Acta Urologica Japonica最新文献

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.

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.

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.

A 70-year-old male came to our clinic with a high fever and left scrotal swelling. Following a diagnosis of left-side epididymitis, antibiotic treatment was started, though the swelling did not improve. Since an additional examination revealed an abscess in the left scrotum, scrotal incision and drainage were performed. Although the symptoms subsided, urine outflow from the incision was observed. The patient then noted that he had inserted a glass ball into the urethral meatus when he was about 30 years old. It was considered that an abscess and fistula had formed due to inflammation caused by the foreign body. Thus a transurethral surgical procedure was used for crushing and removal. The fistula disappeared within three months after the operation and the patient has not been affected by dysuria since that time. Symptoms may appear several years following insertion of a foreign body into the urethra. To the best of our knowledge, the present case is the longest term of indwelling, approximately 40 years, following insertion of a foreign body reported in Japan.

A 71-year-old man presented with exertional dyspnea. Chest radiography revealed multiple pulmonary nodules, and contrast-enhanced computed tomography showed findings suspicious of right renal pelvic cancer. Percutaneous lung tumor biopsy revealed a histological diagnosis of urothelial carcinoma, and right renal pelvic cancer cT3N2M1 was diagnosed. Favorable response was shown during primary chemotherapy with gemcitabine and cisplatin but resulted in tumor progression after four cycles. The patient was switched to a second-line treatment, pembrolizumab, which resulted in rapid tumor growth. Hyper-progression was suspected, and the patient was promptly switched to a third-line treatment, enfortumab vedotin. The tumor shrank significantly. After three treatment cycles, an adverse event of enteritis was observed. A biopsy of the intestinal mucosa led to a histopathologic diagnosis of late-onset immune-related adverse event; therefore, enfortumab vedotin could be continued.

A 74-year-old man visited the urology clinic with the chief complaint of urinary retention in December 2014. Serum level of initial prostate specific antigen (PSA) was 50 ng/ml and he was diagnosed with Gleason Score 4＋4 prostate adenocarcinoma with regional lymphadenopathy (cT3aN1M0). PSA level had declined after the treatment with combined androgen blockade. In November 2018, he was diagnosed with castration resistant prostate cancer (CRPC) as local progression was detected by computed tomography (CT) while PSA level did not increase. Since local symptoms worsened, resulting in repeated hematuria after the treatment with enzalutamide, palliative radiation therapy to the prostate (45 Gy) was performed. Five months later, follow-up CT showed multiple metastasis in bilateral lung and left testicle. Serum level of neuron-specific enolase (NSE) was 24.4 ng/ml without an elevated in serum PSA level. He received rebiopsy of the prostate, but no malignant findings were observed. Consequently, bilateral orchiectomy was performed for diagnosis of left testicular tumor. Pathological examination revealed metastasis of neuroendocrine prostate cancer (NEPC). Chemotherapy using cisplatin and irinotecan was administered after orchiectomy. Complete response of lung lesions was achieved and serum level of NSE decreased within normal range. No recurrence has been confirmed for 4 years after the completion of chemotherapy.