Acta Urologica Japonica最新文献

Late-onset hypogonadism syndrome causes various symptoms in middle-aged and older men due to testosterone deficiency. However, there are few reports on its relationship with lower urinary tract symptoms (LUTS). We investigated changes in urinary symptoms in patients treated with androgen deprivation therapy (ADT) for prostate cancer. This retrospective study included 38 patients who underwent ADT prior to low-dose-rate brachytherapy for low-risk prostate cancer and had no LUTS before treatment at our hospital. The median duration of ADT was 4 months. Prostate volume significantly decreased after ADT (P＜0.001), while the total International Prostate Symptom Score (IPSS) showed a tendency to worsen (P＝0.053). When IPSS was divided into voiding and storage symptom scores, there was no significant worsening in the voiding symptom score (P＝0.29) ; however, there was a significant worsening in the storage symptom score (P＝0.011). In addition, we observed a significant increase in urinary frequency at night (P＝0.009) and a significant worsening of the Overactive Bladder Symptom Score (P＝0.035). Thus, we suggest that short-term ADT may reduce prostate volume ; however, it may also lead to LUTS, particularly urinary storage symptoms.

A 73-year-old man presented with asymptomatic macroscopic hematuria. Contrast-enhanced computed tomography revealed a mass filling the right renal pelvis, along with a 2cm cystic tumor in the dorsal aspect of the right upper pole. A retroperitoneoscopic nephroureterectomy was performed based on the diagnosis of right renal pelvic carcinoma. Pathological diagnosis confirmed that the right renal pelvic mass was an invasive urothelial carcinoma, classified as G2 with INFa, pT1, ly0, and v0, while the cystic tumor was a chromophobe renal cell carcinoma, classified as G2 with INFb, pT1a, and v0. No postoperative chemotherapy was administered. The patient's recovery was uneventful, and, seven years after the operation, he remains alive with no signs of recurrence or metastasis.

A woman in her 40s underwent transurethral resection of bladder tumor in September X-2 followed by preoperative chemotherapy for muscle-invasive bladder cancer. She later had robot-assisted radical cystectomy with neobladder cystostomy in February X-1. In July X-1, computed tomography revealed metastasis in the right pulmonary apex and right upper mediastinal lymph node, and a partial resection of these sites was performed. Based on the pathological results, the patient was diagnosed with bladder cancer metastasis. Pembrolizumab was started in December X-1 ; however, right upper mediastinal lymph node enlargement was noted in October X, with progressive growth. In December X, the patient visited her primary care physician due to amnesia and decreased attention. Magnetic resonance imaging (MRI) revealed abnormal signal areas in the right temporal pole and the medial portions of both temporal lobes. Her symptoms worsened after a week, prompting steroid pulse therapy for suspected limbic encephalitis. Although her brain MRI revealed some improvement, her symptoms persisted. Repeated steroid pulse therapy had no effect. Following intravenous immunoglobulin, the patient's symptoms and MRI findings improved. Based on these findings, she was diagnosed with limbic encephalitis due to bladder cancerassociated paraneoplastic neurological syndrome.

A 37-year-old man with a history of chronic myeloid leukemia presented to our hospital with fever and right scrotal pain. Computed tomography (CT) revealed subcutaneous fluid in the soft tissues of the scrotum and penis. His white blood count was 3,700/μl and C-reactive protein (CRP) was 44.66 mg/dl. Broad-spectrum antibiotics were subsequently administered. The following day, the patient was diagnosed with disseminated intravascular coagulation (DIC) and showed necrotic changes in the skin of the penis and scrotum along with erythema and tenderness extending to the left flank. This led to the diagnosis of Fournier's gangrene. The patient underwent emergency debridement and right scrotal content excision and was managed in the intensive care unit. The patient recovered from DIC 2 days after the surgery, underwent wound closure and skin grafting 29 days after the first surgery, and was discharged 43 days after the first surgery. Later, an analysis by the National Institute of Infectious Diseases revealed that the causative pathogen was the M1UK strain.

A 67 year-old man consulted an urologist with the chief complaint of gross hematuria and discomfort in the urethral region. He was later diagnosed with malignant melanoma by transurethral biopsy. Urethrocystoscopy revealed lesions 3 cm peripherally from the sphincter muscle, and TUR of the urethra to the bladder neck revealed no malignant lesion in the prostatic area, urethra, or bladder. Radical penectomy was performed and the histopathologic diagnosis was pT2 malignant melanoma with negative urethral resection margins. At 9 months postoperatively, there was no evidence of recurrence or metastasis. Primary malignant melanoma of the urethra is an extremely rare disease with a poor prognosis for which no effective treatment has been established other than surgical resection. We report this case with discussion of the literature.

Primary follicular lymphoma of the prostate is extremely rare, with this case representing only the 13th reported in the English literature. This report includes a review of the literature and details of a case in a 75-year-old male with concurrent primary follicular lymphoma and adenocarcinoma of the prostate. The patient was referred to our department due to prostate enlargement observed on CT and complaints of a decreased urinary stream. His PSA level was elevated at 8.9 ng/ml. MRI showed a PI-RADS category 4 lesion in the right peripheral zone of the prostate, with an estimated prostate volume of 60 ml. A transrectal prostate biopsy identified adenocarcinoma in two cores from the right base and one from the left apex, leading to a diagnosis of prostate cancer cT2aN0M0. Subsequently, the patient underwent robotic-assisted laparoscopic radical prostatectomy. Pathological findings confirmed adenocarcinoma in the right and left lobes (pT2a, pN0, EPE0, SV0, LVl1, RM0) and identified concurrent primary follicular lymphoma within the anterior fibromuscular stroma, which was positive for CD20, CD10 and Bcl-2. A complete clinical investigation, including an 18F-fluorodeoxyglucose positron emission tomography scan and bone marrow biopsy, revealed no involvement of other sites, and the patient was ultimately diagnosed with Ann Arbor stage IE lymphoma. No additional treatment was administered, and the patient has been followed up regularly. At six months postoperatively, there was no evidence of recurrence of either prostate cancer or lymphoma.

We report a case of superior vena cava syndrome and trousseau syndrome in a patient with metastatic urothelial carcinoma treated with enfortumab vedotin. The patient was a 59-year-old woman diagnosed with left renal pelvic cancer with multiple lymph node metastases and liver metastasis. Treatment with gemcitabine and cisplatin reduced the size of the local tumor but resulted in liver metastasis progression after three cycles. The patient was switched to pembrolizumab which resulted in rapid tumor growth causing superior vena cava syndrome and trousseau syndrome. Hyper-progression was suspected and the patient was immediately switched to enfortumab vedotin. After enfortumab vedotin therapy, the tumor and multiple metastases shrank significantly and tumor reduction was maintained.

Comprehensive genomic profiling for metastatic castration-resistant prostate cancer (mCRPC) is rapidly becoming widespread. This study sought to investigate the gene alteration profiles of Japanese patients with mCRPC. We retrospectively reviewed 80 consecutive mCRPC patients who underwent comprehensive genomic profiling tests at our institution between 2021 and 2022. All patients underwent next-generation sequencing (NGS) : FoundationOne® CDx (F1-CDx) or FoundationOne® Liquid CDx (F1L-CDx). F1LCDx was indicated for cases in which tissue specimens were older than 5 years or could not be analyzed using F1-CDx. The median patient age was 74 years. Thirty-five and 45 patients received F1-CDx and F1LCDx, respectively. At least one pathogenic variant was found in 35 (100%) who received F1-CDx and 43 (95%) who received F1L-CDx. In total, 11 and 1 patients had pathogenic variants of BRCA2 and BRCA1, respectively. Among them, 4 cases (33%) were found to be germline variants. TP53, CDK12, and PTEN were found in ＞ 20% of cases who received F1-CDx. DNMT3A, TP53, AR, and TET2 were found in ＞ 20% of cases who received F1L-CDx. The proportion of gene alteration subtypes of amplification and loss in F1L-CDx was less common than that in F1-CDx. Pathogenic variants were successfully detected in almost all F1-CDx and F1L-CDx cases in our mCRPC cohort. The total proportion of BRCA1/2 pathogenic variant patients was similar to those in previous reports.

We report a case of a 27-year-old pregnant woman with juxtaglomerular cell tumor of the renal hilum treated by partial nephrectomy. Hypertension had been diagnosed prior to conception and she had been receiving antihypertensive treatment. Hyperreninemia was noted during pregnancy, and postpartum computed tomography revealed a nodule approximately 15 mm in size in the right renal portal region. The nodule was suspected to represent juxtaglomerular cell tumor, a benign tumor that presents with secondary hypertension. We performed open partial nephrectomy, which eliminated the need for antihypertensive treatment and preserved renal function.

A female in her sixties with a history of pyelolithotomy for right kidney stone at age 26 presented with right back pain. Computed tomography of the abdomen showed right hydronephrosis,and a retrograde pyelogram showed stenosis of the pelviureteric junction. Five years after initial presentation, robot-assisted renal ureterocalicostomy was planned for recurrent back pain, and decreased renal function. The lower renal calix was exposed and anastomosis with the ureter was performed for half of the caliceal hole. However, intraoperative flexible endoscopy, which was performed to confirm the position of the repositioned stent, revealed a papillary tumor in the upper renal calix. The patient underwent nephroureterectomy upon diagnosis of renal pelvic urothelial carcinoma.