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

We performed laparoscopic live donor nephrectomy (LDN) on approximately 200 patients in Ehime Prefectural Center Hospital between 2003 and 2016. In 2016, a fifty-something woman who was a donor candidate for her husband was revealed to have a horseshoe kidney through contrast-enhanced computed tomography; other LDN procedures used a retroperitoneal approach, but this one used a transperitoneal approach since the latter approach allowed for a more favorable visual field. The left kidney was selected since renal scintigraphy showed equal bilateral renal function and renal arteries are simpler on the left side. The kidney was removed after the isthmus was successfully transected without ischemia. The opened calyx in the left kidney was sutured via bench surgery, and the kidney was transplanted to the recipient. Postoperative courses of both donor and recipient were good.

A 76-year-old woman was referred to our department because of high fever and bladder irritative symptoms. Computed tomography revealed the presence of a heterogeneous mass with indistinct borders on the left anterior wall of the bladder. The lesion contained a linear hyperdense shadow. We initially suspected malignancy, such as urachal carcinoma or soft-tissue sarcoma. However, upon review of previous computed tomography scans, it was confirmed that the linear hyperdense shadow had migrated from the intestinal tract to the bladder. Considering the possibility of abscess formation caused by a foreign body, we decided to perform a transurethral biopsy. The results of the pathological analysis showed abscess formation. The patient was diagnosed with perivesical abscess caused by accidental ingestion of a fish bone. Following the administration of antibiotics, the lesion markedly shrank. Although it is difficult to distinguish perivesical abscess from malignant disease, invasive treatment can be avoided by appropriate diagnosis based on imaging studies.

We performed robot-assisted laparoscopic radical prostatectomy (RARP) without transcatheter arterial embolization (TAE) for a 72-year-old male patient with prostate cancer and pelvic arteriovenous malformation (AVM). Though lymphatic dissection was made contralateral to the AVM, the operation time (robotic: 2h 40 min, and total: 3h 2 min) was not long. Moreover, the blood loss amount of 250 ml was less than those in the past reports of preoperative TAE. Robotic surgery, a dissection of an abnormal arterial branch from the internal iliac artery before the division of the bladder neck, bunching of the deep dorsal vein complex, and resection of the vascular pedicle connecting with AVM in the final step of prostatectomy, contributed to the safe operation. Moreover, the surgical margin was negative in the pathological report,and the prostate specific-antigen was 0.006 ng/ml 3months following the operation. In addition, CT revealed the same size of AVM and no postoperative complication. It has been demonstrated that in the absence of TAE for pelvic AVM, RARP for prostate cancer is safe and effectively controls cancer.

A 32-year-old man visited the emergency department complaining of the right scrotal pain, which occurred suddenly during sexual intercourse. Palpation revealed induration and tenderness on the caudal side of the right testis. Ultrasonography revealed a mosaic-like mass on the caudal side of the testis and no difference in blood flow between the right and left testes. The patient underwent a thorough examination the next day. Although the blood test did not show elevated tumor marker levels, testicular MRI revealed a mass with heterogeneous signal in the right scrotum. Subsequently, the patient was referred to another hospital for surgery. The pathological examination revealed a mixed germ cell tumor: seminoma (60%), teratoma (20%), and embryonal carcinoma (20%). One year postoperatively, the patient has had no recurrence. Testicular tumors are rarely discovered in acute scrotum, and few such cases have been reported. Torsion of the tumor, hemorrhage, necrosis, rupture, and infection have been reported as mechanisms of occurrence. When acute scrotum is diagnosed, testicular tumor should be considered as a differential diagnosis.

(Objective) Pregnancy in kidney transplant recipient continues to remain challenging due to a high rate of cesarean section along with preterm delivery, and concern for worsening renal function. This study examined the prognosis and perinatal management of post-transplant pregnancies. (Patients and methods) A total of nine post-transplant recipients at Niigata University Medical and Dental Hospital between 2007 and 2021 were retrospectively examined. (Results) All pregnancies were planned. Calcineurin inhibitors and steroids were continued, and antimetabolites were changed to azathioprine. The mean age at delivery was 33±3.8 years, and the mean time from renal transplantation to delivery was 6.5±3.5 years. Five patients (55.5%) had cesarean sections, while four (44.5%) patients had normal vaginal deliveries. The mean gestational age was 35±3.0 weeks, and the mean birth weight was 2,336±565.4 g. No congenital malformation was observed. The most common reason for early delivery was worsening renal function, seen in six (66.7%) patients. The mean serum creatinine level before pregnancy was 1.11±0.23 mg/dL and then worsened to 1.59±0.37 mg/dL during pregnancy. However, it recovered to 1.14±0.40 mg/dL after delivery. One patient had antibody-mediated rejection with donor specific antibody (DSA) prior to pregnancy, and her renal graft function worsened slightly after delivery. Another patient had a de novo DSA after delivery, which was not detected before pregnancy. (Conclusions) In our hospital, pregnancy in kidney transplant recipients were safe and renal graft function after delivery was relatively stable. Patients may require adjustment of calcineurin inhibitors during pregnancy, and the appearance of DSA after delivery should be noted.

Mucinous cystic tumor of low malignant potential (MCTLMP) is a very rare disease.The patient was a 50-year-old man. Contrast-enhanced computed tomography and magnetic resonance imaging showed a multiocular cystic lesion on the top of the bladder. We performed surgery to remove the tumor for definitive diagnosis. Intraoperative rapid pathological diagnosis of the cyst wall showed no malignant findings, so we performed combined resection of the peritoneum and part of the bladder wall.Based on imaging findings, tumor location, and pathological and immunostaining findings (CK20 and CDX2 positivity; β-catenin negativity), the patient was diagnosed with MCTLMP thought to be of urachal origin. After the operation, recurrence was not observed.

(Introduction) Beginning in April of 2022, infertility services-including assisted reproductive technologies and examinations and treatments for male infertility-were covered by health insurance in Japan. Although these changes are expected to bolster birth rates in Japan, increased numbers of patients and surgeries are anticipated, particularly following reductions in patient visits caused by COVID-19. (Materials and methods) We surveyed 13 members of the Male Infertility Special Interest Group of the Japanese Society for Reproductive Medicine using Microsoft Forms. Respondents were asked about the number of new male infertility patients and surgeries at their respective facilities before the COVID-19 pandemic, after the first wave, after the sixth wave, and after the insurance changes to cover treatments for male infertility. Respondents were also asked to describe challenges in meeting the demand created by these insurance coverage changes. (Results) Patients and surgeries (varicocelectomy and testicular sperm extraction) declined markedly after the first wave of COVID-19 but gradually recovered after the sixth wave. However, once male infertility-related services were covered by insurance in Japan, respondents observed a marked increase in new patients and surgeries compared to pre-COVID-19. The most frequently reported problem was that sperm cryopreservation was not covered by insurance. (Conclusions) This survey should be readministered after additional time has passed to capture longer-term changes following changes to insurance coverage in Japan. We anticipate the responses to the survey will reflect ongoing challenges associated with changes in insurance coverage for male infertility-related services.

Small renal cell carcinoma with metastases is rare; thus, to the best of our knowledge, this is the first case of synchronous metastasis to the ipsilateral perirenal fat.A 70-year-old man visited our hospital because of early gastric carcinoma. Contrast-enhanced computed tomography revealed a right renal tumor and two small nodules in the ipsilateral perirenal fat. The renal tumor was 3 cm in diameter and consistent with clear cell renal cell carcinoma. The enhancement pattern of the nodules was similar to that of the renal tumor, we diagnosed cT1aN0M1. Transperitoneal laparoscopic radical nephrectomy of the right kidney was performed. Postoperative pathological analysis showed clear cell renal cell carcinoma of the right kidney, pT1a, G2>1, INFa, v0, ly0, and two nodules in ipsilateral perirenal fat had comparable pathological findings. At 11th month of postoperative follow-up, CT revealed multiple nodules in the left pleura. Pembrolizumab plus axitinib was administered every 3 weeks. Multiple pleural metastases disappeared 3 months after the therapy; however, grade 2 (CTCAE v5.0) diarrhea and hoarseness emerged. Owing to the persistence of symptoms despite axitinib cessation, pembrolizumab was also discontinued. After 2 months of withdrawal, the patient's symptoms resolved spontaneously. After consultation with the patient, he was followed up with no further treatment. He is alive with no evidence of recurrence 36 months after surgery.

A 57-years-old woman was referred to our urological department due to a 7.2-cm tumor in the left kidney, detected on computed tomography (CT). Dynamic CT of the kidney confirmed the diagnosis of left renal cancer, with lung metastasis (cT2aN0M1). The patient had a poor prognosis (IMDC classification), given the following risk factors: Time from initial diagnosis to initiation of systemic therapy < 1year, hemoglobin of 8.4 g/dL, calcium of 10.7 mg/dL, and platelet of 74.2×10⁴/mm³. Laparoscopic left radical nephrectomy was performed before systemic drug treatment because the solitary lung metastasis was relatively small (10 mm) and the patient had symptoms of hematuria and fever. The pathological diagnosis was a clear cell carcinoma with renal sinus invasion (pT3a). Four days postoperatively, the patient developed lymphatic leakage, and was unresponsive to diet and conservative treatment. Lymphatic embolization with iodized poppy oil fatty acid ethyl ester was performed 22 days postoperatively. Contrast material leakage from the left renal hilar lymph node was observed before embolization. Post-embolization CT confirmed no contrast leakage. The patient resumed oral feeding on the 28^th postoperative day, and the drain was successfully removed the next day. She was discharged on the 35^th postoperative day. On follow-up, increased lung metastases were observed on CT. She was treated with the combination of ipilimumab and nivolumab. After one course of treatment, a CT scan showed a further increased in lung metastases (RECIST: PD). Thus, she was initiated on cabozantinib monotherapy. Lymphatic embolization may be a safe and effective treatment for lymphatic leakage that does not improve with conservative treatment.

(Background) Prostate biopsy is the most important examination for the diagnosis of prostate cancer and the most common test in urology. We evaluated the results of transrectal prostate biopsy performed at Kanazawa Medical University Hospital. (Materials and Methods) Prospectively collected cases of 1,935 patients was undergone transrectal prostate biopsy between January 2002 and December 2021. We looked at patients age, serum Prostate-specific antigen (PSA) level, PSA density (PSAD), total prostate volume, number of biopsy times, and number of biopsy core. We examined the positive cancer rate. (Results) The median age of patients was 70 years (range: 36-96 years), the median serum PSA level was 7.6 ng/mL (range: 0.19-15,823 ng/mL), the mean number of biopsy times was 1.3 (range: 1-6), and the mean number of total biopsy core was 8.6 (range: 2-14). There were 880 (45.5%) positive cases and 1,055 (54.5%) negative cases. Comparing the cancer-positive and cancer-negative groups, the median age was 72 years (range: 50-96 years), 68 years (range: 36-93 years), the median PSA level was 11.0 ng/mL (range: 0.19-15,823 ng/mL), 6.6 ng/mL (range: 0.24-86.0 ng/mL), median prostate volume was 29.5 mL (range: 7.4-206 mL), 39.1 mL (range: 9.6-178 mL), median PSAD 0.376 (range: 0.003-1,582), 0.177 (range: 0.016-7.513), mean number of biopsy times 1.2 (range: 1-6), 1.4 (range: 1-6), mean number of total biopsy core 8.9 (range: 2-14), 8.5 (range: 4-14), and there was a significant difference in all comparison.