- HOME
- Department
- Urology
Urology
（1）Overview
In the Urology Department, we cover a wide range of conditions, including tumors of the adrenal glands, kidneys, bladder, and prostate; benign conditions such as urinary stones, benign prostatic hyperplasia, and overactive bladder; urinary tract infections such as pyelonephritis and cystitis; and male reproductive disorders like erectile dysfunction. In surgery, we strive to preserve organs as much as possible and aim for early recovery for our patients.
Our Prostate Center specializes in the diagnosis and treatment of prostate diseases, with a focus on benign prostatic hyperplasia (enlarged prostate) and prostate cancer. We provide a comprehensive suite of treatment options, including medical, surgical, and radiation therapies.
（2）Policy
Our Approach: Organ Preservation and Early Recovery After Surgery
At our department and center, we are committed to preserving healthy, non-cancerous tissue whenever possible to maintain optimal organ function. In robotic surgery for prostate cancer, particular attention is given to preserving the pelvic floor muscles and urethra to reduce the risk of postoperative urinary incontinence. For kidney cancer, if the tumor is 7 cm or smaller, we make every effort to remove only the tumor and preserve kidney function.
After surgery, patients are encouraged to begin walking and eating as soon as possible. We implement a team-based approach to care involving doctors, nurses, physical therapists, and dietitians to support early recovery. (See our Early Recovery Program for more details)
（3）Diseases we treat
- Prostate cancer
- Kidney cancer
- Bladder cancer
- Cancer of the renal pelvis and ureter
- Benign prostatic hyperplasia (BPH)
Prostate cancer
【Symptoms】
In most cases, early-stage prostate cancer does not cause any noticeable symptoms. Therefore, testing for PSA (Prostate-Specific Antigen) during medical checkups is essential for early detection. When cancer becomes locally advanced, symptoms such as difficulty urinating, frequent or painful urination, and blood in the urine may occur. If the cancer has spread to the bones, pain may develop in the affected areas.
【Possible Causes】
Obesity and the westernization of dietary habits may be contributing to the increase in prostate cancer cases. Additionally, genetics also plays a role — individuals with a family history of prostate cancer have about three times the risk compared to those without such a history.
【Prevention】
There are no clear preventive measures. Early detection requires testing for PSA, a tumor marker.
【Treatment Method】
Robot-assisted radical prostatectomy
Radiation therapy
Chemotherapy
Hormone therapy
【Prognosis】
The 5-year survival rates by cancer stage (when cancer is the sole cause of death) are as follows:
Stage Ⅰ：100％
Stage Ⅱ：100％
Stage Ⅲ：99.0％
Stage Ⅳ：60.0％
Kidney Cancer
【Symptoms】
Kidney cancer is a malignant tumor that develops in the kidneys. Recently, it has become increasingly common to detect it at an early stage through ultrasound examinations during routine health checkups. When kidney cancer is small, there are usually no noticeable symptoms. However, as the tumor grows, symptoms such as back pain, abdominal fullness, and blood in the urine may appear.
【Causes】
It is known that some cases of kidney cancer are associated with genetic abnormalities, such as von Hippel-Lindau disease. People who are obese, have hypertension, or who smoke are two to four times more likely to develop kidney cancer compared to those without these risk factors. Patients with kidney failure undergoing dialysis also have a significantly higher risk of developing kidney cancer and therefore require regular screening.
【Prevention】
There is no definitive way to prevent kidney cancer, but it is important to manage obesity and hypertension. Smoking is also a risk factor, so quitting is recommended.
【Treatment Method】
For tumors smaller than 7 cm, the standard treatment is a partial nephrectomy (removal of only part of the kidney) with robot-assisted surgery, whereas tumors larger than 7 cm typically require a total nephrectomy. Radiation therapy is not prioritized due to its limited effectiveness. In cases of metastatic kidney cancer, treatment involves molecular targeted therapies and immune checkpoint inhibitors.
【Prognosis】
The 5-year survival rates by cancer stage (when cancer is the sole cause of death) are as follows:
Stage Ⅰ：94.9％
Stage Ⅱ：87.9％
Stage Ⅲ：76.5％
Stage Ⅳ：18.7％
Bladder cancer
【Symptoms】
Visible blood in the urine (gross hematuria) is the most common early symptom of bladder cancer. Unlike cystitis (bladder inflammation), it is typically not accompanied by pain or a feeling of incomplete urination. If you experience even a single episode of visible blood in your urine, it is recommended that you seek medical attention. Additionally, persistent or recurrent cystitis may sometimes conceal underlying bladder cancer, so caution is advised.
As the disease progresses, symptoms such as lower abdominal pain, urinary retention due to blood clots, and a constant urge to urinate may also appear.
【Causes】
Smoking and exposure to organic solvents are known risk factors for bladder cancer.Smokers are about 2 to 4 times more likely to develop bladder cancer compared to non-smokers.
【Prevention】
There is no definitive method of prevention, but it is important to avoid risk factors such as smoking and exposure to organic solvents.
【Treatment Method】
Non-muscle-invasive bladder cancer (NMIBC)
Transurethral resection of bladder tumor (TURBT)
Intravesical BCG therapy (or BCG instillation therapy)
Muscle-invasive bladder cancer (MIBC)
Robot-assisted radical cystectomy
Chemotherapy
Radiation therapy
【Prognosis】
The 5-year survival rates by cancer stage (when cancer is the sole cause of death) are as follows:
Stage Ⅰ：82.2％
Stage Ⅱ：54.3％
Stage Ⅲ：38.7％
Stage Ⅳ：18.3％
Urothelial carcinoma of the renal pelvis and ureter
【Symptoms】
This is a malignant tumor that develops in the renal pelvis and ureter. The most common early symptom is visible (gross) hematuria. As the tumor grows and obstructs the flow of urine, symptoms such as back pain associated with hydronephrosis, pyelonephritis, and decreased kidney function may appear.
【Causes】
Like bladder cancer, smoking and exposure to organic solvents are the major risk factors.
【Prevention】
It is important to avoid smoking and exposure to organic solvents.
【Treatment Method】
Radical nephroureterectomy (robot-assisted surgery, open surgery)
Chemotherapy
【Prognosis】
The 5-year survival rates by cancer stage (when cancer is the sole cause of death) are as follows:
Stage Ⅰ：78.9％
Stage Ⅱ：65.3％
Stage Ⅲ：53.7％
Stage Ⅳ：12.2％
Benign prostatic hyperplasia (BPH)
【Symptoms】
An enlarged prostate causes symptoms such as difficulty urinating, frequent urination, and increased residual urine.
【Cause】
It is a disease that becomes more common with age, and its exact cause remains unknown.
【Prevention】
There are no defined methods for prevention.
【Treatment Methods】
Medical (Non-surgical) Treatment
1．α-blockers
2．5α-reductase inhibitors
3．Others
Surgical Treatment
1．Transurethral Holmium Laser Enucleation of the Prostate (HoLEP)
2．Transurethral Resection of the Prostate (TURP)
3．Subcapsular Prostate Enucleation (Open Surgery)
【Others】
Benign Prostatic Hyperplasia Clinical Practice Guidelines.
https://www.urol.or.jp/lib/files/other/guideline/08_prostatic_hyperplasia.pdf
（4）Features
Focus on Organ-Preserving Surgery
In our department’s cancer treatment, we have traditionally placed a strong emphasis on organ-preserving surgery. We strive to preserve as much of the healthy tissue as possible, removing only the cancerous areas, in order to maintain the organ’s original structure and function. This allows patients to continue leading comfortable daily lives even after treatment.
Even in cases where preserving the organ and its function is difficult—such as with kidney cancer, renal pelvic cancer, ureteral cancer, or pyeloplasty—we actively perform robot-assisted surgeries. These minimally invasive procedures aim to reduce the physical burden on patients and promote an early return to society.
Robot-Assisted Prostate Cancer Surgery
Since 2015, we have been using a surgical assistance robot called “da Vinci.” With robotic surgery, the robot arms move smoothly like human joints, allowing for precise and delicate dissection and suturing. Because the procedure is performed laparoscopically, it tends to result in less bleeding compared to traditional open surgery.
Most patients start walking around three hours after surgery and can begin eating the same day as the operation.
Robot-Assisted Partial Nephrectomy
For kidney tumors that are 7 cm or smaller, partial nephrectomy is performed to preserve the normal kidney tissue surrounding the tumor. Although kidney function may temporarily decline after surgery, this approach helps maintain better kidney function compared to removing the entire kidney. If you are considering partial nephrectomy, please feel free to consult our hospital.
Robot-Assisted Radical Cystectomy
The standard treatment for muscle-invasive bladder cancer is the complete removal of the bladder (radical cystectomy). Our hospital began offering robot-assisted radical cystectomy in 2021. After bladder removal, urinary diversion becomes necessary. In our department, all steps of the urinary diversion procedure are performed robotically within the abdominal cavity (using methods such as ileal neobladder, ileal conduit, or cutaneous ureterostomy). One of the advantages of performing urinary diversion inside the abdominal cavity is that the intestines do not dry out during surgery. As a result, the incidence of postoperative paralytic ileus is significantly reduced. Compared to open surgery, patients can expect faster recovery and earlier discharge.
(Nakamura, M., et al. “Advantages of Enhanced Recovery after Surgery Program in Robot-Assisted Radical Cystectomy.” Scientific Reports, vol. 13, no. 1, 2023, article 16237.)
Introduction of VR Surgical Navigation
VR surgical navigation is a system that transforms two-dimensional CT or MRI images into three-dimensional models. This allows surgeons to view the surgical site in 3D, leading to more precise surgeries, reduced blood loss, and shorter operation times. It is primarily used for surgical planning prior to partial nephrectomy for kidney cancer.
Enhanced Recovery After Surgery (ERAS) Program
We have implemented an Enhanced Recovery After Surgery (ERAS) program before and after robotic surgery. Patients are given juices to drink two hours before surgery and begin eating about three hours after the procedure. Additionally, with the assistance of a physical therapist, patients start walking within 3 to 4 hours after surgery. A multidisciplinary team actively supports the program to help reduce postoperative complications during hospitalization.
MRI–Ultrasound Fusion-Guided Prostate Biopsy
At our hospital, we perform prostate biopsies under general anesthesia by inserting a needle into the prostate to collect tissue samples. When a suspicious area is identified on the MRI, it can be fused with real-time ultrasound images to guide the biopsy. This fusion allows the needle to accurately target the suspected cancerous area. This method is especially useful when cancer cannot be identified using ultrasound alone or when a previous biopsy failed to provide a diagnosis. It enables more accurate cancer detection and helps identify patients who may require definitive treatment.
For Patients Visiting the Urology and Prostate Center
At our department, we are dedicated to providing a supportive environment where patients can undergo surgery and treatment with confidence and peace of mind. Our care is guided by the latest clinical guidelines and provided by board-certified urologists accredited by the Japanese Urological Association.
If you are seeking surgery or treatment for cancer, please bring a referral letter from your primary care physician or referring doctor. If available, also bring recent imaging results and pathology reports. This helps avoid redundant testing and ensures timely treatment.
After treatment, we will continue follow-up care in coordination with your referring doctor or local clinics. If you have a medication notebook, please bring it with you—both the physician and pharmacist will review it.
If you are unsure about your current treatment or would like to explore other treatment options, please consider using our second opinion service. We provide not only the treatment options available at our hospital, but also comprehensive and objective information based on broader medical knowledge.
Masaki Nakamura, MD, Ph.D
Head of Department
