Acta Urologica Japonica最新文献

In patients with an indwelling Foley catheter, pubic hair may be introduced into the bladder. This is believed to occur because the pubic hairs are pushed into the bladder during catheter replacement. However, compared withpatients on intermittent self-catheterization, patients withan indwelling Foley catheter have fewer chances of their pubic hair being pushed into the bladder. This suggests the presence of an alternate mechanism responsible for introducing pubic hair into the bladder during catheter replacement. We performed several experiments to identify this. In a urethral model created with a silicone tube and Foley catheter, a pubic hair was placed between the tube and catheter, and the catheter was moved forward and backward. We confirmed that the pubic hair moved only toward the hair root side. This motion was assumed to be the mechanism by which pubic hair is introduced into the bladder.

We report a case of testicular cancer after kidney transplantation in a 29-year-old man. Twenty-two years after the surgery, computed tomography (CT) showed a retroperitoneal mass 3 cm in diameter. Positron emission tomography (PET) -CT revealed high FDG uptake in both the right testis and retroperitoneal mass. Regarding serum tumor markers, α fetoprotein (AFP) was slightly elevated to 12.5 ng/ml. He underwent right radical orchiectomy, and pathological examination revealed pure seminoma. After surgery, the serum AFP level remained high (12. 9 ng/ml), and we initially considered this nonseminoma patient to have a good prognosis according to International Germ Cell Consensus Classification. During three cycles of a combination regimen including bleomycin, etoposide, and cisplatin (BEP), we performed adjustment of immunosuppressive therapy, treatment for Cytomegalovirus infection (valganciclovir hydrochloride), and that for other adverse events associated with systemic chemotherapy. The chemotherapy schedule was delayed, and bleomycin (third course, day 15) was skipped due to adverse effects. After 3 cycles of BEP, the retroperitoneal lymph node metastasis shrunk from 3.0 to 1.5 cm in diameter. In contrast to the good radiological response, the serum AFP level gradually increased during the treatment to 102.6 ng/ml. Therefore, we did not consider the AFP elevation to have derived from residual cancer, and decided to perform close follow-up. During the 3-year follow-up, AFP decreased to around 20 ng/ml, and PET-CT did not show any uptake in the retroperitoneal mass or other sites.

Congenital arteriovenous malformation (AVM) in the male pelvis is extremely rare. We present a case of this disease with massive bladder bleeding which caused severe hemorrhagic shock. Diagnosis of pelvic AVM was confirmed by computed tomography and angiography. He was treated with transcatheter arterial embolization of the bilateral internal iliac arteries. We discuss the clinical course and the treatment for AVM in this case, and review the literature.

A 79-year-old woman underwent radical cystectomy after neoadjuvant chemotherapy for urothelial carcinoma of bladder (high grade, pT3aN0M0). Six months later, a computed tomography scan revealed multiple lung metastases. Salvage treatment with chemotherapy and pembrolizumab was administered, and a complete response was achieved. Two years after surgery, however, a left adrenal mass appeared, and positron emission tomography／computed tomography showed significant solitary uptake in the left adrenal gland. She underwent left adrenalectomy and histological findings revealed that the adrenal tumor was a metastatic urothelial carcinoma. No new lesion was observed over one year after surgery. Surgical resection should be considered in cases with solitary metastasis who responded systemic treatment.

A 28-year-old man was diagnosed with chlamydial urethritis by his previous doctor and was prescribed minocycline (MINO). The result of a urinary chlamydia polymerase chain reaction (PCR) test later confirmed to be negative. However, the patient visited our hospital because of persistent miction pain. Upon arrival, pyuria was observed, and we suspected a relapse of chlamydial urethritis, and a single dose of 1,000 mg of azithromycin (AZM) was administered. Urinary gonorrhea/chlamydia PCR and urinary Mycoplasma genitalium (MG) PCR were performed, and only MG was positive. After diagnosis of MG urethritis, sitafloxacin (STFX) 100 mg for5 days, AZM 500 mg for3 days, and MINO 200 mg for7 days were prescribed, but urinary MG PCR did not become negative, and finally MG became negative after 14 days of STFX 100 mg was prescribed.

In 2021, Enfortumab Vedotin (EV) was approved for the treatment of locally advanced and metastatic urothelial carcinoma (UC) in Japan. Some patients require withdrawal or dose reduction due to cutaneous symptoms associated with EV treatment. Currently, the only reported associations of EV with cutaneous symptoms are pre-treatment performance status (PS) and body weight. However, no report has focused on the association between hematological factors and cutaneous symptoms. We retrospectively examined the occurrence of cutaneous symptoms and associated factors in patients who had been treated with EV for UC at Nagasaki University Hospital between February 2022 and June 2023. We evaluated the six patients with bladder cancer and three cases of upper urinary tract cancer. The median age was 73 [57-85] years. Seven patients had cutaneous reactions with EV treatment, and the median date of onset of the cutaneous symptoms was seven　[4 -28] days. PS was better inthe group with skinsymptoms compared with the group without (median : 1.0 vs 3.0), and in those with a higher incidence of eosinophilia or cutaneous symptoms on the previous regimen (71. 4% vs 0%). We suggested that the presence of eosinophilia or cutaneous symptoms at the time of pre-EV regimen administration may be a predictor of the appearance of cutaneous symptoms at the time of EV treatment. The limitation is that it is a single-center, small-case series, which does not allow for a rigorous statistical study.

A 26-year-old male presented to a hospital with complaints of hemoptysis and right scrotal swelling. Computed tomography (CT) revealed right testicular swelling, multiple lung metastases, and small intestinal wall thickening. The patient's β-human chorionic gonadotropin, alpha-fetoprotein, lactate dehydrogenase, and hemoglobin levels were 103.3 ng/ml, 20.8 ng/ml, 300 U/l, and 11.3 g/dl, respectively. He underwent high orchidectomy after being diagnosed with a testicular tumor and multiple lung metastases. Histopathological examination revealed a mixed germ cell tumor (60% choriocarcinoma, 20% seminoma, 10% embryonal carcinoma, 10% mature teratoma, and 1% yolk sac tumor). As the patient exhibited active gastrointestinal hemorrhage requiring frequent blood transfusions, gastrointestinal endoscopy was performed to investigate its cause. When upper and lower gastrointestinal endoscopies revealed no bleeding, the patient was referred to our hospital for further examination and treatment. A small bowel endoscopy revealed a hemorrhagic jejunal mass. Because endoscopic hemostasis was challenging, we partially resected the small intestine. Pathological findings in the resected lesion were consistent with small intestinal metastasis of the testicular tumor. The tumor markers turned negative after four cycles of BEP and four cycles of TIP chemotherapy. He then underwent resection of the remaining lung tumor, and no residual tumor or recurrence was detected one year later.

We retrospectively analyzed the regions and perioperative outcomes associated with lymph node dissection in patients with prostate cancer. Of 543 patients who underwent robot-assisted radical prostatectomy for prostate cancer with or without lymph node dissection according to the modified D'Amico criteria, 333 (61.3%), 128 (23.6%), and 82 (15.1%) were classified into the non-dissection, limited dissection, and extended dissection groups, respectively. Lymph node metastasis was identified in eight patients : one in the limited dissection group and seven in the extended dissection group. Notably, all eight biopsies showed Gleason scores of 4＋4 or higher, and the initial prostate-specific antigen (PSA) concentration was ≥10 ng/ml in seven of these patients. Lymph node metastasis was detected in areas other than the obturator lymph nodes in five patients (62.5%). Although there was no significant difference in the rate of Clavien- Dindo grade ≥II complications among the three groups, six patients (7.3%) in the extended dissection group developed infectious lymphoceles. In the extended dissection group, the PSA progression-free survival (PSA-PFS) was significantly shorter in patients with than in those without lymph node metastasis (p＜0.001). Because lymph node metastases were rare in the limited dissection group in our cohort of patients with a high risk of localized prostate cancer, achieving a diagnosis seems difficult with limited dissection. By contrast, in the extended dissection group, the PSA-PFS prognosis was significantly worse in lymph node-positive cases. Therefore, considering the high complication risk of lymphoceles, extended dissection should be performed in patients with a high likelihood of lymph node metastasis.

We carefully reviewed and evaluated the efficacy of transurethral water vapor energy therapy (WAVE) with Rezumᵀᴹ system for treatment of benign prostatic hyperplasia. Between April and September 2023, 41 patients received WAVE under local anesthesia as day surgery at the outpatient department in our institution. The mean age as of operation was 78.7 years, and mean estimated prostatic volume was 42.3 ml. The median total operative time was 2 minutes, median puncture number of time was 3 times, and median duration of urethral catheter day was 7 days. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, and maximum flow rate (Qmax) were assessed preoperatively and at 1 and 3 months postoperatively. In this evaluation, IPSS and QOL index improved significantly at 1 month postoperatively (IPSS : p＝0.023, QOL index : p＜0.001). Although Qmax was not significantly different between preoperative and 1 month postoperatively (p＝0. 167), a significant difference was shown at 3 months postoperatively (p＝0.006). Objective test findings such as Qmax required more than 1 month to improve. Subjective symptoms such as IPSS and QOL index improved in an early postoperative period. In conclusion, WAVE is an effective procedure for the treatment of benign prostatic hyperplasia.

A 50-year-old woman presented to our hospital in May2021 with a fever of approximately39 °C and abdominal pain. A contrast-enhanced computed tomography (CT) scan revealed an 88 mm right renal tumor. Two weeks later, a follow-up CT scan demonstrated rapid tumor growth, with the major axis measuring 100 mm. During this interval, her abdominal pain worsened, and she developed lower leg edema. A contrast-enhanced CT scan conducted 5 days before the scheduled surgery, four weeks after initial presentation, showed further tumor progression, with a diameter of 155 mm. The tumor, which had infiltrated the ascending colon, duodenum, liver, gallbladder, and inferior vena cava (IVC), was surgically removed along with the right kidney. Due to its complexity, the planned wide excision was deemed infeasible. Therefore, a tumor resection was performed macroscopically. Histopathological examination confirmed the diagnosis of undifferentiated pleomorphic sarcoma (UPS). Subsequently, the patient experienced a postoperative tumor recurrence. Although the patient received doxorubicin chemotherapy, she passed away5 weeks after the operation. This case highlights the critical importance of prompt surgical excision with adequate tumor margins in the management of UPS.