Madoka Kataoka

Objective: The incidence of upper tract urothelial carcinoma is increasing with population aging, yet evidence regarding radical nephroureterectomy (RNU) in very elderly patients is limited. This study evaluated perioperative outcomes, complications, and oncological results of RNU in patients aged ≥85 years compared with younger counterparts. Methods: A total of 305 patients who underwent RNU between April 2003 and December 2024 at a tertiary institution were retrospectively reviewed. After excluding those with incomplete data (n = 4), non-urothelial histology (n = 8), or undeterminable pathology (n = 9), 284 patients were eligible. Group A included 24 patients aged ≥85 years, range 85-94 years, and group B included 260 patients .05). Median laparoscopic operative time was shorter in group A (206 vs. 235 minutes, P = .029). Estimated blood loss, transfusion, and complication rates (10.6% overall; major 2.2%) did not differ (all P > .05). Pathological outcomes were comparable (all P > .05). Adjuvant therapy was less frequent in group A (0% vs. 21.2%, P = .006). Follow-up was 16.3 vs. 35.2, with no differences in survival (all P > .05). The RMST showed shorter survival in group A. Conclusion: The RNU appears feasible in carefully selected patients aged ≥85 years, with perioperative and oncological outcomes broadly comparable to those of younger patients. Chronological age alone should not contraindicate surgery. Restricted mean survival time offers complementary insights into survival estimation in this high-risk population. Cite this article as: Gozu S, Yajima S, Okumura G, et al. Radical nephroureterectomy in the very elderly: A single-center experience of patients aged ≥85 years. Urol Res Pract. 2026, 52, 0125, doi: 10.5152/tud.2026.25125.

Objective: Liposarcoma (LPS) is classified into 4 subtypes. As some subtypes have a high recurrence rate, knowing the risk of recurrence before surgery is important. Here, we aimed to investigate the relationship between Hounsfield units (HU) derived from preoperative computed tomography (CT) and the prognosis of patients undergoing surgery. Materials and Methods: We included 32 patients who underwent surgery for LPS between 2014 and 2022. Preoperative plain CT images were collected, and the HU value of each LPS was measured. The association between 2 HU categories (HU < cut-off vs. ≥ cut-off) and clinical variables was assessed. The optimal cut-off value was determined using statistical methods. We used the Kaplan–Meier method to determine the differences between the 2 HU categories at 2 endpoints: recurrence-free survival (RFS) and overall survival (OS). Results: The dedifferentiated subtype showed significantly higher HU values than the other subtypes (P < .001). The optimal cut-off value for HU was 20. HU < 20 was associated with young age, low-performance status, low Charlson Comorbidity Index, and well-differentiated pathology. The Kaplan–Meier curves demonstrated that RFS and OS were significantly shorter in patients with HU ≥ 20 than in those with HU < 20 (P = .007 and .04, respectively). However, when stratified based on subtype, no significant differences were observed between dedifferentiated and other subtypes. Conclusion: HU ≥ 20 on preoperative CT was associated with poor prognosis in LPS patients. Our findings suggest that preoperative CT-derived HU values may serve as useful predictors of prognosis. Cite this article as: Ogasawara RA, Yajima S, Imasato N, et al. Hounsfield unit on preoperative computed tomography as an indicator of prognosis in patients with liposarcoma. Urol Res Pract. 2024;50(3):187- 192.

Objectives: To evaluate longitudinal changes in lower urinary tract symptoms (LUTS) after artificial urinary sphincter (AUS) implantation in patients undergoing radiation therapy (RT) in comparison to those in non‐irradiated patients.Methods: This retrospective study included 20 and 51 patients with and without a history of pelvic RT (RT and non‐RT group, respectively) who were treated with primary AUS implantation for post‐radical prostatectomy incontinence between 2010 and 2020. Longitudinal changes in the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), the International Prostate Symptom Score (IPSS), and the Overactive Bladder Symptom Score (OABSS) were calculated with a linear mixed model.Results: In the RT and non‐RT group, 18 (90%) and 48 (94%) patients achieved social continence, defined as daily pad use ≤1 at 1 month after activation of AUS, respectively (p = .555). During the mean follow‐up of 38 months, ICIQ‐SF, IPSS, and OABSS significantly improved after AUS implantation in both the RT and non‐RT groups. In the RT group, ICIQ‐SF, IPSS, and OABSS subsequently deteriorated with a slope of 0.62/year (p = .010), 0.55/year (p = .025), and 0.30/year (p = .007), respectively. In the non‐RT group, no significant longitudinal changes in subsequent IPSS and OABSS were observed, although ICIQ‐SF significantly deteriorated (0.43/year, p = .006). Comparing between the groups, the slopes of IPSS and OABSS were significantly greater in the RT group than in the non‐RT group (p < .001, and .015, respectively).Conclusions: Longitudinal deterioration in LUTS that improved immediately after AUS implantation was observed in patients with a history of pelvic RT, but not in patients without a history of pelvic RT.

Introduction: Bladder cancer is characterized by spatial and temporal recurrence in the urinary tract. We describe a case of recurrence at a uretero‐ileal anastomosis after radical cystectomy and nephroureterectomy. It was difficult to control bleeding from the tumor, but hemostasis was achieved.Case presentation: A 73‐year‐old man with a history of radical cystectomy and reconstruction of the ileal conduit and right nephroureterectomy was diagnosed with recurrence at the uretero‐ileal anastomosis site. Bleeding from the tumor could not be controlled by flexible gastrointestinal endoscopy. The patient underwent coagulation via an ileal conduit approach using a rigid scope and bipolar electrocautery, which is usually a modality for transurethral resection.Conclusion: This is the first report in which a modality normally used for transurethral resection was used to control bleeding in a patient with an ileal conduit. This application is useful in cases open surgery or additional irradiation might be difficult.

Objective: Postoperative paralytic ileus is a major adverse event of radical cystectomy, causing prolonged hospitalization. The controlling nutritional status score, consisting of serum albumin, total lymphocyte count, and total cholesterol, indicates the nutritional status and may evaluate gastrointestinal status. This study aimed to clarify the association between the controlling nutritional status score and the development of postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder. Materials and Methods: We retrospectively analyzed the clinical features of patients who underwent open radical cystectomy or robotic assisted laparoscopic radical cystectomy with ileal conduit or ileal neobladder for bladder cancer between April 2011 and May 2021. The association between clinical variables, including the controlling nutritional status score and the development of postoperative paralytic ileus, was examined. Results: Out of 133 patients, 34 (26%) developed postoperative paralytic ileus. The patients who developed postoperative paralytic ileus were likely to have a higher controlling nutritional status score (P = .055) compared to those who did not develop postoperative paralytic ileus. Multivariate analysis revealed that a preoperative controlling nutritional status score of ≥1 (odds ratio: 2.90, 95% CI: 1.08-7.80, P = .034) and longer operating time (odds ratio: 3.02, 95% CI: 1.13-8.11, P = .027) were significant independent factors for postoperative paralytic ileus development. Conclusion: A high controlling nutritional status score and long operating time may be risk factors for developing postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder for bladder cancer. Preoperative controlling nutritional status may be able to predict postoperative paralytic ileus development. Cite this article as: Tanabe K, Nakanishi Y, Okubo N, et al. Association of the controlling nutritional status score with the development of postoperative paralytic ileus after radical cystectomy: Retrospective cohort study. Urol Res Pract. 2023;49(3):184-190.

Objective: To improve perioperative outcomes, robot-assisted radical cystectomy has gained increasing interest. This study aimed to assess the detailed perioperative complications of robot-assisted radical cystectomy in elderly aged ≥80 years and compare them with those of non-elderly. Material and methods: We retrospectively analyzed the clinical features of 74 patients who underwent robotassisted radical cystectomy for bladder cancer between September 2018 and September 2021. Perioperative complication was classified by the Clavien–Dindo classification and organ system-based categories. We assessed the relationship between age or Charlson comorbidity index score (≥3 or <3) and the incidence of perioperative complication or rehospitalization rate within 90 days postoperatively. Results: Of the 74 patients, perioperative complication of all grades and grade ≥IIIa occurred in 54 (73%) and 15 (20%) patients, respectively. The postoperative rehospitalization rate was 20%, and the perioperative mortality rate was 0%. Elderly (n = 20) showed no difference in the incidence of perioperative complication of all grades or grade ≥IIIa compared with non-elderly, and no organ system-based category had a higher incidence in elderly than that in non-elderly. Gastrointestinal tract-related perioperative complication incidence was higher in non-elderly and those with Charlson comorbidity index ≥3 (P = .044, .039, respectively); cardi ovasc ular- relat ed perioperative complication incidence was higher in those with Charlson comorbidity index ≥ 3 (P = .0068). Conclusion: The incidence perioperative complication of robot-assisted radical cystectomy in elderly was not different from those in non-elderly, suggesting that robot-assisted radical cystectomy may be an option for the treatment of bladder cancer in elderly as well as non-elderly. Cite this article as: Tanabe K, Nakanishi Y, Umino Y, et al. Validity and safety of robot-assisted laparoscopic radical cystectomy for the elderly: Results of perioperative outcomes in patients aged ≥80 years. Turk J Urol. 2022;48(5):322-330.

Objective: Urinary tract infection is one of the most common and distressing complications of radical cystectomy with urinary diversion. This study aimed to elucidate the usefulness of the geriatric-8 screening tool for predicting postoperative complications, especially urinary tract infections, in patients who underwent radical cystectomy with urinary diversion. Material and Methods: Ninety-one patients with bladder cancer who underwent radical cystectomy with urinary diversion were assessed for geriatric-8 and classified into 3 groups according to their geriatric-8 score: 14 as the high score group. We retrospectively analyzed the association between geriatric-8 score and postoperative complications classified according to the Clavien-Dindo classification. Results: The median age of the patients was 75 years (interquartile range 71-80 years) and 75 (82%) were male; 41 of the patients (45%) had high geriatric-8 score (>14), 40 of the patients (44%) had intermediate geriatric-8 score (11-14), and 10 of the patients (11%) had low geriatric-8 score (< 11). In multivariate analysis, low score of geriatric-8 was independently associated with the occurrence of grade 2 or higher urinary tract infection within 30 days [odds ratio=5.9; 95% CI=1.2-30.3; P=.03], along with female [odds ratio=6.1; 95% CI=1.7-21.7; P=.006] and open surgery [odds ratio=6.0; 95% CI=1.8-19.6; P=.003]. Conclusion: The geriatric-8 score may contribute to predict postoperative urinary tract infection in patients with bladder cancer who underwent radical cystectomy with urinary diversion. Cite this article as: Yajima S, Nakanishi Y, Umino Y, et al. Value of geriatric assessment using the G8 to predict postoperative urinary tract infections in patients undergoing radical cystectomy. Turk J Urol. 2022;48(4):278-286.

Objective: In the postoperative management of transurethral resection of bladder tumor, attention should be paid to the appearance of delirium. Recently, the mini-cognitive assessment instrument (Mini-Cog) has been validated as a screening tool for cognitive impairment. We assessed whether positive preoperative cognitive impairment screening by Mini-Cog is associated with the occurrence of postoperative delirium. Material and Methods: In this study, consecutive patients who underwent transurethral resection of bladder tumor while awake and were cognitively screened preoperatively using the Mini-Cog test at our institution were retrospectively analyzed. The relationship between the Mini-Cog test and clinical variables was examined. Univariate and multivariate analyses were carried out to determine the risk factors for the occurrence of postoperative delirium. Results: Of the 193 included patients, 37 (19%) patients had probable cognitive impairment (Mini-Cog scores < 3). There were significant differences in patients’ age (P < .001), Eastern Cooperative Oncology Group-physical status (P=.01), decline in instrumental activities of daily living from baseline (P=.03), preoperative diagnosis of dementia (P < .001), and use of benzodiazepine (P=.03) between the Mini-Cog score ≥ 3 group and the Mini-Cog score < 3 group. Multivariate analysis demonstrated that a Mini-Cog score < 3 (odds ratio=6.8, P < .001) and instrumental activities of daily living decline (odds ratio=3.0, P=.02) were independent risk factors for the occurrence of postoperative delirium. Conclusion: Screening of patients for cognitive function using the Mini-Cog test before transurethral resection of bladder tumor may allow for better identification of patients at risk of postoperative delirium. Cite this article as: Yajima S, Nakanishi Y, Matsumoto S, et al. Mini-cog to predict postoperative delirium in patients who underwent transurethral resection of bladder tumor while awake. Turk J Urol. 2022;48(2):106-111.