Acta Urologica Japonica最新文献

We report a case in which pyelolithotomy through a mini-pararectal incision was performed in a patient with right staghorn calculi for whom it was difficult to perform PNL/ECIRS. A 76-year-old woman with right staghorn calculi (60×30×30 mm; total stone volume, 51.29 ml) was admitted to our hospital. The patient had undergone left pelvic bone resection and left external iliac arteriovenous graft replacement for left pelvic osteosarcoma 25 years prior and subsequently required anticoagulant therapy. Anticoagulants were suspended, and heparin and the antibiotics were administered intravenously for three days before surgery. Right pyelolithotomy was performed through an 8 cm pararectal incision in the supine position. A T-shaped incision (5×3 cm) was made in the anterior wall of the renal pelvis and the entire stone was extracted. The operative time was 203 min. Blood loss was 95 g. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day. The patient successfully achieved stone-free status. This surgical procedure is a viable option in cases in which endourologic lithotripsy is difficult to perform.

Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) causes intense abnormal genital sensations without sexual stimulation. A 74-year-old woman visited our clinic with a tingling sensation in the clitoris. Six months earlier, she had felt lower abdominal discomfort, bladder pain, and abnormal genital sensations and visited the urologist at another hospital. She also had appetite loss, weight loss, and insomnia. A gynecologist diagnosed her symptoms as clitoral-related, but topical treatment was ineffective due to the pain caused by contact. During our examination, there was severe burning pain on clitoral palpation, and we suspected PGAD/GPD. Two weeks after administration of Sertraline, a selective serotonin reuptake inhibitor, her symptoms improved. However, since the effect weakened two weeks after starting treatment, the dosage was increased and her symptoms showed remission thereafter. Her symptoms improved after increasing the dosage. Tarlov cysts in the sacrum revealed by magnetic resonance imaging were considered as the potential cause of PGAD/GPD. Since her symptoms had improved and considering her age and surgical risk, the orthopedic surgeon we consulted recommended follow-up instead of surgery.

Small cell carcinoma (SCC) of the prostate has a poor prognosis. We present three cases of primary SCC of the prostate treated with amrubicin as second- or third-line chemotherapy. Case 1 : A 54-year-old male received cisplatin and irinotecan but showed metastatic progression. Amrubicin was initiated as second-line therapy, leading to tumor shrinkage. However, disease progression (PD) occurred in the ninth month, and he passed away 16 months after treatment initiation. Case 2 : An 82-year-old male treated with combined androgen blockade (CAB) later developed pelvic lymph node enlargement, and SCC was diagnosed. He received carboplatin-etoposide and then carboplatin-irinotecan. Amrubicin was given as third-line therapy but showed no significant response. He passed away 24 months after treatment initiation. Case 3 : A 68-year-old male treated with CAB developed M0CRPC and later distant lymph node metastases, confirmed as SCC. He received cisplatin-etoposide and then amrubicin as second-line therapy, achieving a partial response initially but experiencing PD in the fifth month. He passed away 36 months after starting treatment. Amrubicin may be a therapeutic option for primary SCC of the prostate, but achieving prolonged survival remains difficult.

We report two cases of bulbous urethral complete disruption treated by immediate anastomosis. Both patients were injured in traffic accidents and diagnosed with internal pudendal artery injury, perineal hematoma, and bulbous urethral complete disruption. We performed surgical hematoma drainage, perineal hemostasis, and end-to-end urethral anastomosis, which led to good voiding function after surgery. Immediate urethral repair might be an effective choice for selected cases of bulbous urethral disruption because of the short interval to spontaneous voiding and cystostomy catheter removal.

This study investigated the factors associated with the success of salvage radiotherapy (SRT) defined as PSA reaching less than 0.2 ng/ml without concomitant hormonal therapy after biochemical recurrence (BCR) following radical prostatectomy (RP). The study included 38 patients who underwent robot-assisted radical prostatectomy (RARP) and received SRT alone from 2015 to 2021. Patients with prior treatments, those who underwent hormonal therapy, patients whose PSA did not decrease to less than 0.2 ng/ml after RARP, and pN1 cases were excluded. The median age and PSA at the start of SRT were 68 years and 0.26 ng/ml, respectively, and positive surgical margins were observed in 14 cases (37%). The median follow-up time from the start of SRT was 36.1 months, and 52.6% of the cases achieved SRT success with SRT alone. Multivariate analysis demonstrated that pre-SRT PSA ＜0.25 ng/ml and positive surgical margins were significantly different between SRT success cases and non-SRT success cases.

A 73-year-old woman presented with a chief complaint of left-sided abdominal pain from the time of waking. She had a calcified lesion in the left kidney for at least 4 years, but as she was asymptomatic, a detailed examination was not performed. Owing to the sudden onset of left-sided abdominal pain, she visited her local emergency department, where left renal and ureteral stones were identified on computed tomography. She was then referred to our department. A diagnosis of calyceal diverticulum stone disease and associated stone street was made on the basis of retrograde urography and other tests. Transurethral lithotripsy was performed under general anesthesia. A soft ureteroscope was successfully inserted into the diverticulum, where numerous stones were found. After three sessions of transurethral lithotripsy, all stones were removed. The main stone component was calcium oxalate. In this case, it was considered that the 4-year-duration nephrocalcific lesion (calyceal diverticular stones) had drained rapidly from the diverticulum to form a stone street.

A 46-year-old woman presented to a local clinic complaining of discomfort in the right upper quadrant. Abdominal ultrasound revealed a right renal mass, and she was referred for further evaluation and treatment. Contrast-enhanced computed tomography showed a 54 mm right renal tumor and a 12 mm enlarged lymph node in the aortocaval region. She was diagnosed with right renal cell carcinoma, staged as cT1bN1M0. Laparoscopic right nephrectomy and lymph node dissection were performed, confirming the diagnosis of papillary renal cell carcinoma type 2, pT1bpN1. At nine months after surgery, she developed retroperitoneal recurrence with invasion of the second lumbar vertebra. Pembrolizumab combined with axitinib was initiated. After six months of treatment, she achieved a complete response with no detectable lesions. However, 17 months after the initiation of treatment, new multiple liver metastases appeared, and the response was classified as progressive disease. Second-line treatment with cabozantinib was started, leading to complete tumor regression after 16 months, with a complete response confirmed. She has maintained a complete response for 39 months since starting cabozantinib.

Foreign bodies in the lower urinary tract are occasionally encountered in clinical practice ; however, such cases are relatively rare in pediatric patients. We report a unique case in which a cord inserted through the urethra spontaneously knotted within the bladder, making its removal impossible. To our knowledge, this is the second reported case of spontaneous knotting of a cord in the bladder. A 14-year-old boy presented to the emergency department after inserting a USB cable into his urethra through the external meatus, subsequently failing to remove it. Imaging studies revealed a knotted cord within the bladder. The foreign body was surgically removed via open cystotomy by cutting the knotted portion. The postoperative course was uneventful, and the patient was discharged on postoperative day six.

We report a case of paratesticular rhabdomyosarcoma in a one-year and nine-months old male infant. The patient presented with an asymptomatic enlargement of the right scrotum. Ultrasonography indicated a solid mass 3 cm in size in the right scrotum. Computed tomography and magnetic resonance imaging revealed a right testicular tumor with no distant metastases. Serum lactate dehydrogenase, human chorionic gonadotrophin beta, and alpha-fetoprotein were within normal limits. Although surgical treatment was scheduled based on the diagnosis of the testicular tumor, the patient had a high fever with a viral infection, and the surgery was postponed. The tumor rapidly progressed to 7 cm in size within one month. High orchiectomy was performed, and histopathological examination confirmed a paratesticular rhabdomyosarcoma. The patient received adjuvant chemotherapy with vincristine sulfate, actinomycin D, and cyclophosphamide. There was no recurrence one year post-surgery. Paratesticular rhabdomyosarcoma commonly occurs in the paratesticular tissues of pediatric patients. This case highlights the importance of the differential diagnosis of paratesticular rhabdomyosarcoma other than testicular tumor for painless scrotal masses in infants and the requirement for multidisciplinary management in pediatrics.

The patient is an 80-year-old woman who initially underwent transurethral resection of a bladder tumor (TURBT) 7 years ago for bladder cancer at another hospital and was diagnosed with urothelial carcinoma (UC), high grade, pT1, followed by 8 cycles of intravesical BCG instillation therapy. Subsequently, her voiding urine cytology began to show suspicion of malignancy. When voiding urine cytology started to show positive findings, two transurethral biopsies of bladder mucosae and one selective upper tract urine cytology were performed with no evidence of malignancy, so she was followed up as an outpatient. She began experiencing spontaneous pain near the urethra and pain on urination 5 years after the initial TURBT. At this time, cystoscopy revealed redness on the posterior bladder wall. Additionally, redness of the vagina and induration of the labia were observed, raising suspicion of Paget's disease or Bowen's disease. She underwent a biopsy of the vulvar, which revealed UC. Ultimately, biopsies of the bladder, urethra, and vulvovaginal regions were performed at our hospital to determine a treatment plan. Immunohistochemical staining of the vulva was positive for cytokeratins 7 and 20 and negative for GCDFP15, confirming a diagnosis of extramammary Paget disease secondary to bladder CIS. As a result, the patient underwent radical surgery, including removal of the vagina, uterus, bladder, and labia. Pathological findings showed extensive CIS in the vagina and labia majora. Herein, we report a very rare case of secondary extramammary Paget disease extending from bladder CIS to the vagina and labia.