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Urology

  • Atsushi Nagai, M.D., Ph.D. Professor
INDEX :  Main Areas and Themes of Research    Clinical Features
       Educational Features

Main Areas and Themes of Research

1) Urologic oncology

a. Basic research for cancer inhibitory factors using our established two human seminoma cell lines.

b. Novel chemotherapeutic approach for advanced urologic cancers.

c. Urinary reconstructive surgeries aimed at maintaining high QOL.

d. Laparoscopic lymph node dissection for metastatic urogenital tumors.

e. Clinical investigation of high dose rate brachytherapy (HDR-BT) for Stage C and B prostate cancer.

2) Andrology

a. Investigation of survivine expression in testes using male infertility model rats.

b. Clinical research for male sexual dysfunction (erectile dysfunction, ejaculatory disturbance and the aging male)

3) Lower urinary tract dysfunction

a. Urodynamic studies for patients with bladder outlet obstruction.

b. Clinical and basic investigation of novel purified botulinum neurotoxin for rat prostate and humans with symptomatic BPH.

c. Clinical research of correlation between urinary nerve growth factor and pathogenesis of overactive bladder.

d. Basic investigation of urinary epithelium and voiding function in the interstitial cystitis model rat.

Clinical Features

1) Prostate cancer:

About 130 patients are newly diagnosed in our department per year. Nearly 90% have organ-confined disease, and are indicative for surgery (laparoscopic radical prostatectomy or open surgery) or definite radiotherapy (high dose rate brachytherapy; HDR-BT).

2) Minimally invasive treatment

a. Laparoscopic surgeries: 80% of patients of renal cell carcinoma are treated by laparoscopic nephrectomy or laparoscopic partial nephrectomy. The treatment results of nephron-sparing surgery for T1 RCC have been evaluated. Almost all patients are treated with laparoscopic surgery for upper urinary tract cancer diseases. The prognostic factors for survival and bladder recurrence have been evaluated. We also perform laparoscopic surgery for the treatment of prostate cancer.

b. Laser treatment for urinary stones and BPH: Fiberoptic transurethral nephroureterolithotripsy (f-TUL) has been performed after introducing laser equipment. As a non-invasive endoscopic surgery for BPH, holmium laser enucleation of the prostate (HoLEP) has been performed since 2008.

c. Botulinum toxin injections: Intraprostatic botulinum toxin injections for patients with refractory BPH and intradetrusor injections for patients with refractory neurogenic and idiopathic OAB have been investigated.

3) Female urology

Surgical treatments (tension-free vaginal tape; TVT, transobturator tapes: TOT and tension-free vaginal mesh; TVM) for women with pelvic organ prolapse and urinary stress incontinence have been performed.

4) Outpatient clinic for males

Clinical management for male infertility, erectile dysfunction, ejaculatory disturbance, late-onset hypogonadism syndrome or other diseases specific for males are provided.

Educational Features

The term of “Urology” is derived from the Greek “uron” and “logos”, and it means the science of urine. Urology is a division of surgery which encompasses surgical diseases of the kidney, urinary tract and male reproductive system. The main diseases dealt with in urological practice are malformations, renal failure, obstructive uropathy, urogenital tumors, urolithiasis, urinary tract infection (UTI), trauma, and bladder outlet obstruction. There are several sub-specialties in clinical urologic practice such as the dialysis unit, pediatric urology, andrology, neuro-urology and endourology. In endoscopic surgeries, there have been especially rapid developments in many areas, particularly with regard to the bladder, prostate, urethra and upper urinary tract. Laparoscopic surgery has become the standard procedure for adrenal tumor and other urological diseases.

1) Education for medical students

All lectures are based on a new curriculum. Students can absorb the medical knowledge more effectively by concurrently learning with basic and clinical subjects. The main urologic diseases are presented in the blocks concerning “nephrology-urology” and “reproduction”. Students also learn urologic trauma, infection and endocrinology.

A one-week bedside teaching program is scheduled for fifth-year students. During this program, students may experience main urologic practice and patient care. Students can study not only urologic practice, but also ethical and social problems in clinical practice.

2) Education for postgraduates

During the first two-year residency, every resident is obligated to rotate to more than five divisions (junior residency program). After completing the junior residency course, there are two courses. One is a senior residency in urology (four years), and the other is entrance into the postgraduate course for basic research (four years). After a four-year urology residency, they become eligible for a board-certified test given by the Japan Urological Association.