To investigate pre- and post-operative renal global function and renal parenchymal volume (RPV) in both partial nephrectomy (PN) and radical nephrectomy (RN) utilizing film-based technology.The patient cohort consisted of 81 and 82 cases with T1 tumors (≤ 7 cm) treated by PN and RN, respectively. Renal global function was assessed using the estimated glomerular filtration rate (eGFR), and RPV was measured using a Synapse Vincent volumetric analyzer which creates a reconstructed image from a computed tomography scan. Renal global function and RPV were evaluated pre-operatively and 6 months post-operatively.The percent eGFR decline of PN cases was significantly reduced compared with RN cases (p < 0.0001). Post-operative RPV of the contralateral side was significantly increased compared with pre-operative RPV (p < 0.0001) in RN cases. The percent change of the contralat-eral side RPV was slightly increased in RN compared with PN cases (p = 0.1881). A strong positive correlation was noted between post-operative eGFR and post-operative total RPV (r = 0.69, p < 0.0001), and a strong negative correlation was noted between percent eGFR decline and post-operative total RPV (r = -0.63, p < 0.0001).Prominent compensatory renal hypertrophy occurred within 6 months after RN. Post-operative renal functional outcome was closely correlated with the post-operative total RPV. In addition to RPV, further studies to unravel post-operative renal function from multifactorial aspects including surgical factors and intrinsic medical disease should be performed in the future.
Abstract Background Upper urinary tract urothelial carcinoma (UTUC) is uncommon. In advanced cases, radical nephroureterectomy (RNU) alone is not curative, and recurrence and metastasis are likely to occur. Adjuvant chemotherapy (AC) is an evidence-based treatment. However, the optimal number of AC cycles is not clear. This multicenter study investigated the number of cycles required for the beneficial effects of AC in Japanese patients with UTUC. Methods Patients who were diagnosed with UTUC and underwent RNU at our hospital and affiliated hospitals from January 2010 to September 2020 were included in the study. Patients with pathological T3 or higher or lymph node metastasis were observed or given AC, and their responses were compared. The AC regimens included gemcitabine and cisplatin or gemcitabine and carboplatin. Patients were classified into three groups: the observation group, the two cycles of AC group, and the three to four cycles of AC group. Patients were also classified into two groups: the observation and two cycles of AC group and the three to four cycles of AC group. The survival curves for recurrence-free survival (RFS) and cancer-specific survival (CSS) were evaluated using Kaplan–Meier analyses. Results Of the 133 patients enrolled in the study, 24 received 2 cycles of AC, 37 received 3–4 cycles, and 72 were observed only. The median RFS for all patients was 3.58 years, and the median CSS for all patients was 4.77 years. The 5-year RFS was 67.1% for the 3–4 cycles of AC group and 41.7% for the observation and two cycles of AC group. The 5-year CSS was 72.2% for the 3–4 cycles of AC group and 35.9% for the observation and two cycles of AC group. RFS and CSS were significantly longer in the three to four cycles of AC group compared to the observation and 2 cycles group (P = 0.048 and P = 0.005 respectively). Conclusion AC prolonged RFS and CSS in the real-world setting. However, at least three cycles of AC are required to achieve beneficial effects in patients with UTUC.
Upper urinary tract urothelial carcinoma (UTUC) is uncommon. In advanced cases, radical nephroureterectomy (RNU) alone is not curative, and recurrence and metastasis are likely to occur. Adjuvant chemotherapy (AC) is an evidence-based treatment. However, the optimal number of AC cycles is not clear. This multicenter study investigated the number of cycles required for the beneficial effects of AC in Japanese patients with UTUC.
Abstract Angiotensin (Ang) II plays an important role in the brain as a neurotransmitter and is involved in psychological stress reactions, for example through activation of the sympatho-adrenomedullary system. We investigated the effects of centrally administered Ang II on the micturition reflex, which is potentially affected by the sympatho-adrenomedullary system and brain Ang II receptors in urethane-anesthetized (1.0 g/kg, intraperitoneally) male rats. Central administration of Ang II (0.01, 0.02 and 0.07 nmol per rat, intracerebroventricularly, icv) but not vehicle rapidly and dose-dependently decreased the urinary bladder intercontraction interval, without altering the bladder detrusor pressure. Central administration of antagonists of Ang II type 1 but not type 2 receptors inhibited the Ang II-induced shortening of intercontraction intervals. Administration of the highest dose of Ang II (0.07 nmol per rat, icv) but not lower doses (0.01 and 0.02 nmol per rat, icv) elevated the plasma concentration of adrenaline. Bilateral adrenalectomy reduced Ang II-induced elevation in adrenaline, but had no effect on the Ang II-induced shortening of the intercontraction interval. These data suggest that central administration of Ang II increases urinary frequency by acting on brain Ang II type 1 receptors, independent of activation of the sympatho-adrenomedullary system.
