Acta Urologica Japonica最新文献

Transurethral lithotripsy (TUL) using holmium YAG laser has become the standard treatment for kidney stones. Mosesᵀᴹ technology, which delivers the laser with less energy loss, has been introduced and is reported to have advantages over regular laser in terms of shorter operation time and lithotripsy efficiency, but there are few reports from general hospitals. We retrospectively compared the perioperative and postoperative outcome, and complications of 28 cases of TUL using Mosesᵀᴹ mode performed from August 2021 to January 2023 at our hospital, and 25 cases of TUL using regular laser from August 2020 to July 2021. The median stone size was 11.9 and 10.9 mm, the median operation time was 103 and 105 minutes, and the 3-month stone-free rate was 88. 0 and 95.8% for Mosesᵀᴹ mode and regular laser, respectively. No significant difference was observed in the operation time. There was no difference in stone-free rate or complications either. The Mosesᵀᴹ mode group had significantly more cases of ureteral stent removal on the day after placement. In evaluating stone retropulsion on a 4-point scale, Mosesᵀᴹ mode cases showed significantly less retropulsion. TUL using Mosesᵀᴹ mode could be a useful option for treatment of kidney stones.

A 74-year-old woman with no history of trauma visited our hospital with right-sided abdominal pain and general malaise. Blood tests revealed elevated inflammatory markers. A computed tomography (CT) scan revealed a 8 cm mass and subcapsular hematoma on the lower pole side of the right kidney. She was diagnosed with a malignant tumor or renal abscess combined with subcapsular hematoma and inflammation and was treated conservatively with antibiotics. The symptoms quickly improved. Although kidney biopsy was performed, no obvious malignant cells were found. Since a subsequent CT scan could not exclude the possibility of kidney cancer, radical nephrectomy was performed. The histopathological diagnosis was clear cell renal cell carcinoma. She has not experienced recurrence within 10 months after the surgery. Clear cell renal cell carcinoma combined with subcapsular blood is relatively uncommon and can be difficult to diagnose, requiring careful decision-making regarding treatment indications.

A 65-year-old man with dysuria was referred to our department with a prostate-specific antigen concentration of 145.6 ng/ml. Unenhanced T2-weighted magnetic resonance imaging showed high signal intensity mainly in the right lobe of the prostate and a mass lesion with a mucus component. Contrastenhanced magnetic resonance imaging showed a progressively increasing contrast effect in the same region. Prostatic biopsy was performed, and histopathology revealed a Gleason score of 4＋3＝7, and a diagnosis of mucinous carcinoma of the prostate, stage cT3bN0M0. The patient underwent robot-assisted laparoscopic total prostatectomy and enlarged lymph node dissection. Pathological analysis confirmed mucinous adenocarcinoma of the prostate, with a Gleason score of 4＋3＝7, EPE1, RM0, ly1, v0, pn1, sv0, n1 (1/22). The final pathological diagnosis was prostate mucinous carcinoma, pT3aN1M0, and strict post-operative two-year follow-up resulted in no biochemical recurrence (prostate-specific antigen concentration was 0.001 ng/ml). The results suggest that surgical treatment may provide a good prognosis in high-risk prostatic mucous carcinoma.

A 51-year-old female patient developed multiple crizotinib- associated renal abscesses in her left kidney. She noticed a swellingof the right supraclavicular node in June, 202X. She visited a clinic and a blood test showed an elevated carcinoembryonic antigen. She was referred to our hospital and underwent computed tomography (CT) which revealed nodules in her right lung, mediastinum, and right supraclavicular lymph node. After thorough examination, the patient was diagnosed with metastatic lung adenocarcinoma. She had a ROS-1 gene mutation ; thus, treatment with crizotinib was recommended. After the initiation of crizotinib in October, 202X, routine CT showed a complete response. No further CT findings were observed until April, 2 years after 202X, when a polycystic lesion in the left kidney was observed. In August, 3 years after 202X, she complained of high fever and presented to our hospital. Her blood test showed a high c-reactive protein (CRP) levels ; therefore, she was admitted and received levofloxacin drip infusion for 5 days. However, the CRP level was elevated, and she underwent CT, which revealed a significant increase in the size and number of left polycystic lesions. She was diagnosed with multiple left renal abscesses and underwent a percutaneous left renal abscess puncture. Despite continued percutaneous drainage and antibiotic infusion, the high fever and elevated CRP level persisted. Therefore, she underwent left open nephrectomy. Pathology of the left kidney revealed a renal abscess, but there was no sign of malignancy. Crizotinib has been reported to cause rare adverse effects, such as polycystic renal lesions or renal abscesses.

A 54-year-old woman underwent retroperitoneal laparoscopic nephrectomy for a non-functional left kidney due to ureter stone in September 2022. She was operated without problems. Seven hours postoperatively, she complained of chest pain with a distressed facial expression. Electrocardiogram findings were negative for coronary artery disease, and echocardiography was negative for major pulmonary thromboembolism. Computed tomography showed emphysema and pneumomediastinum. The chest pain gradually resolved over time and was eventually diagnosed with pain due to pneumomediastinum. The subsequent clinical course was uneventful and she was discharged without complications on the 10th postoperative day.

A 68-year-old male was referred to our hospital because plain computed tomography (CT) showed right hydronephrosis. Contrast-enhanced CT revealed a mass with an irregular margin and poor contrast effect in the lower pole of the right kidney, which invaded the perirenal fat tissues and the area around the inferior vena cava (IVC). Moreover, a thrombus extending from the right renal vein to the IVC was detected, some of which was suggestive of tumor components on contrast-enhanced magnetic resonance imaging (MRI). Biopsy of the renal pelvic mucosa revealed urothelial carcinoma, which was diagnosed as cT4N0M0 renal pelvic cancer. After five courses of neoadjuvant chemotherapy with gemcitabine plus carboplatin, the patient underwent right nephroureterectomy. To avoid tumor cell dissemination into the abdominal cavity, we removed the thrombus and a portion of the IVC were removed en bloc with the right kidney without opening the vein. On pathological diagnosis, the renal tumor was identified as high-grade urothelial carcinoma with sarcomatoid features and squamous differentiation. The tumor invaded the IVC wall through perirenal fat tissues and further developed into a mass in the lumen of the vein. Although the patient was treated with nivolumab as a postoperative adjuvant therapy, he developed liver metastases and local recurrence on the right psoas muscle 6 months after surgery and is currently receiving chemotherapy with enfortumab vedotin.

Cutaneous ureterostomy (CU) is the most simple and safe method of all permanent urinary diversions, but is associated with a risk for stomal obstruction. It is important to appropriately manage hydronephrosis associated with CU. We evaluated the occurrence of stomal obstruction after CU by 99m Tcmercaptoacetyltriglycine (MAG3) diuretic renography three months after surgery. CU was performed after radical cystectomy in 46 patients (90 renal units,RUs) with a minimum follow-up period of 12 months, including 39 men and seven women. The median follow-up period was 102.1 months. The data analyses were performed with half-times to tracer clearance (T1/2) following furosemide administration. The mean T1/2 was 8.45±8.04 minutes. Seventy-five RUs (83.3%) had T1/2 of less than 15 minutes,and 74 (98. 7%) out of 75 RUs had no hydronephrosis. Ten RUs (11.1%) had T1/2 of more than 20 minutes,and all 10 RUs required stent insertions (six RUs) or became atrophic kidneys (four RUs) without the stent insertion. In conclusion,MAG3 diuretic renography was very useful for diagnosing stomal obstruction after CU. T1/2 of less than 15 minutes could be judged as non-obstructive systems,and T1/2 of more than 20 minutes could be judged as obstructed systems. T1/2 between 15 and 20 minutes indicate equivocal studies. Therefore,we recommend the immediate stent insertion in RUs with T1/2 of more than 20 minutes three months after surgery.

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.