Acta Urologica Japonica最新文献

An 82-year-old woman previously underwent cystectomy and ureterocutaneous ureteral fistula for bacillus calmette guerin-resistant bladder cancer at the age of 70 years old in February 2012. Pathological examination revealed a pTisN0. In October 2020, the patient experienced vulvar itching and pain, which prompted her to consult a gynecologist. Vulvovaginitis was diagnosed, and the patient was observed. However, in June 2023, the vulvar itching persisted, prompting a biopsy for refractory erosions of the vulva. Paget cells were identified in the epidermis, and immunostaining (CK7 (＋), CK20 (＋), p63 (＋), GATA3 (＋), and GCDFP15 (-)) was used to diagnose secondary extramammary Paget's disease due to urothelial carcinoma. Magnetic resonance imaging revealed a 25 mm mass in the pelvic floor, and a biopsy showed the same immunostaining pattern as the skin lesion. Consequently, a diagnosis of local recurrence 11 years after cystectomy and associated secondary extramammary Paget's disease was established. Owing to the evidence of invasion of the mass into the levator ani muscle, she underwent laparoscopic rectal resection plus combined resection of the tumor, perineum, and levator ani muscle in October. Currently, she is 3 months postoperatively without evidence of recurrence.

A urination care team comprising professionals from various fields was developed. This team intervened during hospitalization of patients who were either expected to have voiding disturbances following the removal of indwelling urinary catheters or develop voiding disturbances following catheter removal during hospitalization. The team aims to remove unnecessary indwelling urinary catheters and promote patient independence during urination. However, if patients do not achieve spontaneous micturition or clean intermittent self-catheterization (CISC) during their hospital stay, an indwelling urinary catheter is reinserted. In this study, risk factors for indwelling urinary catheter reinsertion were retrospectively analyzed during hospitalization. In total, 98 patients from January 1, 2018, to December 31, 2020, were examined at Kyoto Katsura Hospital, where the urination care team intervened due to voiding disturbances with residual urine of ≥100 ml. At discharge, 46 (46%) patients were able to urinate independently, 9 (9%) were voiding through a diaper, 14 (14%) practiced CISC, and 29 (30%) had indwelling urinary catheters. Multivariate analysis revealed that age ≥75 years (p＝0.03), a cognitive functional independence measure (FIM) score of ≤25 on admission (p＜0.01), and residual urine of ≥300 ml at intervention (p＝0.03) were independent risk factors affecting the indwelling urinary catheter reinsertion. The indwelling urinary catheter non-reinsertion and reinsertion groups demonstrated significant improvement in the FIM total and motor scores between admission and discharge ; however, the FIM cognitive score did not show any statistically significant difference.

With the ageing of the population in Japan, an increasing number of elderly prostate cancer patients will require treatment. However, the elderly often have comorbidities, which can make treatment decisions for prostate cancer patients difficult. Therefore, we investigated prostate cancer deaths and risk factors among patients aged 80 years or older at diagnosis of prostate cancer at our hospital. Of 532 prostate cancer cases diagnosed and treated at our hospital between January2011 and December 2018, 90 cases were included. The median observation period was 54 months and 13 (14.4%) patients died of prostate cancer. The overall 5-year cancer-specific survival rate was 86.7%, with M1 (47.1%) and GS≥9 (71.9%) as significant risk factors on multivariate analysis. Patients with metastatic prostate cancer, even those older than 80 years, should be cautiously started on treatment after explaining to the patient and family that the chance of prostate cancer death is not low. Even in patients with localized prostate cancer, four out of 45 (8.9%) high-risk prostate cancer patients died of prostate cancer, suggesting that curative treatment is an option, depending on their life expectancy.

Transurethral lithotripsy (TUL) using holmium YAG laser has become the standard treatment for kidney stones. Mosesᵀᴹ technology, which delivers the laser with less energy loss, has been introduced and is reported to have advantages over regular laser in terms of shorter operation time and lithotripsy efficiency, but there are few reports from general hospitals. We retrospectively compared the perioperative and postoperative outcome, and complications of 28 cases of TUL using Mosesᵀᴹ mode performed from August 2021 to January 2023 at our hospital, and 25 cases of TUL using regular laser from August 2020 to July 2021. The median stone size was 11.9 and 10.9 mm, the median operation time was 103 and 105 minutes, and the 3-month stone-free rate was 88. 0 and 95.8% for Mosesᵀᴹ mode and regular laser, respectively. No significant difference was observed in the operation time. There was no difference in stone-free rate or complications either. The Mosesᵀᴹ mode group had significantly more cases of ureteral stent removal on the day after placement. In evaluating stone retropulsion on a 4-point scale, Mosesᵀᴹ mode cases showed significantly less retropulsion. TUL using Mosesᵀᴹ mode could be a useful option for treatment of kidney stones.

A 74-year-old woman with no history of trauma visited our hospital with right-sided abdominal pain and general malaise. Blood tests revealed elevated inflammatory markers. A computed tomography (CT) scan revealed a 8 cm mass and subcapsular hematoma on the lower pole side of the right kidney. She was diagnosed with a malignant tumor or renal abscess combined with subcapsular hematoma and inflammation and was treated conservatively with antibiotics. The symptoms quickly improved. Although kidney biopsy was performed, no obvious malignant cells were found. Since a subsequent CT scan could not exclude the possibility of kidney cancer, radical nephrectomy was performed. The histopathological diagnosis was clear cell renal cell carcinoma. She has not experienced recurrence within 10 months after the surgery. Clear cell renal cell carcinoma combined with subcapsular blood is relatively uncommon and can be difficult to diagnose, requiring careful decision-making regarding treatment indications.

A 65-year-old man with dysuria was referred to our department with a prostate-specific antigen concentration of 145.6 ng/ml. Unenhanced T2-weighted magnetic resonance imaging showed high signal intensity mainly in the right lobe of the prostate and a mass lesion with a mucus component. Contrastenhanced magnetic resonance imaging showed a progressively increasing contrast effect in the same region. Prostatic biopsy was performed, and histopathology revealed a Gleason score of 4＋3＝7, and a diagnosis of mucinous carcinoma of the prostate, stage cT3bN0M0. The patient underwent robot-assisted laparoscopic total prostatectomy and enlarged lymph node dissection. Pathological analysis confirmed mucinous adenocarcinoma of the prostate, with a Gleason score of 4＋3＝7, EPE1, RM0, ly1, v0, pn1, sv0, n1 (1/22). The final pathological diagnosis was prostate mucinous carcinoma, pT3aN1M0, and strict post-operative two-year follow-up resulted in no biochemical recurrence (prostate-specific antigen concentration was 0.001 ng/ml). The results suggest that surgical treatment may provide a good prognosis in high-risk prostatic mucous carcinoma.

A 51-year-old female patient developed multiple crizotinib- associated renal abscesses in her left kidney. She noticed a swellingof the right supraclavicular node in June, 202X. She visited a clinic and a blood test showed an elevated carcinoembryonic antigen. She was referred to our hospital and underwent computed tomography (CT) which revealed nodules in her right lung, mediastinum, and right supraclavicular lymph node. After thorough examination, the patient was diagnosed with metastatic lung adenocarcinoma. She had a ROS-1 gene mutation ; thus, treatment with crizotinib was recommended. After the initiation of crizotinib in October, 202X, routine CT showed a complete response. No further CT findings were observed until April, 2 years after 202X, when a polycystic lesion in the left kidney was observed. In August, 3 years after 202X, she complained of high fever and presented to our hospital. Her blood test showed a high c-reactive protein (CRP) levels ; therefore, she was admitted and received levofloxacin drip infusion for 5 days. However, the CRP level was elevated, and she underwent CT, which revealed a significant increase in the size and number of left polycystic lesions. She was diagnosed with multiple left renal abscesses and underwent a percutaneous left renal abscess puncture. Despite continued percutaneous drainage and antibiotic infusion, the high fever and elevated CRP level persisted. Therefore, she underwent left open nephrectomy. Pathology of the left kidney revealed a renal abscess, but there was no sign of malignancy. Crizotinib has been reported to cause rare adverse effects, such as polycystic renal lesions or renal abscesses.

A 54-year-old woman underwent retroperitoneal laparoscopic nephrectomy for a non-functional left kidney due to ureter stone in September 2022. She was operated without problems. Seven hours postoperatively, she complained of chest pain with a distressed facial expression. Electrocardiogram findings were negative for coronary artery disease, and echocardiography was negative for major pulmonary thromboembolism. Computed tomography showed emphysema and pneumomediastinum. The chest pain gradually resolved over time and was eventually diagnosed with pain due to pneumomediastinum. The subsequent clinical course was uneventful and she was discharged without complications on the 10th postoperative day.

A 68-year-old male was referred to our hospital because plain computed tomography (CT) showed right hydronephrosis. Contrast-enhanced CT revealed a mass with an irregular margin and poor contrast effect in the lower pole of the right kidney, which invaded the perirenal fat tissues and the area around the inferior vena cava (IVC). Moreover, a thrombus extending from the right renal vein to the IVC was detected, some of which was suggestive of tumor components on contrast-enhanced magnetic resonance imaging (MRI). Biopsy of the renal pelvic mucosa revealed urothelial carcinoma, which was diagnosed as cT4N0M0 renal pelvic cancer. After five courses of neoadjuvant chemotherapy with gemcitabine plus carboplatin, the patient underwent right nephroureterectomy. To avoid tumor cell dissemination into the abdominal cavity, we removed the thrombus and a portion of the IVC were removed en bloc with the right kidney without opening the vein. On pathological diagnosis, the renal tumor was identified as high-grade urothelial carcinoma with sarcomatoid features and squamous differentiation. The tumor invaded the IVC wall through perirenal fat tissues and further developed into a mass in the lumen of the vein. Although the patient was treated with nivolumab as a postoperative adjuvant therapy, he developed liver metastases and local recurrence on the right psoas muscle 6 months after surgery and is currently receiving chemotherapy with enfortumab vedotin.

Cutaneous ureterostomy (CU) is the most simple and safe method of all permanent urinary diversions, but is associated with a risk for stomal obstruction. It is important to appropriately manage hydronephrosis associated with CU. We evaluated the occurrence of stomal obstruction after CU by 99m Tcmercaptoacetyltriglycine (MAG3) diuretic renography three months after surgery. CU was performed after radical cystectomy in 46 patients (90 renal units,RUs) with a minimum follow-up period of 12 months, including 39 men and seven women. The median follow-up period was 102.1 months. The data analyses were performed with half-times to tracer clearance (T1/2) following furosemide administration. The mean T1/2 was 8.45±8.04 minutes. Seventy-five RUs (83.3%) had T1/2 of less than 15 minutes,and 74 (98. 7%) out of 75 RUs had no hydronephrosis. Ten RUs (11.1%) had T1/2 of more than 20 minutes,and all 10 RUs required stent insertions (six RUs) or became atrophic kidneys (four RUs) without the stent insertion. In conclusion,MAG3 diuretic renography was very useful for diagnosing stomal obstruction after CU. T1/2 of less than 15 minutes could be judged as non-obstructive systems,and T1/2 of more than 20 minutes could be judged as obstructed systems. T1/2 between 15 and 20 minutes indicate equivocal studies. Therefore,we recommend the immediate stent insertion in RUs with T1/2 of more than 20 minutes three months after surgery.