Acta Urologica Japonica最新文献

A 62-year-old female was referred to our hospital for further evaluation of a right renal mass. Contrastenhanced computed tomography (CT) revealed a 36 mm solid mass in the middle portion of the right kidney with early enhancement and washout, leading to a preoperative diagnosis of right renal cell carcinoma (cT1aN0M0, stage I). The patient underwent robot-assisted partial nephrectomy (RAPN). Histopathological examination showed spindle-cell proliferation arranged concentrically around the blood vessels, and immunohistochemical staining was positive for calponin and α-SMA, confirming the diagnosis of myopericytoma. No recurrence or metastasis was observed during the six months of follow-up.

A 74-year-old male patient presented with painless enlargement of the right scrotum that had persisted for three months. His past medical history included a gastrojejunostomy for metastatic gastric cancer and laparoscopic right inguinal hernia repair. Tumor markers were negative. However, an ultrasound examination revealed a mosaic-patterned mass measuring 4 cm in diameter within the scrotum, while an enhanced mass within the right scrotum was shown by contrast-enhanced computed tomography, raising suspicion of a malignant tumor. Consequently, a right high orchiectomy procedure was performed. Following surgery, histopathological examination results showed nodules composed of proliferating fibroblasts and collagen fibers surrounding the affected testis, which included bundles of smooth muscle and bony fragments within. Mild chronic inflammatory cell infiltration, including lymphocytes, plasma cells, and eosinophils, was also noted extending from the perivascular region to the stroma. As a result, a diagnosis of paratesticular fibrous pseudotumor was determined. Findings obtained in the present case revealed a rare condition and indicate that paratesticular fibrous pseudotumor should be considered as a differential diagnosis when a testicular tumor condition is suspected.

Teratomas are broadly classified according to the presence or absence of germ cell neoplasia in situ (GCNIS), which is defined as neoplastic germ cell proliferation in the seminiferous tubules. Postpubertaltype teratoma is classified into a germ cell tumor derived from GCNIS, and it is malignant in adults. However, a prepubertal teratoma is classified as a germ cell tumor unrelated to GCNIS. It is common in children and has a benign course. We report a case in a 60-year-old man who had been aware of a nodule in his left scrotum for 15 years, and felt heaviness and pain from a few months before he visited a specialist. He visited a local urologist and was referred to our department under the diagnosis of a left testicular tumor in February 202X. In March 202X, he underwent a left high orchiectomy. A 12×5 mm white mass lesion was observed, and a pathological examination showed intestinal epithelial and bronchial epithelial structures. Additionally, no GCNIS was found in background seminiferous tubules. There was no amplification of chromosome 12 short arm as shown by the fluorescence in situ hybridization method. On the basis of these pathological findings, prepubertal-type teratoma was diagnosed in this patient.

We herein report two cases of obstructive pyelonephritis with hyperammonemia causing impaired consciousness. One patient was a 79-year-old female. She was admitted for impaired consciousness and hematuria. Computed tomography (CT) revealed left hydronephrosis and hydroureter indicating obstructive pyelonephritis and her ammonia in the blood was a high level of 208 μg/dl. Her consciousness did not change immediately but improved 10 days after ureteral catheterization. The other patient was an 88-year-old female. She was also admitted for impaired consciousness and hematuria. CT revealed right hydronephrosis and an ureteral stone causing obstructive pyelonephritis and her ammonia level in the blood was a high level of 133 μg/dl. Her consciousness did not change immediately but improved 7 days after ureteral catheterization. Hyperammonemia in patients with obstructive pyelonephritis is a rare entity that can be occasionally observed. In patients with prolonged impaired consciousness due to urinary tract infections, clinicians should consider the possibility of hyperammonemia.

Spinal cord injury (SCI) patients often develop erectile dysfunction and ejaculatory dysfunction, and prolonged post-injury time can be complicated by impaired spermatogenesis. To obtain sperm, penile vibratory stimulation, electroejaculation or testicular sperm extraction (TESE) are required, followed by cryopreservation of the spermatozoa. This is a large physical and financial burden for SCI patients who wish to have children. In this report, we describe a case in which conventional TESE was performed in an unmarried male SCI patient. The patient was a 32-year-old male who suffered a cervical subluxation in a traffic accident when he was 23 years old, resulting in sensory and motor paralysis of the lower half of his body and motor paralysis and contracture of his fingers. He was unmarried but wanted to preserve his sperm for future use. With the diagnosis of obstructive azoospermia, conventional TESE was considered necessary. However, due to the risk of autonomic hyperreflexia, general anesthesia was required. Conventional TESE under general anesthesia was performed and motile spermatozoa were obtained from one testis. The sperm was cryopreserved at a fertility clinic. The mean Johnsen's score of the tissue was 10.0. Since the patient was an unmarried male and the purpose of the procedure was sperm preservation for future use, Japanese medical insurance did not cover these examinations, hospitalization and surgery costs. The financial burden of performing TESE and sperm preservation in unmarried male SCI patients is considerable. Even if infertility treatment is covered by medical insurance in Japan, this is still an issue that should be considered.

An 81-year-old man presented to our hospital with left lower back pain. The computed tomographic scan revealed a retroperitoneal tumor with a heterogeneous contrast effect. Magnetic resonance imaging scan showed that the tumor was suspected to have invaded the left diaphragm, iliopsoas muscle, and pancreas, and an unclear boundary between the tumor and left kidney. Based on these findings, a left retroperitoneal sarcoma or renal carcinoma was suspected. A left retroperitoneal tumor resection, combined with left nephrectomy, was performed. A thoracoabdominal approach was chosen due to suspected diaphragmatic invasion and the need for an adequate operative field on the cephalic side of the kidney. The tumor was resected along with the left kidney, a portion of the diaphragm, and a portion of the iliopsoas muscle, without pancreatic resection. Pathological examination confirmed a dedifferentiated liposarcoma. No intraoperative or postoperative complications were encountered. Surgical resection with a negative surgical margin is crucial for the treatment of retroperitoneal liposarcoma. The thoracoabdominal approach provides excellent surgical exposure and allows for early vascular control. Although the thoracoabdominal approach is rarely used in urological surgery due to concern about the morbidity associated with violating the thoracic cavity, it can be performed effectively and safely for large or invasive retroperitoneal tumors in select cases requiring maximal surgical resection.

A 41-year-old woman who was diagnosed, with neurofibromatosis type 1 (NF1) in childhood, experienced significant fluctuation in blood pressure during cervical kyphosis surgery. Postoperative examination revealed a right pheochromocytoma, which was a large hypervascular tumor with a maximum diameter of 18 cm. The patient had a short stature and thoracic deformity associated with NF1, which posed a challenge in securing the surgical field in the upper abdomen during the resection procedure. Additionally, it was necessary to consider the vascular and bone fragility associated with NF1. A positioning simulation was performed in collaboration with other medical departments the day before surgery. On the day of the surgery, the patient was positioned in a magic bed, to allow for safe rotation. A wide surgical field was successfully secured by performing a thoracoabdominal opening with a midline upper abdominal incision and a diagonal incision at the 9th intercostal space. The intraoperative hemodynamics were stable, and the surgery was completed safely. The patient has been recurrence-free for approximately 2 years since the surgery. Patients with NF1 have various lesions that differ greatly from one individual to another, and each case requires an appropriate surgical approach.

Understanding renal artery tortuosity is important in urological surgery. The right renal artery normally runs dorsal to the inferior vena cava. In precaval renal artery, vascular anomaly, the right renal artery, branching from the abdominal aorta, runs ventral to the inferior vena cava. Furthermore, the precaval renal artery is often an accessory artery and rarely a single main artery. Preoperative identification of these anomalies is important for successful surgery. Herein, we report a case of 71-year-old woman who visited our department after right renal cancer was detected on computed tomography (CT) performed to investigate the sigmoid colon cancer. Per CT findings, the right renal artery ran ventrally to the inferior vena cava and was the single main artery. The right renal artery abnormality was confirmed preoperatively, and robot-assisted laparoscopic partial nephrectomy (RAPN) was completed without any major intraoperative complications. Approximately 25-40% of the renal arteries are estimated to run abnormally. Among these, the prevalence of a precaval right renal artery is estimated to be 0.8-5.0%, and most are collateral arteries. Furthermore, the precaval right renal artery rarely serves as the single main artery. This report aims to describe a case in which RAPN was performed safely in a patient with a single main artery, the precaval right renal artery, as the course of the right renal artery was known preoperatively.

A 64-year-old man was incidentally found to have a right renal tumor during a medical check-up. The tumor was diagnosed as renal cell carcinoma cT1aN0M0 by magnetic resonance imaging and computed tomography, and the left kidney was hypoplastic. Open partial nephrectomy was performed. Postoperatively, lung, stomach, and ipsilateral renal metastases were observed sequentially. By adjusting the dose of IFNα, the progression of cancer was controlled for 18 years while managing the side effects of IFNα. Despite the declining recommendation for IFNα in renal cancer practice guidelines, it may still be a viable treatment option in selected cases.

We report on the safety and efficacy of transcatheter arterial embolization (TAE) for renal angiomyolipoma (AML) cases treated at our facility. A retrospective analysis was conducted on 48 cases of AML treated with TAE at our hospital between 2014 and 2022. The median follow-up period for imaging was 24 months (0-145 months), and that for blood tests was 19 months (0-117 months). Preventive renal artery embolization was performed in 36 cases, and emergency renal artery embolization was performed in 12 cases. The overall complication rate associated with embolization was 75% (36/48 cases), but there were no postoperative complications of Clavien-Dindo classification grade III or higher except for one case with blood transfusion, and there was no difference between the two groups. Renal function was evaluated by eGFR, and there was no difference in renal function changes before and after embolization between the two groups. Tumor reduction was observed in all cases, with no difference in tumor reduction effect. Reembolization was required in three cases after emergency renal artery embolization. TAE for rupture prevention significantly reduced rupture due to marked tumor reduction and did not result in a significant decline in renal function. Emergency TAE requires a prompt response and is more challenging, making the timing of preventive treatment crucial. With the improvement of embolic materials and techniques, the safety and efficacy of TAE have been increasing in facilities where TAE is feasible.