Acta Urologica Japonica最新文献

Diagnosis of upper urinary tract urothelial carcinoma (UTUC), based on imaging findings and urine cytology is often difficult. In this study, we have evaluated the preoperative imaging findings, voided urine cytology, and selective urine cytology in patients with suspected UTUC, who underwent laparoscopic radical nephroureterectomy (LRN). Cases of benign postoperative pathological findings are also reported. Among the 195 patients who underwent LRN between October 2010 and November 2023, 182 patients were included in this study. Simultaneous radical cystectomies and malignant tumors other than urothelial carcinoma were excluded. Most of the cases (137 cases (75.3%)) were classified as class III or less, based on voided urine cytology and 88 cases (48.4%) were classified as class IV or more based on either voided urine cytology or selective urine cytology. Ureteroscopy was performed in 40 cases (22.0%). The four patients who had undergone LRN without malignant findings had not undergone ureteroscopy. Pathological findings indicated normal urothelium in two patients, inflammatory scar in one patient, and amyloidosis in one patient. Accurate preoperative diagnosis requires pathological examinations such as natural urine cytology and selective urine cytology, computed tomographic urography, retrograde pyelography, and ureteroscopy if necessary.

We report a case of small bowel metastasis from renal cell carcinoma (RCC) in a woman in her 70s. In 20XX, she underwent a laparoscopic left nephrectomy for left-sided RCC (pT3bN0M0). Three and a half years later, she presented to the emergency department with recurrent vomiting. Contrast-enhanced computed tomography (CT) revealed a suspected small bowel tumor with intussusception and associated lymphadenopathy. Laparoscopic partial resection of the small intestine was performed, and pathological examination confirmed metastatic RCC in both the small bowel and regional lymph nodes. One month later, positron emission tomography-computed tomography (PET-CT) showed increased uptake in the mesenteric lymph nodes, suggesting residual disease. As a result, systemic therapy with ipilimumab and nivolumab was initiated. After four cycles of treatment, follow-up imaging demonstrated complete resolution of the residual lesions. Isolated small bowel metastasis from RCC, which was observed in this case, is relatively rare.

The incidence of lower urinary tract injuries associated with vaginal delivery is 0.03-0.05%, and reports of urethral injuries related to vacuum delivery are also extremely uncommon. We report a case of urethral injury in a 29-year-old woman during her first pregnancy and delivery due to vacuum extraction. The urethral injury occurred in continuity with a vaginal laceration on the opposite side of the midline episiotomy. A cystoscopy performed after urethral repair did not reveal the left ureteral orifice. Further examination revealed that the left kidney was not identifiable on ultrasound, and no accumulation was observed on DMSA renal scan. Cystoscopy revealed an irregular image of the left anterior vaginal wall, suggesting the presence of a Gartner's duct cyst, while vaginal contrast imaging showed a ureter-like luminal structure emerging from the left vaginal wall. These findings raised the possibility that the ureter from the left kidney opened into the Gartner's duct cyst, rendering it non-functional and that the weakness of the vaginal wall due to the Gartner cyst contributed to the urethral injury.

A 50-year-old man with cerebral palsy presented to our department complaining of pollakiuria and macrohematuria. Although urinary cytology revealed no positive findings, computed tomography (CT) showed muscle-invasive bladder carcinoma and right intrapelvic lymphadenopathy (cT3bN1M0). Cystoscopy revealed a large non-papillary bladder tumor. Radical cystectomy and urinary diversion were performed. Verrucous carcinoma (VC) of the bladder without intrapelvic lymph node metastasis (pT3bN0) was diagnosed histopathologically. VC is often locally invasive and is a non-metastasising well-differentiated variant of squamous cell carcinoma. Patients with cerebral palsy have a high incidence of urinary incontinence, dysuria, and urinary tract infections. VC of the bladder is associated with chronic bladder irritation due to various causes, including chronic cystitis, dysuria, and bladder stones. VC is frequently detected as locally invasive disease of stage T3 or higher ; the only effective treatment is radical cystectomy. Therefore, early detection and surgery are necessary to improve prognosis. Clinical evaluation, including urodynamic studies, is recommended for patients with cerebral palsy, and in cases of persistent pollakiuria, dysuria, and macrohematuria, abdominal CT and cystoscopy should be considered for the early detection of squamous cell carcinoma and VC of the bladder.

The patient was a 53-year-old female. She came to our department with a chief complaint of gross hematuria. A bladder tumor was found, and a diagnosis of amyloidosis was made by transurethral resection of bladder tumor. She had a history of bladder-limited amyloidosis and was diagnosed with recurrent localized amyloidosis of the bladder, and was treated with dymethyl sulfoxide occlusive dressing technique, which was effective.

A man in his 50s with an intellectual disability underwent a cystostomy for neurogenic bladder, followed by regular catheter exchange. Eighteen years later, the patient developed hematuria. Computed tomography and cystoscopy revealed a bladder tumor despite negative urinary cytology. Transurethral resection of the tumor confirmed the diagnosis of squamous cell carcinoma. Radical cystectomy was performed due to muscle invasion. Histopathological analysis revealed a pT3aN1M0 squamous cell carcinoma. No adjuvant therapy was administered, and the patient has remained recurrence-free for seven years postoperatively.

This study investigated the factors that contribute to surgical satisfaction in robot-assisted radical prostatectomy (RARP). We assessed a total of 208 patients who underwent RARP for prostate cancer between May 2020 and April 2022 and completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. The EPIC questionnaire was evaluated in the first and second year after surgery. We examined how treatment outcomes, such as urinary continence, sexual function, resection margins, and PSA recurrence, were associated with patient satisfaction. In the first year, 22, 52, 21, 3, and 2% of the patients were very satisfied (5 points), satisfied (4 points), neither satisfied nor dissatisfied (3 points), dissatisfied (2 points), and very dissatisfied (1 point), respectively ; the corresponding patient satisfaction in the second year was 24, 46, 27, 1, and 2%. Urinary continence was a significant factor contributing to patient satisfaction in the first and second postoperative years. Other outcomes were not statistically associated with patient satisfaction in the first or second year. In conclusion, postoperative urinary continence was the most significant factor contributing to patient satisfaction.

The patient was a 56-year-old woman who had previously undergone living-donor kidney transplantation, followed by urinary diversion surgery due to recurrent pyelonephritis. Nine years after the urinary diversion, abdominal computed tomography performed for evaluation of lower abdominal pain revealed a renal calculus in the transplanted kidney. Percutaneous nephrolithotomy resulted in satisfactory stone fragmentation, but had to be performed again 14 months later to remove a residual stone that had increased in size.

Rezum® water vapor therapy is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that utilizes sterile water vapor injections into the prostate to achieve tissue ablation. This study evaluates the real-world efficacy and safety of Rezum® in managing catheter-dependent urinary retention in a multimorbid patient population. A prospective, single-center study was conducted involving 34 consecutive patients with catheter-dependent urinary retention treated with Rezum® between 2022 and 2024. Patient demographics and procedural characteristics were documented. Post-treatment outcomes, including adverse events, International Prostate Symptom Score (IPSS), quality of life (QO), overactive bladder symptom score (OABSS), post-void residual volume (PVR), and prostate volume, were analyzed. Among the 34 patients, with a mean age of 80.6 years, 33 (97%) achieved spontaneous, catheter-free voiding following the procedure. Symptomatic improvements were noted, with post-treatment mean scores of IPSS at 5.9, QOL at 1.5, and OABSS at 4.1. PVR decreased significantly from 801 ml to 45.2 ml (94% reduction), and prostate volume was reduced from 54.6 ml to 34.7 ml (36% reduction), both with statistical significance (p＜0.01). Adverse events were mild and infrequent, including gross hematuria in 9% and febrile urinary tract infections in 3%. Rezum® represents an effective and safe minimally invasive therapeutic option for catheter-dependent patients. This novel technique is particularly advantageous for individuals at heightened risk of bleeding or those deemed high-risk for anesthesia.

A woman in her 60s underwent a left nephrectomy in 2007 after being diagnosed with left renal cell carcinoma. In 2020, computed tomography (CT) revealed pancreatic metastasis, and subsequently axitinib therapy was initiated. However, axitinib therapy was discontinued due to hand-foot syndrome and nivolumab therapy was initiated in 2021. Follow-up CT scans indicated the progression of pancreatic and lymph node metastases, prompting the initiation of pazopanib therapy. Twelve days after the initiation of pazopanib therapy, she was admitted to our department with complaints of fever, fatigue, and skin rash. She was hospitalized with suspected drug eruption, drug-induced liver injury, and infection. Her symptoms improved with discontinuation of pazopanib, and antibiotic treatment; however, on the 8ᵗʰ day of hospitalization, she experienced lower limb weakness. On the 16ᵗʰ day, blood tests revealed markedly elevated creatine kinase (CK) levels (26, 565 IU/l). Short tau inversion recovery (STIR) magnetic resonance imaging (MRI) revealed high signal intensity in the hamstring and adductor muscles, leading to the diagnosis of myositis. Consequently, pitavastatin treatment was discontinued. CK levels decreased promptly after the discontinuation of statin treatment, and limb weakness improved as well. Pitavastatin is transported from the blood into the liver via organic anion-transporting polypeptide 1B1 (OATP1B1) located on the hepatocyte surface. Previous reports have indicated that tyrosine kinase inhibitors, such as pazopanib, can inactivate OATP1B1, leading to an increase in the plasma concentration of statins. In the present case, myositis was considered to have resulted from a drug-drug interaction between pitavastatin and pazopanib.