Nihon Hinyokika Gakkai zasshi. The japanese journal of urology最新文献

Dysuria is caused by bladder outlet obstruction (BOO) and detrusor underactivity. Female BOO is often overlooked because it is difficult to diagnose a condition from history and symptoms alone. Fowler's syndrome is seen in young women and causes urinary retention due to a primary disorder of urethral sphincter relaxation. Although the level of evidence is still low, sacral neuromodulation or intra-sphincteric Botulinum toxin injection has been applied to Fowler's syndrome. A 44-year-old woman with a chief complaint of dysuria started clean intermittent catheterization because of urinary retention. Videourodynamics showed BOO, open bladder neck, and narrowing of the middle urethra during voiding, and MRI showed thickening of the urethral sphincter. A neurological examination was performed with no neurologic features, so the diagnosis of Fowler's syndrome was suggested. The possibility of a diagnosis of female BOO should always be kept in mind when a woman has dysuria, and urodynamic study or Videourodynamics should be considered.

Testicular torsion is a condition of ischemia due to blood flow disturbance, ischemia-reperfusion injury after the detorsion, and compartment syndrome with increased intratesticular pressure. If no improvement in testicular color and appearance is noted after the detorsion, the tunica albuginea incision can be performed to preserve the testis. Case 1: A 13-year-old male came to our hospital with left scrotal pain, and emergency surgery was performed six hours after the onset with the diagnosis of left testicular torsion. The left testis was externally rotated 180 degrees, and the testis remained poorly colored after the detorsion. The testicular color improved after the tunica albuginea incision. The defect of the albuginea was covered with a tunica vaginalis flap. One year after the operation, testicular size remained the same, and blood flow in the left testis was good. Case 2: A 16-year-old male came to our hospital with right scrotal pain, and emergency surgery was performed 10 hours after the onset with a diagnosis of right testicular torsion. The right testicle was internally rotated 180 degrees, and the testis remained poorly colored after the detorsion. The tunica albuginea incision was performed and covered with a tunica vaginalis flap after improvement of color. Six months after the operation, testicular size remained the same, and blood flow in the right testis was good. Testicular preservation was possible with tunica albuginea incision and tunica vaginalis flap for testicular torsion. However, the long-term effect of these techniques on testicular function is unclear, and long-term follow-up is likely to be necessary.

We report the case of a 41-year-old man who presented with gross hematuria and a bladder tumor on ultrasonography. Magnetic resonance imaging indicated a possible muscle-invasive bladder cancer or urachal carcinoma. Following transurethral resection of the bladder tumor, histopathological findings revealed an adenocarcinoma similar to colorectal cancer. The patient was diagnosed with an urachal carcinoma in the urinary bladder dome. Since multiple lung metastases were observed on computed tomography, and his serum carcinoembryonic antigen level was 116 ng/dL, his final diagnosis was a stage IVb urachal carcinoma. He received 11 courses of mFOLOX6, and underwent a laparoscopy-assisted partial cystectomy and pelvic lymph node dissection. Pathological examination confirmed negative surgical margins, but remained tumor cells were confirmed. The patient continued mFOLFOX6 treatment for 12 months postoperatively, with no disease progression observed.

A 35-year-old man visited a local doctor for continuing analysis of his infertility. Semen analysis revealed azoospermia while an ultrasonography detected a right testicular tumor with a diameter of 10 mm. A blood test was negative for tumor markers. Magnetic resonance imaging showed a 1-cm tumor in the right testis and atrophy of the left testis. A testicular tumor arising from a functional unilateral testis was discovered during infertility treatment for which the patient was referred to our hospital for fertility preservation. Right and left testicular volumes were 18 mL and 3 mL, respectively, and his serum testosterone level was 2.96 ng/mL. Noting the atrophy of the contralateral testicle, we proceeded with a rapid pathology diagnosis by partial testicular resection. If no evidence of tumor malignancy was found, the surgery would have been concluded with no further dissection. Since the patient was undergoing fertility treatment, the decision was made to take sperm from the extracted testicle to preserve his fertility, followed by orchiectomy. Because a seminoma was suspected through the rapid pathological diagnosis, the man eventually underwent higher orchiectomy and testicular sperm extraction. The final diagnosis was seminoma, followed by successful retrieval of a sufficient level of sperm. Post operative serum testosterone level was found to be 0.32 ng/mL, after which testosterone replacement therapy was introduced. Through rapid diagnosis of pathology, successful management and outcome were achieved in the case of testicular cancer combined with infertility.

The patient was a 79-year-old male who underwent external-beam radiation therapy combined with hormone therapy for prostate cancer. A hydrogel SpaceOAR was implanted to prevent adverse rectal events before stereotactic radiotherapy using Cyberknife. After completion of external irradiation, the patient developed a fever and was diagnosed with a prostatic abscess based on clinical and computed tomography findings. Magnetic resonance imaging showed the prostatic abscess consistent with SpaceOAR insertion site. Despite treatment with antibiotic agents, the patient's inflammatory response did not improve. Transurethral resection of the prostatic abscess and vesicostomy were performed for drainage, following which the postoperative inflammatory response improved rapidly. In this case, the SpaceOAR may have partially penetrated into the prostatic capsule when it was implanted, and a urinary tract infection may have occurred due to urinary retention or placement of a urethral catheter, resulting in the formation of an abscess.

A 34-year-old man had undergone living donor kidney transplantation for hypoplastic and dysplastic kidney and gastrocystoplasty and umbilical-urinary tract reconstruction using the appendix for contracted bladder in his early childhood. At the age of 19 years, renal transplant function was lost, and hemodialysis was thus initiated. Since then, he had regularly visited our department while continuing to perform urethral self-catheterization and self-bladder irrigation to alleviate bladder irritation symptoms due to hematuria-dysuria syndrome. Subsequently, the patient experienced hemorrhage from the bladder augmented with the stomach, which led to the development of bladder tamponade and the progression of anemia. He was thus admitted to our department and received continuous bladder irrigation and other conservative therapies, as well as vascular embolization. Because hemostasis was not achieved despite these procedures, partial cystectomy (resection of the bladder augmented with the stomach) was performed. Here, we report our experience with a patient with refractory bladder hemorrhage due to hematuria-dysuria syndrome, for which we performed partial cystectomy and achieved hemostasis. Although gastrocystoplasty has been rarely performed in recent years because of specific postoperative complications such as hematuria-dysuria syndrome, caution should be exercised in patients with anuria due to renal failure or other causes.

A 80-year-old woman presented with a swelling and pain in the left thigh visited our hospital. CT showed an impacted stone in the left ureter, left hydronephrosis and abscess formation extending from the perirenal area to the left thigh. Immediately, the patient was admitted and left nephrostomy was placed. On day 3 of admission, drainage of abscess in the left thigh was performed with the cooperation of an orthopedic surgeon. On day 17, a contrast-enhanced CT showed shrinkage of the thigh abscess, however, showed the left non-functioning kidney and poor drainage of the left iliopsoas abscess. On day 24, open left nephrectomy and unroofing of the iliopsoas abscess were performed, and all the abscess showed shrinkage thereafter. To sum up, multiple drainage should be considered for widely extending abscess originated in the retroperitoneal space.

(Introduction and objective) Water vapor energy therapy (WAVE) received insurance approval in Japan in September 2022 for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Here we report a prospective trial of WAVE. (Patients and methods) This study included 16 patients who underwent WAVE between November 2022 and December 2023. International Prostate Symptom Score (IPSS), IPSS Quality of Life (QOL) score, overactive bladder symptom score, post-void residual urine volume (PVR), prostate volume (PV) measured using transrectal ultrasonography, postoperative catheter removal rate, surgical duration, and adverse events were recorded preoperatively and at 1, 3, 6, and 12 months postoperative. (Results) The median age was 76.5 years, and 11 of 16 patients (69%) received antiplatelets and/or anticoagulants. The median preoperative PV was 43.5 ml, while the median postoperative follow-up period was 6.9 months. Comparison of the baseline and 6-month postoperative follow-up values showed that the median IPSS and IPSS-QOL scores decreased significantly (by 48% and 55%, respectively), while the median PV was significantly reduced by 36%. The median PVR was reduced by 51%; however, the difference was not significant. Catheter removal was successful in 80% of patients. The median surgical duration was 8.5 min (range, 4.0-26.0 min). Complications (grade ≤ II) according to the Common Terminology Criteria for Adverse Events v5.0 occurred in 12 patients. (Conclusion) WAVE is a useful minimally invasive surgical approach in elderly patients and patients receiving antiplatelets and/or anticoagulants, featuring a short surgical duration, improved micturition, and no serious adverse events.

(Purpose) To translate the Female Decreased Sexual Desire Screener (DSDS) into Japanese and perform linguistic validation of the translated DSDS. (Methods) Translation was conducted in the following order: 1) obtaining permission from the original author to create a Japanese version; 2) forward translation; 3) community review; 4) back-translation; and 5) review and approval of the back-translation by the original author. First, permission to create the Japanese version was obtained from the original author by e-mail. The initial translation was done by two urologists, and an additional four urologists then refined and completed the Japanese translation. Linguistic validation was performed as follows. For the community review, semi-structured interviews were conducted with a total of 11 participants (6 sexually active women and 5 non-sexually active women), and some wording changes were made based on the input from the participants. A total of 10 different participants were asked to respond to the questionnaire again, and additional modifications were made. The forward translation with modifications was then back-translated and e-mailed to the original author. (Results) In accordance with the original author's comments on the back-translation, further modifications were made to the Japanese version, which was then back-translated again and confirmed and approved by the original author. (Conclusion) After a multi-step review process, the Japanese version of the DSDS was completed with linguistic validation.

(Background) The purpose of this study was to investigate the current status of urologists regarding the prevention of perioperative infections in preparation for the revision of the Guidelines for the Prevention of Perioperative Infections in Urological Field (2015). (Methods) From January 26 to March 30, 2022, we administered questionnaires to members of the Japanese Urological Association on their adherence to the guidelines and administration methods of antimicrobial prophylaxis for perioperative infections. There were 362 respondents. (Results) The respondents reported adhering to the guidelines completely (15.5%), to some extent (55.5%), poorly (24.3%), and not at all (4.7%). Adherence rates also varied for surgical procedures, ranging from 73.8% in transurethral resection of bladder tumor to 32.9% in laparoscopic (robot-assisted) contaminated surgery. Excluding contaminated surgery and transurethral resection of prostate, where long-term administration is relatively acceptable, open clean-contaminated surgery had the highest rate of long-term administration (≥72 h) (27.2%) and transurethral resection of bladder tumor had the lowest rate (7.3%). Adherence rates for clean surgery and transurethral ureteral lithotripsy shortened to a single dose of antimicrobial agents were low. (Conclusion) The selected antimicrobial agents were generally in compliance with the guidelines. With the exception of contaminated surgery, they were administered long-term in clean-contaminated surgery where the urinary tract and genitalia were exposed. Surgical procedures in which a single prophylactic dose of antimicrobial agents was administered had a low compliance rate. After the revision of the guidelines, it is considered important to update the clinical paths at each facility.