Urology

Overview of the department

We are responsible for comprehensive medical care involving the diagnosis of urinary tract/genital (kidney, ureter, urinary bladder, prostate, penis, and testis) cancers to multidisciplinary treatment. We target minimally invasive treatment, such as robot-assisted prostate treatment. The Male Climacterium Outpatient Clinic, which was first established in this prefecture, and Incontinence Outpatient Clinic, which is managed by female physicians, were established. To treat patients with incontinence, cystocele, or metroptosis, surgery with mesh is performed. Furthermore, kidney transplantation is possible. Urinary tract calculi are managed using the most advanced treatment device.

Consultation system/therapeutic strategies

As the proportion of elderly patients is high, minimally invasive treatment is performed. Robot-assisted surgery (da Vinci Si Surgical System)/brachytherapy for prostate cancer and laparoscopic surgery for kidney cancer are conducted, and patients are motivated to achieve early rehabilitation/discharge. For patients with advanced cancer, unique chemotherapy is selected. Favorable results have been obtained, with a low incidence of adverse reactions. We are making efforts to detect cancer at an early stage using advanced diagnostic imaging techniques, such as PET/3T-MRI. In addition, new procedures (TOT, TVM) using mesh for incontinence, cystocele, and metroptosis are introduced to achieve low-level invasiveness and improve patients’ QOL. In the Male Climacterium Outpatient Clinic, which was first established in this prefecture, anti-aging, involving the sexual function, is targeted.

Fields of expertise

We are contributing to the early detection of prostate/kidney cancers using advanced diagnostic imaging techniques, such as PET/3T-MRI. In particular, for prostate cancer treatment, brachytherapy has been introduced earlier on, as a first in the Hokuriku District. More than 250 patients have been treated. The admission period is four days and three nights. Brachytherapy is completed in approximately 2 hours without laparotomy. In December 2013, robot surgery (da Vinci Si Surgical System) was introduced. The operation time is short in the absence of laparotomy, and the volume of blood loss is small; therefore, patients’ stress can be reduced. Furthermore, postoperative incontinence is mild, contributing to an improvement in patients’ QOL. Our experience of treatment for urination disorder, including incontinence, is the most advanced in the Hokuriku District. In patients with neurogenic bladder, intestinal tract-utilizing bladder expansion is performed. To treat those with prostatic hypertrophy, a new technique using a laser (HoLEP) is adopted as a transurethral procedure. In Fukui Prefecture, surgery with mesh (TOT, TVM) for incontinence, cystocele, and metroptosis has been introduced earlier on to preserve the function without extirpating the uterus. To treat patients with renal/ureteral calculi, a new system for extracorporeal shock wave lithotripsy is introduced. Lithotripsy with a laser is also performed.

Advanced medical practice

1) To improve the rate of detecting cancer that is undetectable on standard prostate biopsy, target biopsy using 3T-MRI is performed.
2) Advanced diagnostic imaging of the localization of kidney/prostate cancer using 11C-acetate PET is conducted. For the diagnosis of urological tumors, fluorothymidine (FLT)-PET, which facilitates the direct diagnosis of tumor proliferation, was introduced as a first in the world.
3) Minimally invasive treatment for prostate cancer is performed using robot surgery (da Vinci).
4) Surgery with mesh (TOT, TVM) for incontinence, cystocele, and metroptosis is introduced to preserve the function without extirpating the uterus.
5) Endoscopic treatment with a holmium laser is performed to treat patients with prostatic hyperplasia (HoLEP).

Symptoms/diseases treated in our department

1) Urination disorder/storage symptom, prostatic hyperplasia /cancer, incontinence, neurogenic bladder/cystitis
2) Hematuria/urinary tract calculi, urogenital cancer (kidney, renal pelvis, ureter, urinary bladder, and prostate)
3) Abdominal/low back pain, kidney cancer/epithelial carcinoma of the urinary tract, urinary tract calculi, urinary tract infection, retroperitoneal fibrosis
4) Pain on urination/cystitis, urethritis (sexually transmitted disease), prostatitis
5) Fever/prostatitis, epididymitis, pyelonephritis
6) Hypertension/adrenal tumors, renal failure
7) Infertility/oligozoospermia, azoospermia, spermophlebectasia

Primary examinations and explanations

1) Endoscopy: Less painful examinations are performed using soft cystoscopy. Using a thin, soft endoscope, the ureter, renal pelvis, and kidney calyx are examined, and biopsy and lithotripsy are possible.
2) PET/MRI: These procedures contribute to the early detection of cancer.
3) Radiography: Cancer, calculi, and pelvic organ prolapse are diagnosed using CT and urography.
4) Urodynamic test: Urinary bladder/urethra/sphincter function tests are conducted to select therapeutic strategies for urination disorder.
5) Prostate biopsy: Biopsy specimens are collected at 10 points by inserting a needle transrectally. There are few complications.