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75 year-old man followed up regularly for the treatment of lung cancer came to our hospital with a chief complaint of general malaise. Blood test results showed deterioration in the renal function, and computed tomography (CT) confirmed left hydronephrosis. He was admitted to the hospital with the diagnosis of obstructive pyelonephritis. Despite antibiotic therapy after the left ureteral stent placement, CT on day 19 of hospitalization showed an enlarged soft tissue shadow along the renal pelvis and ureter, which was suspected to be peripelvic urinary extravasation caused by stent occlusion. We decided that conservative treatment would not improve his condition and conducted surgical therapy considering the possibility of malignancy. Intraoperatively, viscous and fragile tumor affected the renal pelvis and ureter. The operation resulted in left nephrectomy because radical resection was impossible. The pathological diagnosis was sarcomatoid urothelial carcinoma of the renal pelvis with ureter origin. He died due to multipleorgan failureon day 20 after theope ration. Were port a caseof sarcomatoid urothelial carcinoma in the upper urinary tract that was difficult to diagnose preoperatively based on imaging studies.

A 37-year-old man with no symptoms or family history of tuberous sclerosis complex presented to our hospital with abdominal pain in 2013. Abdominal computed tomography (CT) revealed a rupture in the right renal angiomyolipoma (AML) having a maximum diameter of 7 cm. He had undergone a transarterial embolization. Follow-up CT showed an increase in the size of the right tumor to 11 cm, and therefore, right nephrectomy was performed in 2016. The diagnosis of epithelioid AML (EAML) was confirmed. In 2019, he was diagnosed with a solitary tumor near right-sided transverse colon, which was resected and showed recurrence of EAML. He was disease-free 6 months after surgery. EAML has malignant potential, with 30-50% of reported EAML cases resulting in local recurrence or distant metastasis. Previous recurrence or metastasis may occur 0.25-12 years postoperatively. Furthermore, multiple and unresectable recurrences or metastases, arising early in the postoperative period may lead to a poor outcome. Therefore, close and long-term follow-up is required.

We evaluated the safety of laparoscopic radical cystectomy (LRC) during initial phases and its learning curve in a Japanese multicenter cohort by studying 436 patients who underwent LRC with no robot assistance at 10 institutions in Japan. We divided the patients into three groups according to cumulative surgical volume at each institution (first 10 cases, 11-30 cases, after 31 cases in each institution), and compared perioperative and pathologic variables among the three groups. The first, second, and third groups included 100, 166, 170 patients, respectively. The preoperative variables were similar in the three groups except for the rate of neoadjuvant chemotherapy. The methods of LRC procedure, such as urinary diversion, the extent of lymph node dissection, and concomitant urethrectomy or nephroureterectomy, were similar in the three groups. Mean operative time was 629, 562 and 531 minutes, respectively, and mean blood loss was 755, 650 and 435 ml, respectively. Both values decreased over time with the institution's experience. There was no significant difference among the three groups in the rate of positive surgical margin, the number of retrieved lymph nodes, and the rate of intra- and postoperative complications. LRC was safely performed during initial phases with an acceptable complication rate and without compromising oncological results, although operative time was longer and blood loss increased.

A 55-year-old woman was referred to our hospital with dysuria. We were unable to catheterize her using a nelaton catheter because of a urethral stricture, resulting in a large residual urine volume on ultrasonography. The circumference of the periurethral tissue was also thickened and the entire length of the urethra was stenotic, without apparent cause, on magnetic resonance imaging. Biopsy did not reveal malignancy. The pathological diagnosis of the periurethral tissue was simply fibrosis, and there was no definitive diagnosis. We decided to place a guidewire to attempt transurethral dilation, but it was unsuccessful because of the urethral stricture. The patient then underwent Mitrofanoff appendicovesicostomy. Three years later, there was no difficulty with catheterization through the appendix, despite her suffering from a bladder stone during the interim. We consider the Mitrofanoff appendicovesicostomy a good substitute technique for catheterization in patients with very severe urethral stricture.

We compared the perioperative and oncological outcomes of laparoscopic radical cystectomy (LRC) between elderly patients over 75 years old and younger patients. Fifty-three patients underwent LRC between 2003 and 2014 at Tenriyorozu Hospital. Eighteen patients were classified as elderly (over 75) and the other 35 patients were considered young. The median operating time (434 vs 465 min, p＝0.35), estimated bloodloss (534 vs 525 g, p＝0.74), time to recommencing foodintake (7 vs 6 days, p＝1.00), and hospital stay (35 vs 32 days, p＝0.81) were not significantly different between the groups. Perioperative pyelonephritis was significantly more frequent in the elderly group (50% vs 20%, p＝0.02), while other complications were not significantly different between the two groups. The perioperative mortality rate was 0% in both groups. There were no significant differences between the elderly and young groups with respect to 2-year overall survival (74. 4% vs 91. 6%), cancer-specific survival (74. 4% vs 91. 6%), and recurrence-free survival (70.2% vs 81. 8%). LRC is a safe andefficient procedure for selected elderly patients.

A 58-year-old man had undergone laparoscopic radical nephrectomy for right renal cell carcinoma. The histopathological diagnosis was clear cell carcinoma, grade 2＞3, pT1b. Two years and 10 months postoperatively, computed tomography scans demonstrated an enhanced mass on the right adrenal gland. As we could not detect other metastatic lesions, it was diagnosed as solitary adrenal metastasis of renal cell carcinoma. Albeit metastasectomy was planned with curative intent, right hemihepatectomy was also required for surgical removal because the tumor was adherent to the right lobe of the liver broadly and had indistinct margins. So we started neoadjuvant therapy with sunitinib. Eight courses of treatment shrunk the metastatic tumor enough to allow it to be removed completely without partial hepatectomy. Neoadjuvant therapy with the molecular targeted drugs may provide an effective option for metastasectomy in renal cell carcinoma regarding increased curability and decreased the risk of an operation.

A 54-year-old man presented with pollakiuria and dysuria. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a retroperitoneal tumor 10 cm in diameter. Pathological examination of a transrectal biopsy specimen obtained from the patient revealed the presence of an inflammatory myofibroblastic tumor (IMT). The patient underwent surgical resection of the tumor. Histopathologically, the tumor was composed of 3 parts : the largest part was compatible with an inflammatory pseudotumor : the second part, well-differentiated liposarcoma : and the third part, a myxoid liposarcoma. He has been followed up for 14 months ; but there was no evidence of local recurrence of the tumor. We believe that the inflammatory pseudotumor complicated in repairing the inflammation arising from the liposarcoma.

A 50-year-old male had been maintained on hemodialysis for 12 years because of chronic renal failure. The patient experienced sudden left flank pain. Computed tomography (CT) showed a huge left perirenal hematoma, which was diagnosed as a spontaneous rupture of the left kidney. CT also showed multiple cysts in both kidneys and a right renal tumor suspected to be renal cell carcinoma. Although the cause of the rupture was unknown, bilateral nephrectomy was performed. Histological study revealed acquired cystic disease of the kidney (ACDK) with bilateral renal cell carcinoma. Our diagnosis was rupture of the renal cell carcinoma. The patient was free of recurrence at 17 months postoperatively. To our knowledge, this case is the fifth report of renal cell carcinoma in ACDK manifesting as spontaneous rupture in the Japanese literature.

A metastatic penile tumor of malignant melanoma is very rare. The patient had priapism caused by metastatic penile tumor and the primary cancer was in the end stage. However, in this case, we could relieve the dysuria and pain by percutaneous cystostomy and partial penectomy. The corpus spongiosumcorpus cavernosum shunt could not relieve the priapism and might have accelerated the metastasis.

Transurethral resection of the prostate was performed on 584 consecutive patients with clinically diagnosed benign prostatic hyperplasia between April 2001 and July 2007. Pathological examinations revealed prostatic cancer in 30 (5.1%) of them. Seventeen patients had stage A1, and 13 stage A2 cancer. Prostatic biopsy was performed on 7 patients. The mean patient age was 69.4 years (range 60-78 years) for stage A1 cancer and 76.6 years (range 62-90 years) for stage A2. The mean serum PSA concentration was 8.9 ng/ml (range 1.18-41.3 ng/ml) for stage A1 cancer and 9.55 ng/ml (range 2.0-23.9 ng/ml) for stage A2. The mean follow-up period was 25.8 months (range 3-82 months) for stage A1 cancer and 27.3 months (range 1-82 months) for stage A2. In stage A1, all patients had a Gleason sum of 6 or less. In stage A2, 11 patients had a Gleason sum of 7 and 2 patients were 8 or more. Total prostatectomy was performed on 2 patients and no therapy on 15 patients with stage A1. Endocrine therapy was given to 1 patient, radiation therapy to 1 patient and no therapy to 11 patients with stage A2. Adjuvant therapy was given to 2 patients with stage A1 and to no one with stage A2. We concluded that PSA monitoring is an option in stage A2 cancer., 過去約6年間に前立腺肥大症と診断して経尿道的前立腺切除術(TURP)施行した584症例中、手術時に発見した偶発前立腺癌30症例について検討した。病期A1が17例(平均年齢69.4歳)、A2が13例(平均年齢76.6歳)で、平均観察期間はA1症例25.8ヵ月、A2症例27.3ヵ月であった。治療はA1例では2例に根治的前立腺全摘除術を施行し、15例は無治療であった。A2例では1例に内分泌療法、1例に内分泌療法併用の放射線療法を施行し、11例は無治療であった。A1の経過観察2例でPSAの上昇を認め、1例には13ヵ月目に内分泌療法を、1例には18ヵ月目に根治的前立腺全摘除術を施行した。A2に限れば、11例の無治療経過観察例は、観察期間は短いが全例無治療PSA経過観察を継続した。TURPで発見される前立腺癌は早期癌がほとんどであり、偶発前立腺癌の無治療経過観察の可能性を示唆すると考えられた。

泌尿器科20施設を対象に, 清潔間欠自己導尿(CIC)管理を行っている成人女性患者について調査を行った。該当患者は287例(中央値70歳)で, 原因疾患で多かったのは子宮癌99例(中央値71.5歳), 次いで脊椎・脊髄疾患, 糖尿病, 脳疾患であった。子宮癌例において, 術後経過期間は中央値21年, CIC導入までの期間は術後4.0年であった。術後放射線療法併用ありは44例(A群), なし30例(B群), 不明20例で, B群では導入が必要な患者の約60%は術後1年以内に導入され, 20年までに約20%が導入された。A群では術後1年以内が約30%, 20年までに約50%が導入された。膀胱の自然破裂は11例にみられ, 全例放射線療法後であった。子宮癌術後から膀胱破裂までの期間は中央値16年で, 1例を除きCIC導入の契機となっていた。CIC以外の尿路系処置を要していたのは74例で, 放射線併用あり13例, なし61例であった。放射線併用なし群では尿管皮膚瘻, あり群では尿道へのフォリイカテーテル留置, 腎瘻造設が多かった。, We conducted a multi-institute survey on the conditions related to urologic management of severe voiding dysfunction after hysterectomy for uterine cancer with or without postoperative irradiation. Our first study population was a group of adult female patients currently managed by urologists, using clean intermittent catheterization (CIC). Of the 287 patients in this group, 99 (34%) had suffered from uterine cancer. Of these patients, 94 underwent hysterectomy for this disease; 44 and 30 were treated with or without postoperative radiation, respectively, while postoperative irradiation status was unknown for 20. Median follow-up after surgery was 21 (0.2-52) years and median interval from operation to the introduction of CIC was 4.0 (0-49) years. CIC tended to be introduced later for patients with postoperative radiation than those without it. Seventy-four patients, who required invasive urologic interventions other than CIC for voiding dysfunction after hysterectomy, are the second study population. Most of these (82%) had received postoperative irradiation. Continuous Foley catheter placement was the most frequent procedure. Long-term follow-up and urologic management for voiding dysfunction is required for patients undergoing hysterectomy.

2002年9月から2003年8月までに多施設で行われた開放・体腔鏡下泌尿器科手術1, 353症例を対象として同一プロトコールによる抗菌薬の予防投与を行い, 術式別の周術期感染症発生率と抗菌薬予防投与法の妥当性を検討した.手術部位感染(SSI)発生率は清潔手術0.7～3.5%, 準清潔手術6.0～10.0%, 消化管利用膀胱全摘除術23.3%であり, 遠隔部感染(RI)発生率は清潔手術5%以下, 準清潔手術7.6～16.7%, 消化管利用膀胱全摘除術35.2%であった.SSI起炎菌の85.3%はグラム陽性菌でMRSAが58.8%を占め, RI起因菌はグラム陽性菌が若干多い傾向にあったが, 尿路感染ではグラム陰性菌と陽性菌がほぼ同数であり, 尿路感染, ドレーン感染からは高率にMRSAが分離された.また, 周術期感染症の危険因子には性別, 年齢, BMI, TP, 糖尿病, 手術時間, 出血量, 肺疾患が挙げられ, 感染症発症群の術後体温, 白血球数, CRPは高い傾向にあり, 特にCRPは周術期感染症予知の鋭敏なマーカーであると考えられた, In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1, 353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels: Category A; clean less invasive surgery, Category B; clean invasive or clean-contaminated surgery, Category C; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A; first or second generation cephems or penicillins on the operative day only, Category B; first and second generation cephems or penicillins for 3 days, and Category C; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant Staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.

We report a case of transitional cell carcinoma in a patient with chronic renal failure receiving hemodialysis for 22 years. A 55-year-old man was admitted to our hospital. Under diagnosis of invasive bladder cancer and left renal pelvic tumor, removal of the whole urinary tract, e.g., bilateral nephroureterectomy and total cystourethrectomy was performed. Transitional cell carcinoma was found in bilateral renal pelvis, left ureter, bladder and prostate in the resected specimen. Thirteen months after the operation, multiple lung metastases and pathologic bone fracture of the 4th lumber vertebra were found. Chemotherapy (3 courses of modified CISCA, consisting of cisplatin, adriamycin and cyclophosphamide) was performed, but the died of systemic metastases of cancer and bleeding due to perforation of multiple gastric ulcers.

55歳男.人間ドックで骨盤内腫瘤, 左水腎症を指摘された.CTで仙骨前面に接し骨盤内臓器を腹側に圧排する13×11×15cmの腫瘤を認め, 内容は嚢胞成分, 脂肪織, 石灰化等が混在していた.手術は, まず砕石位で下腹部正中切開から経腹膜的に直腸後方の腫瘍に到達した.その際, 右総腸骨動脈部に右萎縮精巣を認め, 摘除した.腫瘤と直腸との間の剥離を進めると, 腫瘍は仙骨前面の一部と強く癒着していた.経仙骨アプローチを加えることとし, 体位をJack knife positionに変え, 仙骨後方に逆Y字切開した.S4, S5神経, 尾骨神経根を結紮切断した後, S4以下の仙骨, 尾骨を切断し腫瘍後面に到達した.鈍的に剥離を進めたが, S3仙骨と腫瘍との間に強い癒着を認めた.一部嚢胞壁が残存し嚢胞内容がこぼれたが, 腫瘍を一塊に摘出した.組織学的には悪性所見を認めず, 良性の成熟奇形腫と診断した.術後排便障害は1ヵ月で軽快し, 尿閉を術直後に認めたが, 1年後には自尿1回200mlと回復した, We report a case of adult sacrococcygeal teratoma resected by an abdominosacral approach. A cystic mass 13 cm in diameter in the pelvic cavity and left hydronephrosis were detected incidentally by abdominal computed tomographic (CT) scan in a 55-year-old man. The pelvic tumor extending from the presacral area to the coccyx was resected via a combined abdominal and transsacral approach. The resected specimen weighed 700 g and the pathological diagnosis was mature teratoma. While the sacrococcygeal area is the most frequent site of teratoma in infants, it is a rare site in adults. This is to our knowledge, the 30th case report of adult sacrococcygeal teratoma in Japan. At one month after the operation the patient had no bowel dysfunction and no dysbasia, but he had mild bladder dysfunction requiring self-catheterization twice a day at twelve months. The patient had no evidence of disease at twenty months after the operation.

症例は86歳男で, 肉眼的血尿を主訴とし, 膀胱鏡で頂部に径3～4cmの腫瘍を認めた.臨床的に病期T1以上と診断し, まず経尿道的膀胱切除術を施行した.病理組織診で筋層浸潤を示すpT2以上のgrade 3移行上皮癌に混在して合胞体細胞様巨細胞を認めた.β-HCG染色を施行したところ陽性であったためβ-HCG産生膀胱癌と診断した.追加療法として膀胱全摘術+多剤併用化学療法も考慮したが, 高齢であり重度の心不全も有していたことから侵襲の少ない膀胱部分切除術を選択した.術後の病理組織診上残存癌は認めなかったが, 肺転移をきたし, 術後約2ヵ月目に死亡した, An 86-year-old man consulted our hospital complaining of gross hematuria. Cystoscopy revealed a nodular broad-based cancer at the dome of the bladder. The patient was initially treated by transurethral resection of bladder tumor. Since histological examination showed grade 3 transitional cell carcinoma containing giant cells that were positive for beta-human chorionic gonadotropin (beta-HCG), we made a diagnosis of beta-HCG-producing bladder cancer. Because of his advanced age and poor general condition, the patient underwent partial cystectomy alone without adjuvant chemotherapy. One month later, a chest X-ray film revealed multiple lung metastases, and he developed paraplegia of the lower extremities suggesting spinal metastases. One month later, he was brought to our hospital with cardiopulmonary arrest. This is, to our best knowledge, the 22nd case report of beta-HCG-producing bladder cancer in Japan.

1)デキサメサゾンは, IL-6産生腎細胞株NC 65の増殖を濃度依存的に抑制した。2)IL-6レセプターmRNAのアンチセンスオリゴヌクレオチドおよび抗IL-6レセプター抗体はNC 65の増殖を抑制したが, IL-6mRNAのアンチセンスオリゴヌクレオチドおよび抗IL-6抗体では増殖抑制は認められなかった, Interleukin-6 (IL-6) has been demonstrated to be an autocrine growth factor of renal cell carcinoma in vitro and released IL-6 has been thought to elicit the acute phase response in vivo. We investigated the possibility of anti-IL-6 therapy of IL-6-producing renal cell carcinoma. There was a dose-dependent decrease in the number of colonies formed in vitro of NC65 renal cell carcinoma cell line in the presence of dexamethasone which is known to inhibit the induction of IL-6 messenger RNA. IL-6 receptor antisense oligonucleotide and anti-IL-6 receptor antibody also showed growth inhibition of NC65 cells. IL-6 antisense oligonucleotide and anti-IL-6 antibody did not alter the proliferation of NC65 cells. These findings suggest that inhibitors of IL-6 production or IL-6 function may be useful for some renal call carcinoma patients.

Two cases of endometriosis causing ureteral stenosis are reported. Case 1. A 46-year-old woman was hospitalized with the complaint of right flank pain. Intravenous pyelography showed right hydronephrosis and retrograde pyelography revealed ureteral stenosis at the distal third ureter. Exploration revealed an abnormal periureteral mass, which was excised together with the distal part of the ureter. A right ureteroneocystostomy was performed with the Boari technique. Case 2. A 39-year-old woman was hospitalized with the complaint of pain in the left lower quadrant. A left retrograde pyelography showed stenosis of the ureter at 4 cm proximal of the bladder. An exploratory laparotomy revealed blue berry spots on the left side of the uterus and dense fibrous tissue around the ureter, which was successfully dissected out. The pathological diagnosis of both cases was extrinsic ureteral endometriosis. Ureteral endometriosis has rarely been described and the literatures on 30 cases reported in Japan were reviewed.

M-VAC療法のVBLをVP-16に変更したM-EAP療法を, 4例の尿路上皮癌患者に施行した.1)評価可能病変を有する3例ではCR 1例, PR 2例.2) 70%濃度の投与量でもCRが1例に得られた.3) 4例中2例はM-EAP療法終了後, 5ヵ月目で癌死した.4) M-EAP療法は尿路上皮癌に有効であると思われるが, 生存期間の延長に寄与するか否かは今後の検討を要する, Combination chemotherapy with methotrexate, etoposide, adriamycin and cisplatin (M-EAP regimen) was administered to 4 patients with advanced epithelial cancer of the urinary tract (Methotrexate 30 mg/M2 day 1, 15 and 22; Etoposide 100 mg/M2 day 1, 2, 15 and 22; Adriamycin 30 mg/M2 day 2; Cisplatin 70 mg/M2 day 2, every 4 weeks). In an attempt to improve the anti-cancer effect of the M-VAC regimen, etoposide was substituted for vinblastine. This series comprised 3 males and 1 female ranging in age from 54 to 68 years (mean age: 63), with a performance status of 1 to 2. The site of the primary lesion was bladder in 3, and left ureter in 1. The clinical response was assessed in 3 of the 4 patients: one achieved complete response and two had partial response. Two of the four died of disease 5 months after chemotherapy. Two of them have been alive for 10 and 8 months with no evidence of disease after chemotherapy. Toxicity included moderate or severe myelosuppression in two patients, and mild to moderate anorexia, vomiting, alopecia, and hiccups in all patients. These preliminary results suggest that the M-EAP regimen is effective against advanced epithelial carcinoma of the urinary tract. However, myelosuppression was a dose-limiting factor.

A Clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1985 to 1988.

A recent four year statistic survey carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital is reported.

A case of giant renal hamartoma considered as congenital mesoblastic nephroma in an adult is reported. A 24-year-old woman was admitted to our hospital with complaints of macroscopic hematuria and left flank pain. On clinical examination, a large left renal tumor was recognized and radical left nephrectomy was performed. The tumor weighed 2, 500 g. On histological examination, the tumor was composed of spindle-shaped cells, that were considered as fibroblasts, surrounded by abundant collagenous interstitial material, and many cystic or tubular structures lined by cuboidal epithelium were also seen in the peripheral region. Because of histological similarity we considered this tumor as congenital mesoblastic nephroma in an adult.