IJU Case Reports最新文献

Introduction

Prostate cancer is incidentally diagnosed in 6%–11% of benign prostatic hyperplasia surgeries.

Case presentation

A 79-year-old man was diagnosed with benign prostatic hyperplasia. The prostate volume was 54.5 mL, and the prostate-specific antigen level was 7.121 ng/mL. Magnetic resonance imaging and prostate biopsy were not performed. He then underwent contact laser vaporization of the prostate. After 3 months, gross hematuria occurred, and the prostate-specific antigen level was 62.495 ng/mL. Cystoscopy and magnetic resonance imaging revealed prostate cancer with bladder invasion. Prostate biopsy and transurethral resection were performed, revealing adenocarcinoma with a Gleason score of 5 + 5. The patient was diagnosed with prostate cancer T4N1M1b, and triplet therapy was initiated. After 6 months, the prostate-specific antigen level was 0.037 ng/mL, and the metastases had shrunk.

Conclusion

Vaporization for high-grade prostate cancer can lead to rapid progression. Therefore, screening for prostate cancer before benign prostatic hyperplasia surgery is important.

Introduction

Laser ablation using a 980-nm wavelength diode laser, which is a new-generation laser, for recurrent bladder cancer is known to have a lower incidence of complications and recurrence than conventional transurethral resection of bladder tumor surgery. This is the first study to report the use of 980-nm diode laser ablation for recurrent non-muscle-invasive bladder cancer in Japan.

Case presentation

A 73-year-old man underwent transurethral laser ablation for the treatment of recurrent non-muscle-invasive bladder cancer. Laser irradiation was performed using LEONARDO DUAL (diode laser/980-nm wavelength) and a 400-μm BARE laser fiber. Pathological evaluation indicated low-grade urothelial carcinoma, pTa. The patient was discharged on the second postoperative day with no perioperative or postoperative complications.

Conclusion

This case suggests the potential of transurethral laser ablation for treating recurrent non-muscle-invasive bladder cancer.

Introduction

Renal artery pseudoaneurysm is a rare yet serious complication following percutaneous nephrolithotomy, especially in patients with solitary kidneys. Effective management is crucial to prevent further renal damage.

Case presentation

We report a case of a 41-year-old male with a solitary kidney who experienced gross hematuria and renal insufficiency 3 months after percutaneous nephrolithotomy. Due to the patient's renal insufficiency and the risks associated with arterial catheterization, ultrasound-guided embolization was chosen as the treatment approach. Initial angiographic attempts were impeded by renal vessel spasms, delaying intervention. However, successful direct percutaneous embolization was subsequently performed using ultrasound and digital subtraction angiography.

Conclusion

The patient's recovery was uneventful, and follow-up assessments showed no recurrence of renal artery pseudoaneurysm. This case highlights the effectiveness of ultrasound-guided embolization as a viable treatment option for post-percutaneous nephrolithotomy renal artery pseudoaneurysm, particularly in patients with solitary kidneys.

Introduction

Nivolumab can cause various immune-related adverse events; it rarely induces Vogt-Koyanagi-Harada-disease-like uveitis. Vogt-Koyanagi-Harada-disease is reported to be closely associated with human leukocyte antigen-DR4.

Case presentation

A 68-year-old man with metastatic renal cancer underwent nephrectomy. Computed tomography showed multiple lung tumors, raising suspicion of lung metastases. However, one lung hilar mass was suspected to be primary lung cancer, leading to a lobectomy, which subsequently revealed lung metastases of renal cancer. The patient underwent nivolumab treatment but developed Vogt-Koyanagi-Harada-disease-like uveitis as an immune-related adverse event. Human leukocyte antigen-DR4 alleles were identified, and the uveitis improved with topical steroids. He maintained partial response of lung metastases after nivolumab resumption. Immunohistochemical staining revealed significantly higher human leukocyte antigen-DR4 expression in lung metastasis than primary renal cancer.

Conclusion

Despite inducing Vogt-Koyanagi-Harada-disease-like uveitis, nivolumab controlled cancer progression effectively. Immunohistochemical staining results suggest the potential involvement of human leukocyte antigen-DR4 expression in both the onset of Vogt-Koyanagi-Harada-disease-like uveitis and nivolumab efficacy.

Introduction

Radical cystectomy for patients who previously underwent both radical prostatectomy and prostatic bed radiation is technically challenging.

Case presentation

A 78-year-old man with a history of radical prostatectomy and salvage radiation for prostate cancer was referred to our hospital for radical treatment of bladder cancer. After two cycles of neoadjuvant chemotherapy, he underwent robot-assisted radical cystectomy with real-time transrectal ultrasound guidance during dissection of the rectovesical space to minimize the risk of rectal injury. There were no perioperative adverse events.

Conclusion

Intraoperative real-time transrectal ultrasound guidance could assist surgeons to safely perform the dissection of the rectovesical space in the surgically high-risk patient.

Introduction

Gastroenterocolitis is one of the adverse events related to immune checkpoint inhibitors. However, inflammation of the intestinal lesion used for urinary diversion is not well known as an adverse event related to their use.

Case presentation

A patient with metastatic bladder cancer was administered pembrolizumab as second-line treatment. After 12 days of administration, he felt abdominal distention. Computed tomography demonstrated thickening of the ileal conduit wall and bilateral hydronephrosis. Biopsy of the ileal conduit revealed inflammatory granulation tissue. Biopsy of the sigmoid colon also revealed colitis. Therefore, we diagnosed enterocolitis including the ileal conduit related to pembrolizumab. We then started to administer 30 mg prednisolone. After this treatment, we confirmed improvement of the clinical symptoms and healing of the ileal conduit mucosa.

Conclusion

Inflammation of an ileal conduit can occur as an immune-related adverse event caused by metastatic urothelial carcinoma treatment with pembrolizumab.

Introduction

The management of urinary tract stones, particularly de novo kidney allograft stones, presents unique challenges for kidney transplant recipients because of their prevalence and specific clinical considerations. Here, we describe a case in which percutaneous nephrolithotomy was successfully used to fragment a large kidney allograft stone ≥20 mm in size.

Case presentation

A 57-year-old woman who underwent ureteroureterostomy post simultaneous pancreas–kidney transplantation presented with gross hematuria after 15 years. Computed tomography revealed a 23-mm stone in the transplanted kidney. Initial attempts at endoscopic combined intrarenal surgery were changed to percutaneous nephrolithotomy because of poor ureter mobility and tortuosity. Stone fragmentation was achieved using pneumatic and ultrasonic lithotripsy. A second procedure using Swiss LithoClast^® Trilogy enabled complete stone clearance and ureteral stent placement.

Conclusion

By understanding the peculiarities of the percutaneous approach, we demonstrated the safe and effective use of a pneumatic and ultrasonic lithotripter for kidney allograft stone fragmentation.

Introduction

Adrenal myelolipomas are uncommon benign adrenal tumors, which mostly occur unilaterally. We describe a rare case of giant bilateral adrenal myelolipoma mistaken for retroperitoneal liposarcoma.

Case presentation

A 49-year-old man developed fever, left flank pain, and a large mass in his left abdomen. Plain computed tomography showed a 23-cm mass with fat-containing components in the retroperitoneal cavity, suggestive of retroperitoneal liposarcoma. A similar 9-cm mass was observed in the right adrenal gland, suggesting adrenal metastasis. With a clinical diagnosis of retroperitoneal liposarcoma, we administered preoperative radiation therapy and performed a bilateral tumor resection. On postoperative day 9, a surgical site infection occurred, necessitating incisional drainage and the administration of intravenous antibiotics. The histopathological diagnosis was bilateral myelolipoma of the adrenal glands.

Conclusion

In cases of bilateral retroperitoneal tumors with a large fat component, adrenal myelolipoma should be considered in the differential diagnosis to avoid overtreatment.

Introduction

Understanding of adverse reactions to coronavirus disease 2019 vaccines remains limited.

Case presentation

Case 1: A 52-year-old woman, post-kidney transplantation, experienced sudden vision loss in her left eye after receiving a second dose of coronavirus disease 2019 vaccine. She was diagnosed with ischemic optic neuropathy.

Case 2: A 53-year-old woman, post-kidney transplantation, presented with worsening diplopia and left eye pain following the second dose of coronavirus disease 2019 vaccine. She was diagnosed with left abducens nerve palsy.

Conclusion

Vigilance is essential for recognizing the potential for delayed cranial neuropathy in immunocompromised individuals after coronavirus disease 2019 vaccination.

Introduction

Needle-track seeding of prostate cancer into the rectal wall following transrectal prostate biopsy is exceedingly rare. We report a case of mucinous prostate cancer recurrence in the rectal wall due to biopsy needle seeding, discovered after robot-assisted radical prostatectomy.

Case presentation

A 67-year-old man underwent robot-assisted radical prostatectomy for mucinous prostate cancer (clinical stage T2cN0M0, Gleason score of 4 + 4, and initial prostate-specific antigen level of 8.8 ng/mL). Five years postoperatively, endoscopy revealed a rectal tumor, which was diagnosed as needle-track seeding from the previous transrectal prostate biopsy. Following resection of this rectal tumor, the patient's prostate-specific antigen level fell to <0.008 ng/mL. No signs of recurrence or metastasis were observed 3 months postoperatively.

Conclusion

While rare, transrectal prostate biopsies can pose a small risk of needle-track seeding into the rectal wall. Endorectal examination should be considered if biochemical recurrence of prostate cancer occurs following radical prostatectomy.