Department of Urology
Professor Isao Hara
In our department, we provide safe and advanced medical care for community residents by our excellent facility and good staff. We perform daily clinical activities by highly specialized staff in each field such as malignant tumors in urology, urolithiasis, dysuria, and kidney transplantation. We also have 3 physicians (Dr. Hara, Dr. Koujimoto and Dr. Yoshikawa) who have urology laparoscopic technique certification (officially approved by the Japan Society for Endoscopic Surgery and Japanese Society of Endourology), which is relatively difficult to obtain.
1. Malignant tumors in urology
Because most of patients in the Department of Urology are elderly people, patients with cancer account for 70 to 80% of all patients in facilities such as university hospitals. Especially, along with the spread of PSA (prostate‐specific antigen), the number of patients with prostate cancer is recently dramatically increasing. Because there are various therapeutic procedures for early stage prostate cancer that have been found recently, we are required to decide a treatment method carefully considering not only the degree of the disease but also each individual patient’s living environment. In our department, we have performed laparoscopic radical prostatectomy, which is less invasive than laparotomy radical prostatectomy, since 2007. Furthermore, we introduced a robotic-assisted surgery system “The Da Vinci Surgical System” in October 2012, since then we have performed about 250 cases of robotic-assisted radical prostatectomy as of March 2016. We have also performed high-dose-rate brachytherapy as a radiation therapy from long ago and the number of cases is at a top level in Japan.
For invasive bladder tumors, we have worked on the establishment of neobladder reconstruction surgery as a urinary diversion after radical cystectomy. Regarding urinary diversion, ileal conduit was a standard procedure in the past, however neobladder reconstruction is widely adopted as the most advanced procedure at present because its urinary diversion allows urination closer to physiological. Introduction of this procedure allows a patient who had been required to have a urine collection bag with a traditional procedure to urinate by him/herself.
In the field of renal tumors, the spread of laparoscopic surgery is remarkable, and many radical nephrectomies are performed as laparoscopic surgery. Recently, partial nephrectomy is also common for small-diameter renal tumors from the perspective of preservation of kidney function. Partial nephrectomy requires more sophisticated operative procedures than radical nephrectomy, but we have positively worked on the partial nephrectomy as a laparoscopic procedure in our department. Furthermore, we are expected to fulfill standards of a facility for robotic-assisted partial nephrectomy and the surgery will become available as a health insurance treatment in May 2016.
We have conducted basic and clinical studies for urolithiasis for a long time in our department and our specialized staff with abundant experience perform medical examinations and treatments. We try to perform standard therapy based on the guidelines for urolithiasis and work on establishment of a better treatment method.
Extracorporeal shock wave lithotripsy (ESWL)
ESWL is a medical procedure to crush calculi by their exposure to shock wave energy generated outside of the body, and crushed calculi are excreted from the body with urine. The treatment is available at the outpatient clinic (Monday morning) without hospitalization.
For ureterolithiasis, we perform the latest surgery using holmium laser and a small-diameter ureteroscope (Transurethral Ureterolithotripsy; TUL) in about 3 days of short term hospital admission in our department. In addition, we positively perform endoscopic surgery (percutaneous nephrolithotripsy, PNL) for a staghorn calculus and more than 2 cm of a large renal calculus which are difficult to be treated in a general facility.
Prevention of recurrence
Now urolithiasis can be removed by minimally invasive surgery, but the biggest characteristic of this disease is the tendency to relapse. It is said that half of the patients have a recurrence in 5 years. In order to prevent a recurrence, the cause needs to be first clarified by an analysis of components of a calculus, blood test and urinalysis etc., and a treatment for the cause has to be performed. Our department put an effort into the prevention of recurrence, measuring the concentration of oxalic acid and citric acid in urine, which is not applicable to insurance but critical for a causal diagnosis for urolithiasis, in the laboratory and the like. Medical staff specialized in urolithiasis perform careful life guidance, dietary advice, and pharmacotherapy based on the latest information. If you are troubled with repeated recurrence, please consult us.
Enlargement of the prostate is the most common disease among our outpatients, which is characterized by dysuri. The prostate gland is normally the size of walnut, but it starts to enlarge after 50 years of age. Patients complain about symptoms such as extension of urinary excretion time, narrowing of the urinary stream, increased urinary frequency, and residual urine. We generally perform medical treatment with medicine, however we consider surgical treatment when the disease does not react to the medical treatment or for a patient with severe enlargement of the prostate. In our department, we perform the latest enucleation using a laser, and it has merits of having a smaller amount of hemorrhage and a shorter indwelling period of a urethral balloon after surgery etc. than traditional transurethral surgery.
4. Kidney transplantation
We have performed 25 cases of living donor renal transplantation and 19 cases of cadaveric renal transplantation since the first renal transplantation was performed in 1985, and are proud of our good performance, 75.7% of 5-year graft survival rate and 63.5% of 10-year graft survival rate. In addition, in 2007, regarding the extraction of the kidney from a donor during living-donor renal transplantation, in order to reduce the burden of donors, we changed surgical procedures from a traditional abdominal surgery to endoscopic surgery, which has merits of a small surgical wound and early recovery.