タグ: RadicalProstatectomy

雨上がりの鴨川にて — 多岐にわたる手術日

10月 18th, 2025

本日は鴨川・亀田総合病院。

朝は土砂降りの雨でしたが、午後には雨も上がり、海風が心地よい清々しい天気となりました。

月に一度の土曜日手術日。

初回となるハンナ型間質性膀胱炎の方への生検＋ハンナ凝固＋水圧拡張術を2件、

ロボット支援前立腺全摘除術（RARP）1件、

fTUL（経尿道的腎尿管結石砕石術）1件、

尿道スリング手術1件、

両側尿管損傷の方の造影評価1件、

腹腔鏡下膀胱全摘除術＋回腸導管造設術1件を行いました。

間質性膀胱炎：診断と初回治療の重要性

「頻尿でなかなか治らない」という症状から診断に至るまで、半年以上、長い方では数年を要することもあります。

初回治療では、癌（CIS）でないことを確認するための生検は必須と考えます。

望月先生の経尿道的手術技術は本日も見事で、丁寧な凝固操作が印象的でした。

腹圧性尿失禁とチームワーク

腹圧性尿失禁の方は移植後であったため、経閉鎖孔スリングを選択しました。

高橋先生との息の合った手術で、スムーズかつ確実な手技。術後経過も良好でした。

尿管損傷・結石症例・悪性腫瘍手術

尿管損傷の方は造影にて漏れがないことを確認し、ステント交換を実施。今後、両側尿管膀胱新吻合術を予定しています。

fTULでは非常に難しい結石症例でしたが、志賀部長の匠の技で無事に終了。

RARPは藤川先生・奈路田先生の連携が光る素晴らしい手術で、

膀胱全摘除術＋回腸導管造設は伊原先生、中薗先生、深貝先生の見事なチームワークで滞りなく完遂されました。

チームへの感謝と術後の喜び

すべての手術が16時に無事終了。

麻酔科、手術スタッフ、看護チームの的確なサポートに、いつも頭が下がります。

さらに今日は嬉しい報告が続きました。

尿管損傷で腎瘻状態だった方がついにドレーン抜去・カテーテルフリーとなり、

回腸尿管で修復した方もカテーテルフリーに。

そしてボアリフラップの方は退院が決定。

治療の成果を実感できる、良い一日となりました。

　週末を使った入院手術で都内から利用される事が多くなってきました。

　鴨川の海が少し輝きを取り戻すように、患者さんの笑顔がひとつ、またひとつ戻っていく。

そんな瞬間に立ち会えることに、心から感謝です。

亀田総合病院K棟家族ラウンジ
【前立腺がん術後の尿もれ：10年越しの解放】

10月 17th, 2025

前立腺全摘術と放射線療法を受けてから、約10年間——。

長い間、尿もれのためにパットやオムツの生活を続けてこられた患者さんがいらっしゃいました。

当院を受診されたきっかけは、低侵襲な治療（PRP注入療法やスターフォーマー）で改善の希望を持たれたことでした。

しかし、診察の結果、重症の尿失禁であることが分かり、人工尿道括約筋（AMS800）の手術をおすすめしました。

患者さんは、機械を身体に入れることへの不安や、手術に対する恐怖感から、決断までに時間を要されました。

それでも、勇気を出して手術を受けられた結果——

本日、「パットもオムツも、そして“ゴミ出し”からも解放された」と、満面の笑みでお話しくださいました。

その喜びの表情を見て、私たちスタッフも本当に嬉しくなりました。

「こんなに情報が少ないなんて知らなかった」とおっしゃっていました。

前立腺がんの治療後、長く尿もれで悩まれている方は決して少なくありません。

こうした情報が、同じ悩みを抱える方々に届き、希望のきっかけになればと願っています。

亀田総合病院　バスターミナル
The theme: Urinary Continence and Erectile Function Preservation in Robot-Assisted Radical Prostatectomy

4月 16th, 2025

[Conference Presentation Announcement]

Selected for the Annual Meeting Video Award at the Japanese Urological Association!

On April 17, 2025, Dr. Nakazono will be presenting at the Annual Meeting of the Japanese Urological Association.

His work has been selected for the prestigious Annual Meeting Video Award in the video presentation category!

The theme: Urinary Continence and Erectile Function Preservation in Robot-Assisted Radical Prostatectomy

This presentation showcases a highly skilled surgical video that directly addresses the challenging issue of preserving urinary continence and erectile function during robot-assisted radical prostatectomy. It is accompanied by a detailed and meticulously compiled set of clinical data.

“How many years has he been practicing?!” — International surgeons stunned by his skills

When international doctors viewed Dr. Nakazono’s surgery, they were astonished, asking,

“How many years has he been in practice?!”

His precise and delicate technique, particularly in nerve-sparing procedures, has earned widespread recognition. The video reflects not only his technical mastery but also his deep consideration for each patient’s long-term quality of life.

Aiming for “zero thermal injury” to the neurovascular bundles

The featured video focuses on nerve-sparing techniques that aim to preserve erectile function by avoiding thermal damage.

Dr. Nakazono carefully minimizes the use of electrocautery or sealing devices near the nerves, and this is clearly explained in the presentation.

This approach has the potential to significantly improve postoperative outcomes in terms of both erectile function and urinary continence.

Evolving techniques: From open surgery to laparoscopic and robot-assisted approaches

At Kameda Medical Center, we have pursued this theme for many years.

Our approach has evolved from open surgery to laparoscopic and now to robot-assisted techniques.

Yet, the philosophy of “nerve preservation above all” has remained consistent throughout.

To all urologists — Don’t miss this presentation!

Radical prostatectomy is not only about cancer cure but also about preserving postoperative quality of life.

This presentation will offer one ideal approach to that goal — with compelling surgical footage and robust data.

If you’re attending the conference, we strongly encourage you to watch Dr. Nakazono’s presentation.

Don’t miss it — April 17, 2025 (Thursday)!
– A Rare Case of Postoperative Urinary Retention –

4月 3rd, 2025

Can’t Urinate After Prostate Removal?

Recently, we received a call from a patient who had undergone laparoscopic radical prostatectomy and had already been discharged. He reported being unable to urinate—a rare concern following this type of surgery. Fortunately, a local hospital in Shizuoka promptly placed a urinary catheter. Since then, his condition has improved, and after the catheter was removed yesterday, he has been urinating well with almost no leakage. We were relieved to hear that his recovery is progressing smoothly.

Now, you might be surprised to hear about urinary retention after prostate removal. In fact, it’s extremely uncommon. After radical prostatectomy, the more typical issue is urinary incontinence, not difficulty passing urine. Cases of immediate postoperative urinary retention are rare and only occasionally reported in the medical literature.

So, why does this happen?

In rare cases, urinary retention shortly after surgery may be caused by urethral edema (swelling), temporary narrowing at the bladder-urethral anastomosis, or a small hematoma (blood collection). In such situations, forcing urination is not advisable. Instead, the safest and most effective approach is to reinsert a urinary catheter and wait for the inflammation and swelling to subside naturally.

According to the literature, conservative management with catheter reinsertion is the standard of care for such cases (Tewari et al., 2007; Campbell-Walsh Urology, 11th edition).

It’s also worth noting that postoperative symptoms such as urinary leakage or difficulty urinating are typically temporary and improve over time. In this case, the patient regained stable urination early on and had minimal leakage, making this a particularly favorable outcome.

This experience reminded us once again that successful surgery is not just about removing disease—it’s also about supporting patients through recovery and maintaining their quality of life (QOL) by addressing even the smallest postoperative issues with care and attention.

Kameda Medical Center
“Record-Breaking Surgery Day at Kameda General Hospital”

2月 19th, 2025

Saturday, February 15, 2025, marked our busiest surgical day yet!

A huge thank you to the anesthesiology team, nurses, co-medical staff, and ward team at Kameda General Hospital for their incredible support.

On this day, we performed three radical prostatectomies:

✅ Two nerve-sparing procedures – one using robotic surgery, the other with laparoscopy

✅ One non-nerve-sparing procedure – unfortunately, preservation was not possible

Nerve Preservation in Prostate Cancer Surgery

Whenever we perform radical prostatectomy, we always consider nerve preservation.

During surgery, we carefully observe:

🔹 The color difference between normal prostate tissue and cancerous tissue

🔹 The firmness of the tissue – infiltrated tissue tends to be harder than normal

🔹 The surgical margin – ensuring complete cancer removal while preserving function

While some cases are straightforward, in more advanced cases, distinguishing cancer from normal tissue becomes difficult. When that happens, the disease is often already in a progressed stage, meaning nerve preservation is no longer an option.

Why Is Nerve Preservation Important?

Most people associate nerve-sparing surgery with erectile function, but it also plays a crucial role in urinary continence.

The best nerve-sparing outcome is when post-surgery function remains unchanged from pre-surgery.

If recovery takes several months, it usually means the nerves sustained some level of damage and are slowly healing.

This is why precise surgical technique is critical—preserving nerve function from the start leads to the best possible recovery.

Surgical Precision Matters

Minimally invasive techniques, whether robotic or laparoscopic, allow for:

✅ Better visualization during surgery

✅ Careful tissue handling to reduce damage

✅ Improved functional outcomes for both erectile function and continence

By refining our techniques and advancing our understanding of nerve preservation, we continue to push for better outcomes for our patients.