{"title":"[Clinical Study of Lymph Node Dissection in Robot-Assisted Radical Prostatectomy for High-Risk Prostate Cancer].","authors":"Shotaro Hatano, Takayuki Goto, Jin Kono, Takayuki Sumiyoshi, Kimihiko Masui, Takuma Sato, Takeshi Sano, Atsuro Sawada, Shusuke Akamatsu, Takahiro Inoue, Osamu Ogawa, Takashi Kobayashi","doi":"10.14989/ActaUrolJap_70_11_367","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_11_367","url":null,"abstract":"<p><p>We retrospectively analyzed the regions and perioperative outcomes associated with lymph node dissection in patients with prostate cancer. Of 543 patients who underwent robot-assisted radical prostatectomy for prostate cancer with or without lymph node dissection according to the modified D'Amico criteria, 333 (61.3%), 128 (23.6%), and 82 (15.1%) were classified into the non-dissection, limited dissection, and extended dissection groups, respectively. Lymph node metastasis was identified in eight patients : one in the limited dissection group and seven in the extended dissection group. Notably, all eight biopsies showed Gleason scores of 4+4 or higher, and the initial prostate-specific antigen (PSA) concentration was ≥10 ng/ml in seven of these patients. Lymph node metastasis was detected in areas other than the obturator lymph nodes in five patients (62.5%). Although there was no significant difference in the rate of Clavien- Dindo grade ≥II complications among the three groups, six patients (7.3%) in the extended dissection group developed infectious lymphoceles. In the extended dissection group, the PSA progression-free survival (PSA-PFS) was significantly shorter in patients with than in those without lymph node metastasis (p<0.001). Because lymph node metastases were rare in the limited dissection group in our cohort of patients with a high risk of localized prostate cancer, achieving a diagnosis seems difficult with limited dissection. By contrast, in the extended dissection group, the PSA-PFS prognosis was significantly worse in lymph node-positive cases. Therefore, considering the high complication risk of lymphoceles, extended dissection should be performed in patients with a high likelihood of lymph node metastasis.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 11","pages":"367-372"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Clinical Outcomes of Transurethral Water Vapor Energy Therapy with Rezumᵀᴹ System].","authors":"Yoshiko Sugita, Toshiya Shitara, Hideharu Bessho, Haruko Takada, Satoru Bando, Hiroyuki Otani, Tetsuo Fujita, Masatsugu Iwamura","doi":"10.14989/ActaUrolJap_70_11_373","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_11_373","url":null,"abstract":"<p><p>We carefully reviewed and evaluated the efficacy of transurethral water vapor energy therapy (WAVE) with Rezumᵀᴹ system for treatment of benign prostatic hyperplasia. Between April and September 2023, 41 patients received WAVE under local anesthesia as day surgery at the outpatient department in our institution. The mean age as of operation was 78.7 years, and mean estimated prostatic volume was 42.3 ml. The median total operative time was 2 minutes, median puncture number of time was 3 times, and median duration of urethral catheter day was 7 days. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, and maximum flow rate (Qmax) were assessed preoperatively and at 1 and 3 months postoperatively. In this evaluation, IPSS and QOL index improved significantly at 1 month postoperatively (IPSS : p=0.023, QOL index : p<0.001). Although Qmax was not significantly different between preoperative and 1 month postoperatively (p=0. 167), a significant difference was shown at 3 months postoperatively (p=0.006). Objective test findings such as Qmax required more than 1 month to improve. Subjective symptoms such as IPSS and QOL index improved in an early postoperative period. In conclusion, WAVE is an effective procedure for the treatment of benign prostatic hyperplasia.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 11","pages":"373-377"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[A Case of Retroperitoneal Primary Undifferentiated Pleomorphic Sarcoma with a Rapid Course].","authors":"Kentaro Kiyozuka, Ryosuke Suzuki, Kosuke Sakai, Naoki Kohei, Akinori Nozawa","doi":"10.14989/ActaUrolJap_70_10_331","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_10_331","url":null,"abstract":"<p><p>A 50-year-old woman presented to our hospital in May2021 with a fever of approximately39 °C and abdominal pain. A contrast-enhanced computed tomography (CT) scan revealed an 88 mm right renal tumor. Two weeks later, a follow-up CT scan demonstrated rapid tumor growth, with the major axis measuring 100 mm. During this interval, her abdominal pain worsened, and she developed lower leg edema. A contrast-enhanced CT scan conducted 5 days before the scheduled surgery, four weeks after initial presentation, showed further tumor progression, with a diameter of 155 mm. The tumor, which had infiltrated the ascending colon, duodenum, liver, gallbladder, and inferior vena cava (IVC), was surgically removed along with the right kidney. Due to its complexity, the planned wide excision was deemed infeasible. Therefore, a tumor resection was performed macroscopically. Histopathological examination confirmed the diagnosis of undifferentiated pleomorphic sarcoma (UPS). Subsequently, the patient experienced a postoperative tumor recurrence. Although the patient received doxorubicin chemotherapy, she passed away5 weeks after the operation. This case highlights the critical importance of prompt surgical excision with adequate tumor margins in the management of UPS.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 10","pages":"331-334"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuki Nishimura, Yuta Oki, Daichi Nonomura, Kyosuke Matsuzaki, Kensaku Nishimura
{"title":"[A Case of Secondary Extramammary Paget's Disease Developed at 11 Years after Cystectomy].","authors":"Yuki Nishimura, Yuta Oki, Daichi Nonomura, Kyosuke Matsuzaki, Kensaku Nishimura","doi":"10.14989/ActaUrolJap_70_10_335","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_10_335","url":null,"abstract":"<p><p>An 82-year-old woman previously underwent cystectomy and ureterocutaneous ureteral fistula for bacillus calmette guerin-resistant bladder cancer at the age of 70 years old in February 2012. Pathological examination revealed a pTisN0. In October 2020, the patient experienced vulvar itching and pain, which prompted her to consult a gynecologist. Vulvovaginitis was diagnosed, and the patient was observed. However, in June 2023, the vulvar itching persisted, prompting a biopsy for refractory erosions of the vulva. Paget cells were identified in the epidermis, and immunostaining (CK7 (+), CK20 (+), p63 (+), GATA3 (+), and GCDFP15 (-)) was used to diagnose secondary extramammary Paget's disease due to urothelial carcinoma. Magnetic resonance imaging revealed a 25 mm mass in the pelvic floor, and a biopsy showed the same immunostaining pattern as the skin lesion. Consequently, a diagnosis of local recurrence 11 years after cystectomy and associated secondary extramammary Paget's disease was established. Owing to the evidence of invasion of the mass into the levator ani muscle, she underwent laparoscopic rectal resection plus combined resection of the tumor, perineum, and levator ani muscle in October. Currently, she is 3 months postoperatively without evidence of recurrence.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 10","pages":"335-341"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Assessment of Risk Factors for Reinsertion of Indwelling Urinary Catheters Despite Intervention for Voiding Disturbances by the Urination Care Team].","authors":"Masayuki Kurokawa, Fumiko Okada, Kosuke Ogawa, Yoshiyuki Okada, Mitsue Ito, Manami Shimizu, Takahiro Nonaka, Kazutoshi Okubo","doi":"10.14989/ActaUrolJap_70_10_323","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_10_323","url":null,"abstract":"<p><p>A urination care team comprising professionals from various fields was developed. This team intervened during hospitalization of patients who were either expected to have voiding disturbances following the removal of indwelling urinary catheters or develop voiding disturbances following catheter removal during hospitalization. The team aims to remove unnecessary indwelling urinary catheters and promote patient independence during urination. However, if patients do not achieve spontaneous micturition or clean intermittent self-catheterization (CISC) during their hospital stay, an indwelling urinary catheter is reinserted. In this study, risk factors for indwelling urinary catheter reinsertion were retrospectively analyzed during hospitalization. In total, 98 patients from January 1, 2018, to December 31, 2020, were examined at Kyoto Katsura Hospital, where the urination care team intervened due to voiding disturbances with residual urine of ≥100 ml. At discharge, 46 (46%) patients were able to urinate independently, 9 (9%) were voiding through a diaper, 14 (14%) practiced CISC, and 29 (30%) had indwelling urinary catheters. Multivariate analysis revealed that age ≥75 years (p=0.03), a cognitive functional independence measure (FIM) score of ≤25 on admission (p<0.01), and residual urine of ≥300 ml at intervention (p=0.03) were independent risk factors affecting the indwelling urinary catheter reinsertion. The indwelling urinary catheter non-reinsertion and reinsertion groups demonstrated significant improvement in the FIM total and motor scores between admission and discharge ; however, the FIM cognitive score did not show any statistically significant difference.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 10","pages":"323-330"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kodai Hattahara, Yuki Hashimoto, Masayuki Uegaki, Koji Nishizawa, Toru Yoshida
{"title":"[A Study of the Prognosis of Prostate Cancer Patients Over 80 Years of Age].","authors":"Kodai Hattahara, Yuki Hashimoto, Masayuki Uegaki, Koji Nishizawa, Toru Yoshida","doi":"10.14989/ActaUrolJap_70_10_309","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_10_309","url":null,"abstract":"<p><p>With the ageing of the population in Japan, an increasing number of elderly prostate cancer patients will require treatment. However, the elderly often have comorbidities, which can make treatment decisions for prostate cancer patients difficult. Therefore, we investigated prostate cancer deaths and risk factors among patients aged 80 years or older at diagnosis of prostate cancer at our hospital. Of 532 prostate cancer cases diagnosed and treated at our hospital between January2011 and December 2018, 90 cases were included. The median observation period was 54 months and 13 (14.4%) patients died of prostate cancer. The overall 5-year cancer-specific survival rate was 86.7%, with M1 (47.1%) and GS≥9 (71.9%) as significant risk factors on multivariate analysis. Patients with metastatic prostate cancer, even those older than 80 years, should be cautiously started on treatment after explaining to the patient and family that the chance of prostate cancer death is not low. Even in patients with localized prostate cancer, four out of 45 (8.9%) high-risk prostate cancer patients died of prostate cancer, suggesting that curative treatment is an option, depending on their life expectancy.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 10","pages":"309-315"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Comparison of Mosesᵀᴹ Mode and Conventional Laser in Transurethral Lithotripsy for Kidney Stones].","authors":"Kasumi Kanai, Hiromasa Sakamoto, Masafumi Tsuruta, Hirohisa Yano, Teruyoshi Aoyama","doi":"10.14989/ActaUrolJap_70_10_317","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_10_317","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 10","pages":"317-321"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Spontaneous Subcapsular Renal Hemorrhage of Clear Cell Renal Cell Carcinoma with Inflammation].","authors":"Mayuko Kusuda, Shuhei Yokokawa, Atsushi Fujikawa, Yoshinori Takekawa","doi":"10.14989/ActaUrolJap_70_9_267","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_9_267","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 9","pages":"267-270"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Robot-Assisted Laparoscopic Radical Prostatectomy for Prostatic Mucinous Carcinoma : A Case Report].","authors":"Hiromu Horitani, Takumi Ishikawa, Shun Umeda, Fuuki Kondo, Satoru Yumiba, Sayaka Horii, Yuu Ishizuya, Masao Kobayashi, Yutaka Ono, Shigemi Nakamori","doi":"10.14989/ActaUrolJap_70_9_277","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_9_277","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 9","pages":"277-281"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Crizotinib Associated Renal Abscess --A Case Report-].","authors":"Shohei Toyota, Taku Kato, Hidetoshi Ehara, Shigeyuki Sugie","doi":"10.14989/ActaUrolJap_70_9_283","DOIUrl":"https://doi.org/10.14989/ActaUrolJap_70_9_283","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":39291,"journal":{"name":"Acta Urologica Japonica","volume":"70 9","pages":"283-287"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}