Objective: To prospectively assess the clinical efficacy and safety of lower-pole fluoroscopically guided percutaneous nephrolithotomy (PNL). Methods: A total of 90 renal units in 87 patients underwent lower-pole fluoroscopically guided PNL for renal calculi. The average patient age was 56.0 years. Staghorn calculi were present in 41 renal units. There were 22 were upper pole, 54 middle pole, 76 lower pole, 70 pelvic and 18 ureteropelvic junction calculi. Patients without significant residual fragments greater than 3mm on postoperative day 2 were defined as primarily successful. Significant residual fragments were treated with shock wave lithotripsy (SWL) every other day from postoperative day 3. Results: Mean operative time was 129.5 min (SD, 49.0). Blood transfusion was required in four patients. Septic shock developed in three patients. Sixty-three percent of the patients (57 of 90 procedures) were primarily successful after PNL: 83.7% of non-staghorn patients (41 of 49 procedures) and 39.0% of staghorn patients (16 of 41 procedures). Of the 33 patients with significant residual fragments, 13 staghorn and six non-staghorn patients had residual fragments in their middle calyces. Of the preoperative variables, staghorn calculus and calculus in the middle calyx were significant predictors of significant residual fragments after PNL. After adjunctive SWL, the overall success rate was 94.5%. Conclusions: Our study suggests that lower-pole fluoroscopically guided PNL is a safe and effective therapy for patients with staghorn or non-staghorn calculi. In patients with staghorn calculi or calculi in the middle calyx, adjunctive treatment is sometimes required to treat significant residual fragments.

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Abbreviations & Acronyms ASA = American Society of Anesthesiologists Cr = creatine ECUD = extracorporeal urinary diversion ECUD-IC = extracorporeal ileal conduit urinary diversion ERAS = enhanced recovery after surgery Hb = hemoglobin ICUD = intracorporeal urinary diversion ICUD-IC = intracorporeal ileal conduit urinary diversion IQR = interquartile range LRC = laparoscopic radical cystectomy RARC = robot-assisted radical cystectomy SD = standard deviation Objectives: To compare the perioperative and oncological outcomes of pure laparoscopic intracorporeal ileal conduit urinary diversion versus extracorporeal ileal conduit urinary diversion after laparoscopic radical cystectomy for bladder cancer in a multicenter cohort in Japan. Method: A total of 455 patients who underwent laparoscopic radical cystectomy carried out at 10 institutions were included in this retrospective study. The perioperative data of the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups were compared using the propensity score matching method. The Kaplan-Meier curves were obtained to elucidate time to ureteroenteric stricture, reoperation, recurrence and survival. Results: In total, 72 matched pairs were evaluated for the final analysis. The median follow-up period was 28 and 23 months in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively. The operative time in the intracorporeal ileal conduit urinary diversion group was approximately 1 h longer than that in the extracorporeal ileal conduit urinary diversion group. The early and late postoperative complication rates were similar in both groups, except for the reduced wound-related complication rates in the intracorporeal ileal conduit urinary diversion group. The median days to regular oral food intake were 4 and 5 days in the intracorporeal ileal conduit urinary diversion and extracorporeal ileal conduit urinary diversion groups, respectively (P = 0.014). No significant difference was noted in the occurrence of ureteroenteric strictures and reoperation rate. Furthermore, recurrence-free, cancerspecific, and overall survival rates and recurrence patterns did not significantly differ. Conclusions: Laparoscopic intracorporeal ileal conduit urinary diversion is a safe, feasible and reproducible procedure with similar postoperative complication rates, ureteroenteric stricture rate and oncological outcomes when compared with extracorporeal ileal conduit urinary diversion, but faster postoperative bowel recovery and decreased wound-related complication rates.

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BACKGROUND The high rate of failure of new agents in oncology clinical trials indicates a weak understanding of the complexity of human cancer. Recent understanding of the mechanisms underlying castration resistance in prostate cancer led to the development of new agents targeting the androgen receptor pathway; however, their effectiveness is limited. Hence, there is a need for experimental systems that are able to better reproduce the biological diversity of prostate cancer in preclinical settings. In this study, we established a unique patient‐derived xenograft (PDX) model to identify biomarkers for treatment efficacy and resistance and better understand prostate cancer biology. METHODS A prostate cancer tissue sample from a Japanese patient was transplanted subcutaneously into male, severe combined immune‐deficient (SCID) mice and this PDX mouse model was named KUCaP3. Sequential tumor volume changes were observed before and after castration. Androgen receptor (AR), prostate‐specific antigen (PSA), and other molecular markers were examined immunohistochemically. Sequence analysis of AR was also performed to detect mutations. Proteomic analysis of cyst fluid and sera samples of KUCaP3 mice were analyzed by mass spectrometry (MS). RESULTS KUCaP3 cell line, derived from human tissue, was successfully and serially passaged in vivo with approximately 60% take rate. KUCaP3 exhibited cyst formation, showed androgen‐dependent growth initially, and developed castration‐resistant growth several months after castration of the mice. Immunohistochemical analysis showed that KUCaP3 was positive for AR, PSA, CK18, and α‐methyl acyl‐coenzyme A racemase, but negative for CK5/6 and ERG. The AR gene in KUCaP3 cells contained a substitution from CAT (histidine) to TAT (tyrosine) at the nucleotide positions corresponding to codon 875 (H875Y) in the ligand‐binding domain. Chemiluminescent immunoassay revealed higher levels of PSA in cystic fluid and the serum of KUCaP3‐bearing mice. MS analysis detected 23 proteins of human origin in cystic fluids of KUCaP3. CONCLUSIONS We developed KUCaP3, an androgen‐dependent PDX model with cyst formation. Several proteins including PSA were detected in the cystic fluid and sera of tumor‐bearing mice. This original PDX model has the potential to be used as a clinically relevant model to evaluate molecular markers for prostate cancer diagnosis and treatment. Prostate 76:994–1003, 2016. © 2016 Wiley Periodicals, Inc.