Acta Urologica Japonica最新文献

Metanephric adenoma is an extremely rare disease. We describe two cases of metanephric adenoma. Case 1 : A 17-year-old male adolescent developed gross hematuria, and urinalysis revealed positive protein and occult blood. He was referred to our department for further evaluation and likely tumor removal. Contrast-enhanced computed tomography (CT) showed a neoplasm (23 mm) with poor contrast effect during the early as well as the late contrast phase. Case 2 : A 61-year-old woman presented with an incidentally detected tumor in the lower pole of the right kidney ; contrast-enhanced CT revealed a large neoplasm (10 mm) with poor contrast effect during the early as well as late contrast phase. Both patients underwent robot-assisted partial nephrectomy (RAPN) under the preoperative diagnosis of papillary renal cell carcinoma. Metanephric adenoma is histopathologically indistinguishable from papillary renal cell carcinoma preoperatively, and histopathology and immunostaining are neceaasry for accurate diasnosis.

TA 51-year-old Japanese man presented with a history of percutaneous transhepatic portal veinembolization, right hepatic lobectomy for hepatocellular carcinoma, and left upper pulmonary lobectomy forpulmonary metastasis of hepatocellular carcinoma. Owing to the elevated tumor marker levels,ultrasonography and fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PETCT) were performed, which revealed a left renal tumor 24 mm in diameter with FDG accumulation ;accordingly, renal metastasis of hepatocellular carcinoma was diagnosed. Localized radiofrequencyablation (RFA) was scheduled due to the absence of metastases other than that in the left kidney. The tumorcould not be effectively visualized using ultrasonography immediately before RFA ; therefore, a CT scan wasperformed. CT revealed a hematoma around the left kidney resulting from the spontaneous rupture of a leftrenal tumor ; consequently, RFA was discontinued. A left nephrectomy was performed for radicaltreatment of the left renal tumor. The pathological diagnosis of the resected specimen was left renalmetastasis of hepatocellular carcinoma. This is the third reported case in Japan of spontaneous rupture of ametastatic renal tumor from hepatocellular carcinoma.

Recent advances in medical and nursing care have improved the prognosis of patients with severe motor and intellectual disabilities (SMID). However,there has been a proportionate increase in the incidence of malignant tumor-related deaths in this population owing to their prolonged survival. In this study,we reviewed the clinical characteristics of four bladder cancers in young SMID patients treated at our hospital. In all patients,a diagnosis of a bladder tumor was made after a referral from the family medical department to the urology department ; the median time from the first symptom to the diagnosis was 12.5 months (range : 0-17 months). In clinical staging,two patients had non-invasive cancer,while the other two had invasive bladder cancer (one patient with cN1). Radical cystectomy with ileal conduit was performed in three patients (pathological stages were pTa with CIS,pT3aN1,and pT3bN0),and transurethral bladder tumor ablation was performed in the fourth one. The median postoperative follow-up period was 134 months (range : 20-182 months). Three patients survived afterward,while one patient died due to other causes. These findings suggest that young SMID patients tend to have a more severe form of bladder cancer compared to the general young population. Therefore,complaints of gross hematuria and urinary symptoms in young patients with SMID need appropriate evaluation in cooperation with the family department for an early diagnosis.

We report a case of retroperitoneal abscess mimicking a malignant retroperitoneal tumor. A 77-yearold woman was referred to our hospital because of retroperitoneal tumor without any symptoms. The tumor was located just behind the inferior vena cava, and the tumor size was about 38 mm. The tumor showed no abnormal findings in positron emission tomography (PET) and 123I-MIBG scintigraphy. We considered the tumor as benign tumor or retroperitoneal cyst. Follow-up computed tomography (CT) 6 months after the first visit to our department showed no change in the tumor. However, 3months later, she presented with fever, general fatigue and back pain. CT scan at that time showed that the tumor had enlarged to about 70 mm, and the tumor seemed to have invaded into the inferior vena cava. Thrombus into the inferior vena cava was also found. These findings were suggestive of malignancy, so we decided to remove the tumor. During the operation, the tumor was removed together with the inferior vena cava and right kidney because of severe adhesion. The pathological diagnosis was retroperitoneal abscess. Retroperitoneal abscess is caused by various reasons including diabetes mellitus, steroid use, inflammatory disease of gastrointestinal tract and retroperitoneal organs. Although the etiology was unknown in the present case, acute infection of the preexisting retroperitoneal cyst was a possible cause.

There is a riskof positive resection margins (RMs) in patients who had undergone robot-assisted laparoscopic radical prostatectomy (RARP) following systematic prostate biopsies. This study examined the riskof positive RM post-RARP when magnetic resonance imaging-ultrasonography (MRI-US) fusion biopsy was performed along with systematic prostate biopsy. Sixty-one patients who had undergone MRI fusion biopsy and systematic transrectal and transperineal biopsies, followed by RARP, at our hospital between September 2020 and October 2023 were included. The median age was 61 years, and the median PSA level was 8.4 ng/ml. Although there was no significant difference between the two groups, the RM-positive group exhibited a significantly higher clinical stage. Of the 122 lobes of the prostate (including the right and left lobes), the RM-positive group (26 lobes) had a significantly higher proportion of positive transrectal biopsies of the internal and external glands of the 61 cases. Additionally, in the RM-positive group, the proportion of positive transperineal biopsies of the internal glands and the ratio of positive systematic biopsies were significantly higher. Logistic regression analysis of riskfactors linked to increased RM-positivity revealed that neurovascular bundle (NVB) preservation and positive target biopsy were not significant variables. However, systematic biopsies positivity rate was a significant riskfactor. Thus, the riskof RMpositivity was shown to be associated with the systematic biopsy positivity rate, which suggested that systematic biopsies may be necessary for evaluating the indications for NVB preservation.

A 75-year-old woman had suffered from intermittent gross hematuria. Ultrasonography, enhanced CT, cystoscopy and urinary cytology had no abnormal findings. Four months later, antibiotics were administered for recurrent gross hematuria and urinary frequency, and not effective. Then, a subcutaneous masson her buttock wasfound to be rapidly growing. The tumor waspathologically diagnosed asan adenocarcinoma by surgical resection. One month later, she had lower abdominal pain and the enhanced CT examination revealed right renal pelvic tumor. Laparoscopic nephroureterectomy was performed and the pathological diagnosiswaspoorly differentiated urothelial carcinoma with adenocarcinoma differentiation. Under the immunohistochemical analyses, the patient was diagnosed with renal pelvic tumor with subcutaneous metastasis. Chemotherapy was not effective for the rapid metastasis throughout the body, and the patient died 4 monthsafter the surgery.

Chronic testicular pain (CTP) is testicular pain that persists for more than 3 months, and the cause of the pain is often unknown, sometimes requiring differentiation from varicocele (VC). In this study, the shortform McGill pain questionnaire (SF-MPQ), which allows a detailed assessment of pain, was used to examine the clinical differences between CTP and scrotal pain due to VC. A retrospective study (IRB# : TeiRin21- 036) was conducted on 77 patients who visited our clinic between 2018 and 2022 with the chief complaint of scrotal pain. Of the 77 patients, 19 were diagnosed with CTP and 58 patients with VC. All patients were evaluated for marital status, smoking, alcohol consumption, body mass index, and duration of pain. In addition, comorbidities were assessed using the Charlson Comorbidity Index (CCI). All patients were asked to complete the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), and SF-MPQ. With respect to the patient background, the CTP group was significantly older than the VC group, had a higher percentage of married patients, and had higher CCI. Concerning pain assessment, the CTP group had significantly higher NRS and VRS than the VC group. In terms of pain sensation and character, the CTP group experienced significantly more throbbing, shooting, stabbing, sharp, burning, and tender pain than the VC group. Regarding, the emotional aspects of pain, they significantly felt the pain tiring- exhausting, sickening, fearful, and punishing-cruel. These results suggest that the SF-MPQ may be a useful questionnaire in the evaluation of CTP.

A 75-year-old female who was referred to our hospital with dizziness as the main complaint. Computed tomographic (CT) and positron emission tomography-CT scans indicated the presence of generalized lymphadenopathy and a 10 cm tumor in her left kidney. Further evaluation led to a diagnosis of Hodgkin’s lymphoma and left renal cell carcinoma. Due to her poor general condition secondary to the lymphoma, she was referred to our institution where chemotherapy was promptly initiated. After one year, metastases to the sternum and right hilar lymph nodes from the renal cancer were detected. Therefore, treatment for the lymphoma was discontinued, and combination therapy with Pembrolizumab and Axitinib for the renal carcinoma was started. Eight months after starting treatment for kidney cancer, the patient developed gastritis as an immune-related adverse event (irAE), which improved with high-dose steroid therapy. Subsequently, severe thrombocytopenia developed following the initiation of steroid therapy but improved upon discontinuation of Axitinib. Currently, treatment is ongoing with Cabozantinib without recurrence of either gastritis or thrombocytopenia.

The clinical practice manual for late-onset hypogonadism (LOH) was updated in 2022. This study analyzed the total and free testosterone levels of patients who visited our specialized hypogonadism outpatient clinic and examined the characteristics of patients eligible for androgen replacement therapy (TRT), using the 2007 guidelines and the new guidelines as references. Among a total of 770 patients that visited our clinic,11.9% (92/770) of the patients had total testosterone levels (＜250 ng/dl) that met the LOH diagnostic criteria of the new guidelines,and 39.2% (302/770) had free testosterone levels (＜7.5 pg/ml) that met the LOH diagnostic criteria. These patients represented 62.2% of the patients who underwent TRT,according to the 2007 guidelines. When patients who underwent TRT were divided into two groups depending on whether they met the diagnostic criteria in the new medical treatment guide,there was no significant difference in the subjective effectiveness rate of TRT and the improvement rate of Aging Males’Symptoms (AMS) score before and after TRT.

Upstaging to pT3a is rare after partial nephrectomy for cT1 renal cell carcinoma (RCC), and its prognosis is reported to be poor. Of 389 patients with cT1 RCC who underwent laparoscopic/robotic assisted partial nephrectomy between 2011-2022, 27 were diagnosed with pT3a. Upstage was observed in 3.6% of patients with cT1a and 19% with cT1b. The median preoperative diameter was 43 mm in the upstaged tumors. One local and five distant metastatic recurrences occurred during the median follow-up period of 59 months, with a median time to distant recurrence of 30 months. Fuhrman grade ≥3 was identified as a significant factor for distant metastatic recurrence. The metastasis-free survival, cancers pecific survival, and overall survival at five years postoperatively were 75. 7%, 96. 2%, and 88. 1%, respectively. Among the upstaged patients, those with higher Fuhrman grade should be carefully monitored for recurrence.