of invasive bladder cancer is poorin spite of radical surgery and adjuvent therapy. To find a better biological target for
diagnosis and treatment of bladder cancer, we screened and identified a novel gene bynewbioinformaticalmethods

developed

ourselves

and

named

the

gene

as

UCA1(Urotheial Carcinoma Antigen 1).UCA1 has been proved a long non-coding RNA
and to express in bladder cancer specifically. We have finished gene cloning,localizing
and sequencing under the auspices of the National Natural Science Foundation.The
correlation between UCA1 and tumor invasion was also observed. To detect the7

functional region of UCA1 promoter and important transcription factor contributing to
its overexpression in bladder cancer cell, A series of different length of UCA1 promoter
was constructed into luciferase report gene vector. A functional region in the promoter
was then identified by 5'deletion analysis. Silico analysis and site directed mutagenesis
analysis were used to assess and locate important transcriptional factors. A region of
180bp was restricted to be highly related with over-expression of UCA1 andModelInspector predicted thirteen potential binding sites for the loss or gain of activity
from the deletion constructs. SDM of these TFBS led to a drop in activity in six
transcriptional factor mutants.Finally, C/EBPβ was proved to act as an importanttranscriptional regulator and up-regulate UCA1 expression in bladder cancer by ChIP
and EMSA. The undergoing study on function suggested that UCA1 is combined with
BRG1, which is a core subunit of the chromatin remodeling complex SWI/SNF. Since it
has been proved that C/EBPβis inhibited by SWI/SNF，we hypothesize that UCA1 may
affect the chromatin-remodeling function of SWI / SNF by binding BRG1, weakening
inhibition of tumor by BRG1 in one hand, and inhibiting down-regulation of C/EBPβ by
SWI/SNF

in

the

other

hand.

This

mechanismisdescribed

asa

UCA1-BGR1-C/EBPβ-UCA1 positive feedback circle by our gourp. Through this circle,
UCA1 may up-regulate itself and amplify its function in promoting bladder cancer. We
will study further on this hypothysis.

４..Association Analysis of 14 Single Nucleotide Polymorphisms with Prostate
Cancer Risk in Chinese Subjects

Lei Wang a, Haruki Kakub, Peng Huangb, Ming Lic, Liping Xied, Kenji Shimizue, Hiromi
Kumonb, and Yanqun Naa（a Peking University Wujieping Urology Center, China
bDepartment of Urology, Okayama University Graduate School of Medicine, Dentistry

and Pharmaceutical Sciencies,
cDepartment

Japanof Urology, Peking University School of Oncology, Beijing Cancer

Hospital & Institute, China
dDepartment of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang

University, China
eDepartment of Molecular Genetics Okayama University Graduate Scholl of Medicine,8Dentistry and Pharmaceutical Sciencies, Japan）

ABSTRACT
AIM Accumulating evidence supports an important role of genetics in prostate cancer
etiology. Single nucleotide polymorphism reflects a crucial aspect of individual
difference in genetic susceptibility. The present study aimed to investigate theassociation between 14 missense single nucleotide polymorphisms and prostate cancer
risk in Chinese Han population and established a Risk Prediction Model.
PATIENTS AND METHODS One hundred and fifty prostate cancer patients and 114
cancer-free controls, which were recruited from five university hospitals in Beijing cityand one university hospital in Hangzhou city between January 2009 and June 2010,
were included in the cancer association study. The fourteen selected missense single
nucleotide polymorphisms, which located in different tumor-related genes and had beenverified to be associated with prostate cancer susceptibility in Japanese population,
were genotyped using Snapshot assay.
RESULTS Four single nucleotide polymorphisms were found to be significantly
associated with risk of prostate cancer in Chinese Population. Among them, 3 single
nucleotide polymorphisms had high-risk associations (Odds Ratio range 1.72-4.78) andthe other one had protective effect (Odds Ratio 0.26). The four related genes included
two DNA-repair genes and one each of tumor suppressor gene and apoptosis regulator
gene.

Two

other

singlenucleotide

polymorphisms,

eachlocateinchromosome-segregation gene and metabolic enzymes gene, had borderline significance.
Cumulative effects were also revealed for these 4 single nucleotide polymorphisms byusing a multiple odds ratio method. A risk predicting model was established in
predicting prostate cancer risk among Chinese men. The life-time risk of prostatecancer occurrence for the highest-risk group we appointed was 20.2 times higher thanthat of the lowest-risk group (8.53% vs. 0.42%).
CONCLUSIONS According to the present case-control study, many missense genetic
variants might contribute to the genetic predisposition to prostate cancer in Chinese
Han population. These variants also manifested certain effects in predicting prostatecancer occurrence. Larger studies with sufficient power will be needed to confirm ourfindings.

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5. Clinical Research of Holmium Laser Therapy of Scrotum Paget Disease
Jianbo Wang，Xishuang Song, Zhiwei Zhang, Deyong Yang
(Department of Urology, The First Affiliated Hospital of Dalian Medical University,
China)[ABSTRACT]Objective: To investigate the holmium laser therapy of scrotum Paget disease.
Methods: 31 patients with scrotal skin lesions confirmed as scrotum Paget disease instage A by biopsy were carried out the treatment of holmium laser on the basis of theanti-infection and the skin preparation. All patients were followed up. The relapsingpatients were cured by holmium Laser.
Results: The mean operation time was 20～60 minutes. The surgery was totally
undertaken but only 6 case was done a second time because of postoperative recurrence.
The 25 patiens were not recurred during 1 to 3 years while the 6 patiens of second time
were not recurred during 1 to 2 years.
Conclusions: The patients with scrotal skin lesions should be diagnosed by biopsy as
early as possible and the holmium laser therapy might be the best means of curing thedisease in stage A.

６ ． Ureteral stent retrieval and ureteral stent exchange using crochet hooktechnique for female patients.
Takashi Kawahara1, 2, Hiroki Ito1, 2, Hideyuki Terao1, Takehiko Ogawa2, Hiroji Uemura2,
Yoshinobu Kubota2, Junichi Matsuzaki1（1 Department of urology, Ohguchi Higashi General Hospital, 2 Department of urology,
Yokohama City University Graduate School of Medicine , Japan）
ABSTRACT

10

Objectives: We previously reported the procedures of ureteral stent removal andureteral stent exchange using crochet hook technique. We describe the detailed
technique and outcome of these procedures.
Methods: A total of 40 female patients (56 stents) underwent the removal of ureteralstents using crochet hook technique with no cystoscopy and no fluoroscopy. Allprocedures were carried out with the patients either under anesthesia, conscious
sedation, or analgesic suppositories as deemed appropriate for each procedure including
Shock Wave Lithotripsy (SWL), Ureteroscopy (URS), Percutaneous Nephrolithotomy(PCNL), and ureteral stent removal. A total of 21 ureteral stents were exchanged using
crochet hook technique for female patients without cystoscopy. All procedures werecarried out with the patients under conscious sedation.
Results:A total of 47 of the 56 stents (83.9%) were successfully removed. In addition, 47
of 52 (90.4%) were successfully removed except for two migrated stents and two heavily
encrusted stents which could not be removed using cystoscopy. Concerning pain,
ureteral stent removal using the crochet hook technique showed a lower visual analogue
pain scale (VAPS) score than for the standard technique using cystoscopy. And a total of
20 of the 21 stents (95.2%) were successfully exchanged and one stent was unsuccessful
including migration to the ureter.
Conclusions:Ureteral stent removal and exchange using a crochet hook is easy, safe, andcost effective. This technique was also easy to learn.

７.Endoscopic treatment for obstructive complications after urinary diversion.
Cao ming，Xue Wei, Huang Yiran（Renji Hospital, Shanghai, China）
Ureteric obstruction is a common complication after radical cystectomy and urinary
diversion, which occours in 4%-8% of all the patients. Urolithiasis and strictureformation at the anastomosis of the ureter and intestine are central to the etiology ofthis pathophysiologic change. Although not all patients with ureteroenteric strictureand hydronephrosis require intervention, there are quite a few people suffered withrecurrence upper urinary infection, obstinate flank pain, or renal insufficiency

11

associated with anatomical obstruction were suggested to be performed with operative
treatment. Traditionally this complication has been managed with open surgery,however, this procedure is a great challenge because of the lack of anatomic landmarks
and frequent adhesions from previous surgery. Currently, minimally invasive
endourological techniques were used more frequently for the treatment and may
become an alternative to open surgery. We present our experience with patients who
presented with ureteric obstruction after radical cystectomy and urinary diversion.

８．A novel endourological strategy in complete staghorn calculus patient withcomorbidity: 2-staged TUL -assisted PCNL (TAP).

Noritaka ISHITO, Tomoko SAKO, Shinsuke GOHARA, Yoichi SHIOTSUKA, Yasuo
YAMAMOTO, Hitoshi TAKAMOTO（Department of Urology, Kurashiki Medical Center, Japan）

Introduction
Endourological options in complete staghorn calculus patient with comorbidity are stillchallenging and controversial regarding minimal invasiveness. We studied theusefulness and safety of a novel technique of 2-staged TUL-assisted PCNL (TAP) in acomplete staghorn calculus patient with comorbidity.
Materials and Methods
The patient profile is as follows: Age 85y.o. Male physician, BMI: 24.2. He suffered fromleft complete staghorn calculus (82×53mm, CT value: 1550HU) without hydronephrosis.
Comorbidity was pyelonephritis, renal insufficiency and requiring anti-coagulant.
PCNL and flexible-TUL were simultaneously performed (TUL-assisted PCNL: TAP).
Nephrostomy was formed in the modified Valdivia position during the 1st TAP without
occlusion UPJ balloon catheter. Excavation was started with flexible-TUL from the UPJ
side of the stone for the caliceal fornix. Caliceal needle puncture was madepercutaneously with simultaneous ultrasound, fluoroscopy and endoscopy during
excavation with flexible-TUL. This new technique was named by tripartite synchronous
tangibility (TRISTAN). After a week, the 2nd TAP was performed in the flank position
to remove residual stones through mono-tract nephrostomy and using a ureteral accesssheath.

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Results
Total operation time was 125min (PCNL: 32min., flexible-TUL: 114min.) in the 1st TAP
and 215min (PCNL: 188min., flexible-TUL: 196min.) in the 2nd TAP. The estimatedbleeding volume was 281ml in the 1st TAP and 97ml in the 2nd TAP. Staghorn calculus
was completely removed after salvage PCNL (local anesthesia). The patient was afebrileafter surgery. There was no aggravation of renal function perioperatively. Stone wascomposed mainly of struvite.
Conclusion
A novel technique of 2-staged TAP for complete staghorn calculus is feasible andeffective in problematic cases with pyelonephritis, renal insufficiency, octogenarians,
and requiring anti-coagulants.

９ .

ImpactofRight-sided

NephrectomyonLong-term

OutcomesinRetroperitoneoscopic Live Donor Nephrectomy: Based on 533 Consecutive Cases at
Single Center
Takafumi Yagisawa, Kazuya Omoto, Taiji Nozaki, Yugo Sawada, Tomokazu Shimizu,
Hideki Ishida and Kazunari Tanabe（Department of Urology, Tokyo Women’s Medical University, Japan）
Abstract
BACKGROUND:Short right renal veins might complicate kidney transplantation, thus
the left kidney is preferred for live donation. In order to assess the long-term graft
survival of right-sided retroperitoneoscopic live donor nephrectomy (RPLDN), we
reviewed and compared the outcomes of right- and left-sided RPLDN.
METHODS:Five hundred and thirty three patients underwent live donor renaltransplantation with allografts procured by RPLDN from July 2001 to August 2010 at
our institute. Of these, 24 (4.5%) cases were of right-sided RPLDN (R-RPLDN). Studyvariables included operating time, time to procurement of the kidney, blood loss, warm
ischemic time (WIT), postoperative hospital stay, and graft and patient survival rates.

13

RESULTS:No significant differences were found between the right- and left-sided
RPLDN (L-RPLDN) groups regarding operating time, time to procurement of the kidney,mean blood loss, and postoperative hospital stay. No significant differences were foundin the recipients' postoperative graft function and frequency of slow recovery graftfunction. Despite statistically significant increased WIT (mean 5.9 vs. 4.7 min, p<0.001)
in R-RPLDN compared to that in L-RPLDN, there was no significant difference between
the two groups regarding long-term patient and graft survival rates. The complication
rate in R-RPLDN was 17% vs. 6.5% in L-RPLDN (p=0.132). No renal vein thrombosis
was experienced in either group.
CONCLUSIONS:Although our study was retrospective and there was only a small
number of R-RPLDN patients, R-RPLDN could be an option for laparoscopic live donor
nephrectomy because of its safety and excellent long-term graft outcomes.

10. Clinical practice for BPH medical treatment in China
Xianghua Zhang（Peking University Wujieping Urology Center, China）
Male LUTS can be divided into Storage, voiding or post micturition symptoms, andabout 2/3 of men with LUTS have symptoms from more than one symptom group, manyreasons can affect treatment decisions in male LUTS.
Treatment of LUTS should according to patients’ symptom profiles. For example,
patients with voiding LUTS should be offered with α1-AR antagonist (e.g. Tamsulosin),
it is the standard treatment for BPH patients with low risk of progression, can improve
IPSS and Q0L of moderate to severe LUTS patients, shows good tolerability and safety,
and the efficacy can be sustained for at least many years (results of many long term
studies include China study support it). However, α1-AR antagonist monotherapy is not
sufficient in all men with LUTS. If storage symptoms persist after α1-AR antagonist
monotherapy, combination treatment with α1-AR antagonist and antimuscarinic agent
might be considered; if patients only with predominant storage symptoms,
antimuscarinic agents monotherapy also can be considered. Because antimuscarinic
agents are associated with small rise in PVR in men with LUTS and proven BOO, it will
be prescribe cautiously in these patients.
In conclusion, symptoms decide the treatment of male LUTS. Patients with voiding

14

LUTS should be offered with α1-AR antagonist; for patients with both Voiding andstorage LUTS, combination treatment with α1-AR antagonist and antimuscarinic agent
might be considered; if patients only with predominant storage symptoms,
antimuscarinic agents monotherapy also can be considered.

11．IMPROVEMENT OF SEXUAL FUNCTIONS IN PATIENTS WITH BENIGNPROSTATIC HYPERPLASIA TREATED BY HOLMIUM LASER ENUCLEATION
OF THE PROSTATE (HoLEP).
Kazuhiko Fukumoto, Teruhiko Yokoyama, Shin Ohira, Aya Obatake, Masaichiro Fujita,
Tomohiro Fujii, Yoshimasa Jo, Yoshiyuki Miyaji, Atsushi Nagai（Department of Urology, Kawasaki Medical School, Kurashiki, Japan）
Introduction and Objective
Holmum laser enucleation of the prostate (HoLEP) for patients with benign prostatic
hyperplesia (BPH) is expected to improve lower urinary symptoms (LUTS). It has beenreported that successful treatment of LUTS is associated with improvement of erectile
dysfunction (ED). In this study, we investigated the effects of HoLEP to sexual functions
in patients with BPH.
Methods
Seventy out of 210 patients treated with HoLEP between October 2007 and March 2011were evaluated by International Prostate Symptom Score (IPSS), QOL index,
International Index of Erectile Function 5 (IIEF-5), and sexual function and sexual
bother questionnaire of UCLA Prostate Cancer Index (UCLA PCI) before the treatment
and at 3, 6 and 12 months post treatment.
Results
The mean prostate specimen weight was 30.2gms. with a range of 3 gms. to 106 gms.
The mean IPSS score improved from 20.6 to 7.57 at 3 months (p<0.001), to 6.64 at 6
months (p<0.001) and to 6.32 at 12 months (p<0.001). The mean QOL index improved
from 5.01 to 2.06 at 3 months (p<0.001), to 2.01 at 6 months (p<0.001) and to 1.90 at 12
moths (p<0.001). The mean IIEF-5 score significantly decreased from 7.88 to 6.07 at 12
months (p=0.003). In regards to the sexual functions of UCLA PCI, overall sexualfunction and sexual bother did not change significantly after treatment. However, 3 out

15

of 7 items, frequency of erections, frequency of intercourse, and morning erections weresignificantly improved after treatment (Table 1). Interestingly, 21(38.9%) out of 54
patients without sexual intercourse (SI) before treatment regained SI after treatment.
On the contrary, only one (6.3%) out of 16 patients with SI before treatment lost SI after
treatment.
Conclusions
HoLEP for BPH patients is associated with significant improvement in some of thesexual functions as well as LUTS. Especially, morning erection can significantly
improve during 3 to 12 months after HoLEP.

12. Early outcomes and safety analysis of the Beijing LESS Laparoscopic Radical
Prostatectomy Technique
Gang Zhu 1, Yaqun Zhang1, Philippe Grange2, Kilian Walsh3, Bin Jin1, Yaoguang Zhang1,
Gordon Muir2, Ben Wan1, Jianye Wang1.
（1. Department of Urology, Beijing Hospital, China.
2. Department of Urology, Transplant and Abdomen Clinical Academic Group, Kings
Health Partners, King’s College Hospital, United Kingdom.
3.Department of Urology, University Hospital Galway, , Ireland）
Abstract
Purpose: The aim of this paper is to illustrate the safety, adoption and adaptation of oursurgical technique of LESS radical prostatectomy (LESS-LRP) with conventional androutinely available instruments.
Materials and Methods: A prospective clinical database was established in September
2010 to assess the outcome following the introduction of a novel technique of LESS-LRP
at our institution. By August 2011 six procedures had been performed. The meanpatient age was 74.7 (74-76 yrs.). The mean BMI was 23.8 (19.5-32.2 kg/m2). The
LESS-LRP was preformed through an extra-peritoneal approach by using single port
access with QudaPort, 0o lens 5mm flexible tip video-laparoscope and conventional,
commercially available laparoscopic instruments. All procedures underwent LESS-LRP
by one surgeon. Parameters assessed were operative time, estimated blood loss,

16

intraoperative complications, drainage time, post-operative pain score (VAPS, 0-10),
pathological results and post-operative PSA levels.
Results: LESS-LRP was possible for all six cases without additional trocar placement orconversion to standard laparoscopic or open radical prostatectomy. The mean operative
times were 252.5 (190-305 min), estimated blood loss was 300 (100-500 ml). There was
no documentable intraoperative complication. The wound-drainage time was a mean 5.2(2-7 d), and the first post-operative day VAPS was 0.83 (0-3). Final pathological staging
was pT2aN0M0 in 4 cases and pT2cN0M0 in 2 cases. Surgical margins were negative
for cancer. The one-month post-operative PSA was less than 0.02 ng/ml in each case.
Two were continent without pad usage and 4/6 cases were utilising 1 pad/day.
Conclusions: Our technique LESS-LRP is feasible and early outcomes are acceptable.
We plan to continue and welcome other institutions adopting this method.

13．Predictive factors for acute and late urinary toxicities after permanent prostatebrachytherapy
Ryuta Tanimoto1, Kensuke Bekku1, Norihisa Katayama2, Yasuyuki Kobayashi1, Shin
Ebara1, Motoo Araki1, Mitsuhiro Takemoto2, Kotaro Yoshio2, Hiroyuki Yanai3, Haruki
Kaku1, Yasutomo Nasu1, Hiromi Kumon1（1Department of Urology, 2Department of Radiology, and 3Department of Pathology,
Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical
Sciences, Okayama, Japan）
Abstract
PURPOSE: To describe the frequency of acute and late Radiation Therapy Oncology
Group (RTOG) urinary toxicity and the predictive factors associated with urinary
toxicity in consecutive prostate brachytherapy patients.
PATIENTS AND METHODS: From January 2004 to April 2011, 466 patients
underwent permanent 125I-seed brachytherapy (median follow-up, 48 months). The
IPSS and RTOG toxicity data were prospectively collected. The prostate volume, IPSS
before and after brachytherapy and post-implant analysis were examined for an17

association with urinary toxicity which was defined as RTOG urinary toxicity 1 or more.
Logistic regression analysis was used to examine the factors associated with urinary
toxicity.
RESULTS: The rate of RTOG urinary toxicity Grade 1 or more at 1, 6, 12, 24, 36, 48
months was 67%, 40%, 21%, 31%, 27%, 28%, respectively. Grade 2 or more urinary
toxicity was less than 1% at an each point. IPSS was highest at 3 months and returned
to normal level at 12 months after brachytherapy. On univariate analysis, patients withlarger prostate size, greater baseline IPSS, the higher prostate V100, higher prostate
V150, higher prostate D90 and more number of seeds had more acute urinary toxicities
1 month as well as 12 months after brachytherapy. On multivariate analysis, thesignificant predictors for urinary toxicity were a greater baseline IPSS and prostate
V100 one month as well as 12 months after brachytherapy.
CONCLUSION: Most urinary symptoms were tolerated and resolved within 12 months
after prostate brachytherapy. Acute and late urinary toxicities after brachytherapy werestrongly related with baseline IPSS and the prostate V100.

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