Acta Urologica Japonica最新文献

We retrospectively compared treatment outcomes and complications based on body mass index (BMI) in patients with renal stones treated with mini-endoscopic combined intrarenal surgery (ECIRS) using percutaneous tracts 20 Fr or smaller. Among 1,432 patients who had ECIRS performed at multiple registered facilities between January 2015 and December 2022, 870 patients with renal stones who underwent mini-ECIRS were included after excluding those with anatomical anomalies or incomplete clinical data. The patients were divided into two groups : BMI ≥30 (Group A) and BMI ＜30 (Group B). The treatment outcomes and complications were compared between the two groups. One month postoperatively, plain computed tomography (CT) and kidney ureter bladder radiography (KUB) were performed to assess stone fragmentation and hydronephrosis. According to postoperative imaging, stone-free was defined as residual fragments 4 mm or less on KUB and 2 mm or less on CT. Of the 870 patients, 86 were in Group A and 784 in Group B. The median (interquartile range) cumulative stone diameter was 33.8 (26.35-50.75) mm in Group A, and 32 (24-47) mm in Group B, respectively. The median operative time was 122.5 (92.25- 166.75) min in Group A and 114.5 (89.75-156) min in Group B. The mean and median (interquartile range) postoperative hospital stay were 5.9±2.5 days and 5 (4-7) days in Group A, and 5.4±3.3 days and 5 (4-6) days in Group B. Stone-free rates were 77.9% (67 cases) by KUB and 61.6% (53 cases) by CT in Group A, and 76.1% (597 cases) by KUB and 58.0% (455 cases) by CT in Group B. The incidence of postoperative fever (≥38.0°C) was 38.4% (33 cases) in Group A and 31.8% (249 cases) in Group B, while septic shock occurred in 2.3% (2 cases) of Group A and 2.6% (20 cases) of Group B. A statistically significant difference (p＜0.05) was found in the postoperative hospital stay between the two groups, but no significant differences were observed in the stone-free rates or complication rates. Mini-ECIRS using percutaneous tracts of 20Fr or smaller for renal stones showed no significant difference in SFR and complications between patients with a BMI ≥30 and those with a BMI ＜30.

An 81-year-old woman to our hospital complaining of backpain and was diagnosed with a left renal tumor with lung and iliac metastasis. A renal tumor biopsy confirmed clear cell renal cell carcinoma. The patient began combination therapy with pembrolizumab and lenvatinib but experienced fatigue and edema after 1 month. Suspecting cardiac dysfunction induced by Lenvatinib, Lenvatinib was discontinued and treatment with pembrolizumab alone was continued. Three months after treatment initiation, the lung and iliac metastases had resolved, allowing for laparoscopic nephrectomy. Five months post-surgery, no new metastases were detected.

A49-year-old man noticed discomfort in the right scrotum and consulted a nearby medical institution. Magnetic resonance imaging revealed a 10 mm tumor in the right spermatic cord, showing low signal intensity on T1-weighted images and high signal intensity on T2-weighted and diffusion-weighted images. Since malignancy could not be ruled out, he was referred to our hospital. Physical examination revealed an elastic, mobile tumor in the right spermatic cord. Ultrasonography showed a solid tumor measuring 10 mm near the right testicle. Although differential diagnoses included lipoma and neurilemmoma, the possibility of malignancy prompted tumor resection. The tumor was a nodular lesion with a clear brown border. Histopathological examination confirmed the diagnosis of paraganglioma. Postoperative metaiodobenzylguanidine scintigraphy, computed tomographic imaging, and hormone testing did not reveal any significant findings, confirming the diagnosis of paraganglioma originating from the spermatic cord.

A 72-year-old woman was referred to our hospital complaining of abdominal pain. Contrast enhanced computed tomography revealed a 53 mm solid tumor with low contrast enhancement on the medial aspect of the right adrenal gland. On magnetic resonance imaging, the tumor showed low signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and high signal intensity on diffusion-weighted images. The patient was diagnosed as having a right adrenal tumor and was referred to our hospital for surgery. Laparoscopic right adrenalectomy was performed. During surgery, we could easily peel the tumor from the adrenal gland, but it was strongly adhered at the inferior vena cava. Considering the possibility of a primary tumor of the inferior vena cava, we converted to open surgery and achieved complete tumor resection by combined partial resection of the inferior vena cava. The cut surface of the tumor was white and firm. Histopathological examination with hematoxylin-eosin staining revealed spindle cell proliferation forming bundle-like structures. Immunohistochemical staining was positive for DESMIN and α-SMA, suggesting leiomyosarcoma. Furthermore, the vascular smooth muscle structure of the resected inferior vena cava was completely replaced by leiomyosarcoma. Therefore, our diagnosis was venous leiomyosarcoma originating from the inferior vena cava. The patient has remained recurrence-free at 21 months after surgery.

A 52-year-old man presented to our hospital with penile swelling and pain. The patient was injured when he forcibly bent his erect penis and heard a dull sound different from the"usual click sound"in the morning. His penis was bent dorsally with a hematoma and was purplish red. We diagnosed this as penile fracture and performed surgical treatment. We made a circumferential incision and degloved his penile prepuce. We removed the hematoma and repaired the injured tunica albuginea with absorbable sutures. Urethral injury was not found. He had no complications or erectile dysfunction after surgery. He had the habit of hearing the clicking sound caused by bending his erect penis since he was fifteen years old. This habit seems to resemble the"taqaandan"procedure, which was reported in Kermanshah, Iran. Only 14 penile fractures related to the habit resembling taqaandan have been reported in Japan.

Epidermoid cysts originating from the upper urinary tract are extremely rare, and only five cases have been reported previously. We report a rare case of epidermoid cyst that originated from the right ureter : A 76-year-old man presented with asymptomatic gross hematuria. Computed tomography showed a right ureteral tumor (14×8 mm in size). Retrograde pyelography showed a defect (14 mm diameter) of the contrast medium in the same region. Urinary cytological examination indicated class III. A ureteral tumor was clinically indicated, and retroperitoneoscopic-assisted radical nephroureterectomy was performed. Postoperative histopathological examination of the resected specimen showed ureteral epidermoid cysts without any malignancy.

Ganglioneuroma, an infrequent benign tumor that originates from the sympathetic nervous system, is usually a solitary occurrence and rarely occurs at multiple sites. Here, we report a case of retroperitoneal ganglioneuroma with multifocal bone involvement in a middle-aged woman. A 43-year-old female was incidentally diagnosed with a retroperitoneal tumor on abdominal ultrasonography. Contrast-enhanced computed tomography revealed a retroperitoneal tumor that was 11 cm in diameter above her left kidney and multiple bone lesions. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed a slightly high FDG uptake (standardized uptake value (SUV) max, 3.7) in the retroperitoneal mass and mild accumulation in the L1 vertebral body, zygoma, acetabulum, and calcaneus. Biopsies were performed for the retroperitoneal and lumbar spine tumors, both of which were diagnosed as ganglioneuromas. Total surgical resection is the standard treatment of this condition ; however, for this patient, it was difficult to remove all the tumors, and the ganglioneuromas generally followed a benign course. Therefore, a watchful waiting approach was chosen and no tumor growth was observed three years after her first visit to our hospital.

In patients with an indwelling Foley catheter, pubic hair may be introduced into the bladder. This is believed to occur because the pubic hairs are pushed into the bladder during catheter replacement. However, compared withpatients on intermittent self-catheterization, patients withan indwelling Foley catheter have fewer chances of their pubic hair being pushed into the bladder. This suggests the presence of an alternate mechanism responsible for introducing pubic hair into the bladder during catheter replacement. We performed several experiments to identify this. In a urethral model created with a silicone tube and Foley catheter, a pubic hair was placed between the tube and catheter, and the catheter was moved forward and backward. We confirmed that the pubic hair moved only toward the hair root side. This motion was assumed to be the mechanism by which pubic hair is introduced into the bladder.

We report a case of testicular cancer after kidney transplantation in a 29-year-old man. Twenty-two years after the surgery, computed tomography (CT) showed a retroperitoneal mass 3 cm in diameter. Positron emission tomography (PET) -CT revealed high FDG uptake in both the right testis and retroperitoneal mass. Regarding serum tumor markers, α fetoprotein (AFP) was slightly elevated to 12.5 ng/ml. He underwent right radical orchiectomy, and pathological examination revealed pure seminoma. After surgery, the serum AFP level remained high (12. 9 ng/ml), and we initially considered this nonseminoma patient to have a good prognosis according to International Germ Cell Consensus Classification. During three cycles of a combination regimen including bleomycin, etoposide, and cisplatin (BEP), we performed adjustment of immunosuppressive therapy, treatment for Cytomegalovirus infection (valganciclovir hydrochloride), and that for other adverse events associated with systemic chemotherapy. The chemotherapy schedule was delayed, and bleomycin (third course, day 15) was skipped due to adverse effects. After 3 cycles of BEP, the retroperitoneal lymph node metastasis shrunk from 3.0 to 1.5 cm in diameter. In contrast to the good radiological response, the serum AFP level gradually increased during the treatment to 102.6 ng/ml. Therefore, we did not consider the AFP elevation to have derived from residual cancer, and decided to perform close follow-up. During the 3-year follow-up, AFP decreased to around 20 ng/ml, and PET-CT did not show any uptake in the retroperitoneal mass or other sites.

Congenital arteriovenous malformation (AVM) in the male pelvis is extremely rare. We present a case of this disease with massive bladder bleeding which caused severe hemorrhagic shock. Diagnosis of pelvic AVM was confirmed by computed tomography and angiography. He was treated with transcatheter arterial embolization of the bilateral internal iliac arteries. We discuss the clinical course and the treatment for AVM in this case, and review the literature.