Japanese Journal of Urology最新文献

A 71-year-old man with a history of hoarseness and right upper extremity numbness was referred to our department for evaluation of an intrathoracic mass that was detected on chest radiography and a right kidney tumor observed on computed tomography (CT). Histopathological examination of percutaneous kidney biopsy and bronchoscopic lung biopsy specimens revealed renal clear cell carcinoma with multiple lung metastases. The patient showed a poor risk based on the International Metastatic renal cell carcinoma Database Consortium score, and nivolumab plus ipilimumab were initiated as first-line therapy. His symptoms gradually improved, following four courses of nivolumab plus ipilimumab treatment, and CT revealed shrinkage of all lesions. However, he developed diarrhea, rash, anemia, and elevated serum C-reactive protein levels (CRP) following this therapy. Diarrhea and rash were considered immune-related adverse events, and he was treated with oral prednisolone and topical corticosteroid. Nivolumab administration was discontinued because anemia worsened together with elevated serum CRP levels despite improvement in diarrhea. He subsequently developed constipation and abdominal bloating, following further treatment for 4 months. CT revealed intestinal tumor-induced intussusception, necessitating partial resection of the small intestinal tumor, which was histopathologically diagnosed as metastases. Both anemia and elevated CRP improved postoperatively. Currently, all metastatic lesions other than the resected intestine have continued to respond to treatment over 12 months after initiation of nivolumab plus ipilimumab therapy.

(Introduction) A known complication of the surgical treatment of benign prostatic hyperplasia (BPH) is bladder neck contracture (BNC). BNC is often treated using transurethral incision of the bladder neck (TUI-BN); however, there are few reports on the outcomes of TUI-BN. Therefore, we examined the outcomes of patients who underwent TUI-BN after transurethral prostate surgery. (Material and methods) We retrospectively examined 25 patients who underwent TUI-BN between February 2015 and January 2021 for the following: (1) patients' characteristics; (2) the time from transurethral prostate surgery to TUI-BN; (3) the trigger of BNC diagnosis; (4) surgical procedure of BNC repair/perioperative course; (5) micturition function immediately after TUI-BN; and (6) Postoperative outcomes. (Results) The median age of the patients was 77 years, and the surgical procedures for BPH were transurethral resection of the prostate (TURP) in four cases, transurethral resection in saline plasma vaporization of the prostate (TURisP) in nine cases, and transurethral enucleation with bipolar (TUEB) in 12 cases. The median time to onset of BNC symptoms was 364 days, and 18 patients (72%) were diagnosed within 2 years. The trigger of BNC diagnosis was urinary symptoms in 21 cases, of which 16 patients had exacerbation of urination. The median duration of the surgical procedure of BNC repair was 14 min, and the incisions most frequently used (in 44% of cases) were at the 4 o'clock and 8 o'clock positions. Transient stress urinary incontinence was observed as a complication in three cases. In the 4 o'clock and 8 o'clock incisions, the maximum urine flow rate improved significantly (11.1 mL/s perioperatively vs. 20.9 mL/s postoperatively; P=0.004). These symptoms improved in 16 of the 21 symptomatic cases, and the maximum urine flow rate improved significantly (P< 0.01). The median observation period after surgery was 170 days; eight postoperative patients were lost to follow up. There were two cases of recurrence. (Conclusions) BNC is likely to develop within 2 years after transurethral prostate surgery. In this study, the success rate of the initial TUI-BN was 92%, as reoperation was required in two cases; however, the overall prognosis was good.

(Objective) The etiology of acute epididymitis in children remains poorly understood. Several studies have demonstrated that urine tests are negative in the majority of children with acute epididymitis, and the condition is self-limiting. The need for radiological evaluation of the urinary tract in children with acute epididymitis is still debatable. The aim of this study was to describe clinical and imaging findings in children with acute epididymitis. (Methods) We identified 47 children with acute epididymitis at our institute between 2017 and 2021.We retrospectively reviewed their clinical features and radiological and laboratory data. All children underwent ultrasonography of the kidney and urinary tract. (Results) Median patient age was 9 years (range, 6 months-16 years) and 60% of the cases occurred between the ages of 7 and 12 years. Thirteen children (28%) had a past history of genitourinary malformations. The common malformations were hypospadias in eight children and bladder dysfunction in three. Ultrasound revealed no new urinary tract abnormalities in the remaining 34 children. Urinalysis were performed in 27 children, nine of whom (33%) had pyuria. Urine culture was positive in two children. Of the nine children with genitourinary malformations, eight had pyuria. All 18 children without genitourinary malformations had a negative urinalysis except for one patient (p< 0.0001). (Conclusions) Acute epididymitis is a common cause of acute scrotum in pediatric patients. In this study, one-third of acute epididymitis cases presented pyuria, and about 30% had a past history of genitourinary malformations. The presence of pyuria was associated with a past history of genitourinary malformations. For children with no previous genitourinary malformations, routine use of ultrasound for the detection of urinary tract abnormalities is questionable due to the low yield.

A 75-year-old man was being followed up at a nearby clinic for hypertension and chronic renal failure. The patient was referred to our department as abdominal ultrasound revealed a left renal tumor. Plain computed tomography (CT) showed a 50 mm complex renal cyst in the upper pole of the left kidney. Plain magnetic resonance imaging showed a cystic mass with numerous septa. Partial thickening of the septa was suspected, and the lesion was classified as Bosniak IIF or III. As the patient had renal dysfunction, regular imaging study of the tumor lesion was performed to determine the timing of surgery. In the following year, plain CT revealed a new renal tumor 20 mm in diameter located lateral to the known tumor, with the mass having a tendency to increase. The patient underwent a laparoscopic radical left nephrectomy after the introduction of hemodialysis. Histopathological examination revealed that the tumor located in the medial upper pole of the left kidney was a multilocular cystic renal neoplasm of low malignant potential and that the new tumor located lateral to the known tumor was fumarate hydratase-deficient renal cell carcinoma. Simultaneous occurrence of fumarate hydratase-deficient renal cell carcinoma and multilocular cystic renal neoplasm of low malignant potential in the ipsilateral kidney is extremely rare. We report our case with a review of the literature.

(Objectives)Factors related to prostate-specific antigen (PSA) recurrence, including PSA at 6 months after radical prostatectomy, were evaluated to determine if the postoperative follow-up period in the cancer regional alliances critical path could be individualized using a coordinated path. (Patients and methods)Among 352 patients who underwent laparoscopic radical prostatectomy at our hospital from May 2009 to June 2015, 331 who did not undergo preoperative hormone therapy were examined retrospectively. Cases with PSA < 0.01 ng/mL at 6 months after surgery (group A, n=209) were compared with those with PSA > 0.01 ng/mL at the same time point (group B, n=122). (Results)PSA recurrence was significantly higher in group B (n=21 (10.0%) vs. n=70 (57.4%), p< 0.001) and the time to recurrence was significantly shorter (44 vs.12.5 months, p< 0.001). In multivariate analysis within group A, the Gleason Grade Group (GGG) and extraprostatic extension in surgical specimens were predictors of PSA recurrence. In group A, all cases (n=30) of GGG1 in surgical specimens had no extraprostatic extension and no PSA recurrence. There were 90 cases of surgical specimens with GGG2 and no extracapsular infiltration, and only 4 of these cases had recurrence (4.4%). (Conclusion)The results of the study indicate that follow-up interval stratification is possible using the PSA level at 6 months after radical prostatectomy, GGG and extraprostatic extension in the surgical specimen.

We report a case of bladder cancer in a 54-year-old woman who underwent renal transplantation for chronic renal failure. Six years after the transplantation, she was diagnosed with muscle-invasive bladder cancer with multiple lung metastases. She received gemcitabine/cisplatin therapy for Stage IV bladder cancer, and the dose of the immunosuppressants was reduced to prevent adverse effects. Since lung metastatic lesions disappeared after four courses of chemotherapy and no new lesions were found, we performed radical cystectomy and right nephroureterectomy with ileal conduit construction. Although she was followed closely without therapy, multiple lung metastases appeared 6 months after the radical cystectomy. Gemcitabine/carboplatin therapy was administered, and the lung metastasis improved slightly until the end of the 4th course, but aggressive growth was observed after the 5th course. She switched to palliative treatment without requesting additional treatment and died of cancer 1 year and 9 months after total cystectomy.There is no evidence-based treatment strategy for advanced bladder cancer after kidney transplantation. It is necessary to recognize that the patient had renal dysfunction and was in an immunosuppressed state. Thus, it is crucial to select appropriate drug and surgical treatments for each patient.

(Purpose) This study examined the usefulness of positron emission tomography (PET) / computed tomography (CT) in the diagnosis of metastasis in patients with urothelial carcinoma. (Materials and methods) The subjects were patients who were newly diagnosed with urothelial carcinoma in our department on whom we performed CT and PET/CT to search for metastasis. (Results) The median age of the 92 subjects was 71 years, and bladder and upper tract urotherial cancer were underlying diseases in 41 (46%) and 51 (54%) patients, respectively. In 66 (72%) of the 92 cases, no metastasis was observed by CT, while PET/CT revealed metastasis in 9 (14%). The 57 (86%) patients in whom both CT and PET/CT showed no metastasis underwent radical surgery, while 2 patients (4%) exhibited pathological lymph node metastasis.Of the 26 patients in whom CT revealed metastasis, PET/CT showed no metastasis in 3 (12%), and the absence of pathological metastasis was confirmed in all patients. Of the 23 patients found to have metastasis in both CT and PET/CT, metastasis that could not be identified by CT was discovered by performing PET/CT in 10 (43%) patients.PET/CT showed significantly higher diagnostic accuracy than CT alone (p< 0.01), with sensitivities of 94.1% and 67.6%, specificities of 100% and 94.8%, and positive diagnosis rates of 97.8% and 84.7%, respectively. (Conclusions) PET/CT in patients with urothelial cancer revealed that metastases that cannot be diagnosed by CT alone are found at a significant frequency. Since these metastases can affect treatment choices in patients with urothelial cancer, PET/CT is considered to be useful in diagnosing patients with urothelial cancer.

(Objectives) This study aimed to evaluate the surgical outcomes and functional parameters of lower urinary tract and bowel symptoms in patients who have undergone robot-assisted sacrocolpopexy (RASC) due to pelvic organ prolapse. (Patients and methods) This retrospective study included 110 consecutive RASC cases in the urology department of Ageo Central General Hospital, Japan, from November 2020 to October 2021. The medical records of these patients were retrieved. Data on uroflowmetry, post-void residual urine test, and self-administered questionnaires on urination and defecation were assessed. (Results) The mean operating time was 146 min, and the estimated blood loss was 14.8 ml. The intraoperative, postoperative, and severe complication rates of cases classified as Clavien-Dindo grade IIIa or higher were 0%, 9.1%, and 0%, respectively. The maximum flow rate and post-void residual volume of urine significantly improved after the operation. Similarly, the quality of life (QOL) scores and overactive bladder symptom score (OABSS), as well as the responses for the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Urinary Distress Inventory-6 (UDI-6), significantly improved one month after the operation and were sustained for six months. On the other hand, the total scores from the Constipation Scoring System (CSS) and the subscales of the Patient Assessment of Constipation (PAC) -QOL worsened. These scores, except for those of the PAC-QOL satisfaction subscale recovered to the preoperative levels; the PAC-QOL satisfaction subscale scores significantly improved six months postoperatively. The rates of de novo overactive bladder (OAB), stress urinary incontinence (SUI), and constipation one month postoperatively were 8%, 33%, and 10%, respectively. (Conclusions) RASC was performed safely in our institution with acceptable postoperative lower urinary tract and bowel outcomes.

A 68-year-old female presented with macroscopic hematuria. Cystoscopy revealed a wide-based submucosal mass. Computed tomography revealed a 3.5 × 2.5-cm solitary mass situated from the trigone to the left lateral bladder wall and the left hydroureter and hydronephrosis. T2-weighted magnetic resonance imaging (MRI) revealed low intensity, and diffusion-weighed MRI showed increased diffusion without invasion. The bladder tumor was immediately resected transurethrally. Histological diagnosis of the tissue obtained by transurethral resection was extranodal marginal zone B cell lymphoma of MALT. Positron emission tomography-CT showed no lesions other than the bladder tumor. The patient was diagnosed with stage-IE lymphoma of the bladder (Ann Arbor classification). Radiotherapy was performed at the bladder and pelvis (30 Gy) with six courses of rituximab (375 mg/m²). No local or distant recurrence after a 48-month follow-up was noted.

Of the patients who have had artificial urinary sphincter (AUS) implantation, 30%-50% require reoperation because of recurrent stress urinary incontinence (SUI) or infection. The most common cause of recurrent postoperative SUI is the mechanical failure of the AUS. This case report describes AUS replacement without urethral manipulation after the mechanical failure of the AUS. A 63-year-old man underwent AUS implantation to treat severe SUI that developed after robot-assisted laparoscopic total prostatectomy. Intraoperatively during AUS implantation, the cuff was inflated under direct vision and the AUS was confirmed to work properly; however, SUI did not improve when the AUS was activated 7 weeks after surgery. Urethroscopy confirmed that the urethra was not contracted, and computed tomography indicated that the tube was not continuous with partially deflated pressure-regulating balloon (PRB). On reoperation, the tube was found to be disconnected at the intended point of connection. By refilling PRB and performing urethroscopy, we confirmed the PRB without leakage and good urethral cuff coaptation, respectively.The AUS replacement procedure was then completed with only the replacement of the control pump and reconnection of the tubing. After the surgery, AUS was immediately activated to confirm the improvement of SUI. After 3 months post-surgery, the patient have enjoyed urinary continence. If the defective part of the AUS system can be identified during replacement, the procedure can be completed with only partial replacement and without manipulation of the urethra, thus avoiding the risk of urethral injury.