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Background The prognostic significance of tumor location for patients with upper urinary tract urothelial carcinoma (UUT-UC) has been disputed. Several papers have reported that ureteral cancer is associated with worse prognosis. Objective To investigate the prognostic significance of the presence of ureteral tumors in UUT-UC patients who underwent radical nephroureterectomy (RNU). Design, setting, and participants In this multicenter retrospective study, 1068 eligible patients (median follow-up: 40 mo [interquartile range: 17–77 mo]) were divided into three groups based on tumor location: renal pelvic, ureteral, and both–regional (having both renal pelvic and ureteral tumors). The ureteral and both–regional groups were subsequently integrated into the ureteral involvement group to evaluate its prognostic impact. Intervention All patients underwent RNU. Outcome measurements and statistical analysis The prognostic impact of tumor location on survival was analyzed. Results and limitations The renal pelvic, ureteral, and both–regional groups consisted of 507 (47.5%), 430 (40.3%), and 131 (12.3%) patients, respectively. The ureteral and both–regional groups had a higher rate of lymphovascular invasion and lymph node metastasis compared with the renal pelvic group. The renal pelvic and both–regional tumors presented more frequently with locally advanced stages (pT3/T4) compared with the ureteral tumors. The 5-yr cancer-specific survival (CSS) and progression-free survival (PFS) rates of patients in the ureteral (70.5% and 66.7%, respectively) and both–regional groups (64.8% and 57.8%, respectively) were significantly worse than those in the renal pelvic group (81.9% and 78.1%, respectively). In a multivariate analysis, the presence of ureteral involvement was a significant prognostic factor for CSS (hazard ratio [HR]: 1.50; p =0.006) and PFS (HR: 1.35; p =0.023). This study is inherently limited by the biases associated with its retrospective and multicenter design. Conclusions The presence of ureteral involvement had a significant impact on the survival of surgically treated UUT-UC patients associated with a poor prognosis. Patient summary We demonstrated that the ureteral involvement was associated with poor survival compared with patients with renal pelvic tumor only in upper urinary tract urothelial patients treated by nephroureterectomy.

Objective To compare the efficacy and safety of single half-dose silodosin and single full-dose tamsulosin in Japanese men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Methods Japanese men aged ≥50 years with LUTS/BPH and an International Prostate Symptom Score (IPSS) of ≥8 were enrolled in the randomized crossover study and divided into silodosin-preceding (S-T) and tamsulosin-preceding (T-S) groups. The S-T group received 4 mg silodosin once daily for 4 weeks followed by 0.2 mg tamsulosin once daily for 4 weeks. The T-S group received the reverse treatment sequence. A washout period prior to drug crossover was not included. Subjective and objective efficacy parameters including IPSS, quality of life (QOL) index, uroflowmetry, and safety were compared between the two groups. Results Thirty of 34 men (S-T group n = 16; T-S group n = 14) completed the study. Both drugs significantly improved all IPSS items and QOL index in the first treatment period. Subjective improvement in nocturia by silodosin was observed in both the first and crossover treatment periods. Objective improvement in maximum flow rate by silodosin was only observed in the first treatment period. Adverse events occurred more frequently with silodosin than with tamsulosin; however, none of the adverse events required treatment discontinuation. Ejaculation disorders occurred in three participants (10%) and were associated with silodosin use. Conclusion Single half-dose silodosin has a similar efficacy to full-dose tamsulosin in Japanese men with LUTS/BPH and thus, may represent an effective, safe, and affordable treatment option.

Akifumi Nagatomo,1 Norihisa Nishida,1 Ikuo Fukuhara,2 Akira Noro,3 Yoshimichi Kozai,3 Hisao Sato,3 Yoichi Matsuura1 1Research and Development Division, Morishita Jintan Co, Ltd, Osaka, Japan; 2Fukuhara Clinic, Hokkaido, Japan; 3New Drug Research Center, Inc., Hokkaido, Japan Background: Obesity has become a great problem all over the world. We repeatedly screened to find an effective food to treat obesity and discovered that rosehip extract shows potent antiobesity effects. Investigations in mice have demonstrated that rosehip extract inhibits body weight gain and decreases visceral fat. Thus, the present study examined the effect of rosehip extract on human body fat in preobese subjects. Methods: We conducted a 12-week, single-center, double-blind, randomized, placebo-controlled study of 32 subjects who had a body mass index of ≥25 but

Objectives To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU). Patients and Methods We retrospectively reviewed 754 patients with UTUC without prior or concurrent bladder cancer or distant metastasis at 13 institutions in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence of UTUC. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance index (c-index) focusing on predictive accuracy and decision-curve analysis, which indicate whether a model is appropriate for decision-making and determining subsequent patient prognosis. Results The cumulative incidence rates of bladder UTUC recurrence at 1 and 5 years were 15 and 29%, respectively; the median time to bladder UTUC recurrence was 10 months. Multivariate analysis showed that papillary tumour architecture, absence of lymphovascular invasion and higher pathological T stage were both predictive factors for bladder cancer recurrence. The predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence were not different (c-index: 0.60 and 0.62). According to the decision-curve analysis, the risk stratification was an acceptable model because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rates of bladder cancer 5 years after RNU were 10, 26 and 44% in the low-, intermediate- and high-risk groups, respectively. Conclusions We identified risk factors and developed a risk stratification model for UTUC recurrence in the bladder after RNU. This model could be used to provide both an individualised strategy to prevent recurrence and a risk-stratified surveillance protocol.

Objectives To investigate the oncological and functional outcome of distal ureterectomy compared with nephroureterectomy in the management of distal ureteral urothelial carcinoma. Methods Using a database including upper urinary tract urothelial carcinoma patients (n = 1329), 282 patients were identified with urothelial carcinoma localized in the distal ureter on clinical evaluation. To adjust for potential baseline differences between groups, 43 patients undergoing distal ureterectomy were matched with 86 patients undergoing nephroureterectomy using propensity scoring. Cox regression models tested the effect of surgery type on recurrence-free survival and cancer-specific survival. Estimated glomerular filtration rate was measured before and after surgery. Results The median follow-up period was 50 months. There were no significant differences in 5-year recurrence-free survival and cancer-specific survival rates between the distal ureterectomy and nephroureterectomy groups (P = 0.22 and P = 0.70, respectively). Multivariate analysis showed that surgery type was not associated with recurrence-free survival and cancer-specific survival (P = 0.90 and P = 0.28, respectively). In the subanalysis, recurrence-free survival and cancer-specific survival in the distal ureterectomy group were equivalent to those of the nephroureterectomy group in both pTa-1 and pT2-4 patients. Renal function was better preserved in the distal ureterectomy group than in the nephroureterectomy group (rate of change in estimated glomerular filtration rate 2% vs −20%; P

Air bubbles floating in the bladder dome during transurethral resection of a bladder tumor can interfere with the resection, causing intravesical explosion and increasing the potential risk of tumor cell reimplantation. We describe a simple and effective technique for evacuating air bubbles from the bladder dome using routine resectoscopes. First, the beak of the resectoscope is positioned near the air bubble in the bladder dome. Second, the drainage channel of the resectoscope is closed. Third, the irrigation tube is detached from the irrigation channel, and then the channel is opened. Subsequently, the air bubble with entangled scum will be retrogradely aspirated from the beak of the resectoscope to the irrigation channel. Reversing the direction of the water stream enables evacuation of the air bubble with the scum under direct vision. This simple and effective technique may assist surgeons and ensure the safety of patients during a transurethral procedure.

Objectives To develop and validate predictive models for postoperative estimated glomerular filtration rate and risk of chronic kidney disease after radical nephrectomy in Japanese patients. Methods The present retrospective study included a development cohort of 209 patients without preoperative chronic kidney disease who underwent radical nephrectomy between 1994 and 2008, and were followed up for longer than 3 years, and a validation cohort of 144 similar such patients. Univariate and multivariate linear regression or logistic regression analyses were carried out to identify the independent predictors of estimated glomerular filtration rate or chronic kidney disease 3 years after radical nephrectomy. Incorporating all independent predictors, predictive models for postoperative renal function were developed and externally validated. Results Age, the presence of diabetes mellitus, and preoperative estimated glomerular filtration rate were independent predictors of both postoperative estimated glomerular filtration rate and chronic kidney disease. A formula for predicting the postoperative estimated glomerular filtration rate and a nomogram for predicting the risk of postoperative chronic kidney disease were developed. The adjusted R2 of the formula and area under the receiver operating characteristic curves of the nomogram were 0.446 and 0.865 in the development cohort, and 0.396 and 0.787 in the validation cohort, respectively. Conclusions We developed and validated novel predictive models for the postoperative renal function 3 years after radical nephrectomy in Japanese patients.

Background: Methotrexate, vinblastine, doxorubicin, and cisplatin regimen, and gemcitabine and cisplatin regimen are widely used for advanced or metastatic urothelial carcinomas (UCs). However, a standard treatment for patients who fail these firstline chemotherapies is unavailable. We examined the efficacy and safety of secondline paclitaxel, gemcitabine, and cisplatin (PCG) chemotherapy in Japanese patients. Methods: Between 2004 and 2010, 25 patients with metastatic UCs who failed to respond to platinumbased regimens were treated with PCG. They received intravenous paclitaxel (60 mg/m2) and gemcitabine (1000 mg/m2) on days 1 and 8, and cisplatin (70 mg/m2) on day 2 of every 21 day course. We retrospectively collected patients’ clinical and pathological data and evaluated adverse effects and survivals. Results: Patients underwent 95 PCG cycles in all (average, 3.8 cycles per patient). One patient (4%) achieved complete response, 5 (20%) showed partial response, 8 (42%) had disease stabilization, and 5 (26%) had disease progression. Median overall survival was 8.5 months. Neutropenia and thrombocytopenia of grade ≥ 3 were observed in 68% and 56% of patients, respectively. No treatment related death occurred. Multivariate analysis revealed that hemoglobin levels 1.73 m2) were significant risk factors for overall survival. Conclusion: PCG chemotherapy in the secondline setting potentially contributed to good prognosis in selected patients with relatively significant but tolerable toxicity.

This retrospective study included 178 Japanese patients who underwentradical nephrectomy between 1980 and 2010. Kaplan–Meier survival curves with a log–ranktestandtheCoxproportionalhazardsmodelwereusedtoinvestigatetheimpactofthe estimated glomerular filtration rate at 1 month after the radical nephrectomy oncardiovascular-event-free, cancer-specific and overall survivals.

1 Case We report a case of IgG4-related prostatitis successfully treated with transurethral resection of the prostate (TUR-P). A 47-year-old man with a history of autoimmune pancreatitis and sclerosing cholangitis presented with lower urinary tract symptoms. Because ultrasonography revealed a mildly enlarged prostate and uroflowmetry showed a severely diminished flow curve, benign prostatic hyperplasia was diagnosed. Despite the administration of α1-blockers, the patient's condition did not improve, and TUR-P was performed in accordance with his wish. 2 Outcome Pathological examination showed dense lymphoplasmacytic inflammation with no evidence of synchronous malignancy. On immunohistochemical staining, a large number (>40/high-power field) of IgG4-positive cells were observed in the lesions showing the inflammation, confirming the diagnosis of IgG4-related prostatitis. The patient's urinary function dramatically improved postoperatively, and good urinary function has been maintained for 3 years without additional treatment. 3 Conclusion Recognition of the impact of IgG4-related prostatitis on objective urinary function will help in appropriately treating patients with this condition.

Metastasis from renal cell carcinoma (RCC) to the testis is rare. This case report presented an extremely rare case of simultaneous bilateral testicular metastases from RCC in a 65-year-old man who had experienced indolent scrotal enlargement over a period of several months. Scrotal ultrasonography showed 4.0- and 2.0-cm-sized masses in the left and right testes, respectively. Contrast-enhanced computed tomography identified multiple tumors in the kidneys, the pancreas and the left adrenal gland. Left orchiectomy and pathological examination were performed and indicated testicular metastasis from clear cell RCC. The patient underwent complete surgical resection of all residual lesions. Postoperative follow-up examination without adjuvant therapy identified no recurrence over 11 months. This study also reviewed existing literature and determined that retrograde venous spread from the primary kidney tumor to the testis may be an important pathway for testicular metastasis from RCC. In conclusion, RCC can result in testicular metastases not only unilaterally, but also bilaterally, as was observed in the present case.

We report 2 rare cases of intrascrotal tumors complicated acute scrotum. Case 1: A 15-year-old adolescent presented to our emergency room with acute right scrotal pain. Testicular torsion was suspected, and surgical exploration was performed. A spermatocele with 180 degrees torsion on its pedicle was observed. The patient was diagnosed with torsion of a spermatocele, and it was excised. Case 2: A 25-year-old man presented with acute left scrotal pain. Testicular torsion was suspected, and manual detorsion relieved the pain effectively. However, scrotal swelling did not subside after detorsion, and surgical exploration was performed. The left testis was stony hard on palpation, and intraoperative ultrasound revealed a mosaic echo pattern. A testicular tumor was highly suspected and left high orchiectomy was performed. Histopathological examination revealed seminoma pT1. Torsion of a testicular tumor was diagnosed. Although these 2 cases are extremely rare, they should be considered for the differential diagnosis of acute scrotum.

Objectives To investigate longitudinal changes in renal function after radical nephrectomy, and to explore risk factors of postoperative severe renal impairment in a Japanese multicenter cohort. Methods The present retrospective study included 701 patients who had no metastasis, end-stage kidney disease or bilateral kidney cancer, who underwent radical nephrectomy and who were followed up for at least 1 year. The longitudinal change in postoperative renal function during a 10-year follow-up period was evaluated according to the presence or absence of potential risk factors including greater age, chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease. A slope of annual change in estimated glomerular filtration rate was analyzed using a linear mixed model. Associations between the potential risk factors and a >50% estimated glomerular filtration rate decrease were evaluated using a multivariate Cox regression model. Results Overall, the postoperative estimated glomerular filtration rate recovered over time with a significant positive slope of 0.34 mL/min/1.73 m2/year. Renal function did not tend to recover in patients with chronic kidney disease, hypertension, diabetes mellitus or cardiovascular disease. The multivariate analysis showed that greater age and diabetes mellitus were independent risk factors for severe renal impairment. Conclusions Overall, patients who had deteriorated renal function immediately after radical nephrectomy recovered over time. However, patients with chronic kidney disease, hypertension, diabetes mellitus and cardiovascular disease did not tend to recover renal function postoperatively. Greater age and diabetes mellitus were independent risk factors for a >50% decrease in estimated glomerular filtration rate.

To compare the efficacy and safety of single half-dose silodosin and single full-dose tamsulosin in Japanese men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH).Japanese men aged ≥50 years with LUTS/BPH and an International Prostate Symptom Score (IPSS) of ≥8 were enrolled in the randomized crossover study and divided into silodosin-preceding (S-T) and tamsulosin-preceding (T-S) groups. The S-T group received 4 mg silodosin once daily for 4 weeks followed by 0.2 mg tamsulosin once daily for 4 weeks. The T-S group received the reverse treatment sequence. A washout period prior to drug crossover was not included. Subjective and objective efficacy parameters including IPSS, quality of life (QOL) index, uroflowmetry, and safety were compared between the two groups.Thirty of 34 men (S-T group n = 16; T-S group n = 14) completed the study. Both drugs significantly improved all IPSS items and QOL index in the first treatment period. Subjective improvement in nocturia by silodosin was observed in both the first and crossover treatment periods. Objective improvement in maximum flow rate by silodosin was only observed in the first treatment period. Adverse events occurred more frequently with silodosin than with tamsulosin; however, none of the adverse events required treatment discontinuation. Ejaculation disorders occurred in three participants (10%) and were associated with silodosin use.Single half-dose silodosin has a similar efficacy to full-dose tamsulosin in Japanese men with LUTS/BPH and thus, may represent an effective, safe, and affordable treatment option.

Air bubbles floating in the bladder dome during transurethral resection of a bladder tumor can interfere with the resection, causing intravesical explosion and increasing the potential risk of tumor cell reimplantation. We describe a simple and effective technique for evacuating air bubbles from the bladder dome using routine resectoscopes. First, the beak of the resectoscope is positioned near the air bubble in the bladder dome. Second, the drainage channel of the resectoscope is closed. Third, the irrigation tube is detached from the irrigation channel, and then the channel is opened. Subsequently, the air bubble with entangled scum will be retrogradely aspirated from the beak of the resectoscope to the irrigation channel. Reversing the direction of the water stream enables evacuation of the air bubble with the scum under direct vision. This simple and effective technique may assist surgeons and ensure the safety of patients during a transurethral procedure.

To identify risk factors and develop a model for predicting recurrence of upper urinary tract urothelial carcinoma (UTUC) in the bladder in patients without a history of bladder cancer after radical nephroureterectomy (RNU).We retrospectively reviewed 754 patients with UTUC without prior or concurrent bladder cancer or distant metastasis at 13 institutions in Japan. Univariate and multivariate Fine and Gray competing risks proportional hazards models were used to examine the cumulative incidence of bladder recurrence of UTUC. A risk stratification model and a nomogram were constructed. Two prediction models were compared using the concordance index (c-index) focusing on predictive accuracy and decision-curve analysis, which indicate whether a model is appropriate for decision-making and determining subsequent patient prognosis.The cumulative incidence rates of bladder UTUC recurrence at 1 and 5 years were 15 and 29%, respectively; the median time to bladder UTUC recurrence was 10 months. Multivariate analysis showed that papillary tumour architecture, absence of lymphovascular invasion and higher pathological T stage were both predictive factors for bladder cancer recurrence. The predictive accuracy of the risk stratification model and the nomogram for bladder cancer recurrence were not different (c-index: 0.60 and 0.62). According to the decision-curve analysis, the risk stratification was an acceptable model because the net benefit of the risk stratification was equivalent to that of the nomogram. The overall cumulative incidence rates of bladder cancer 5 years after RNU were 10, 26 and 44% in the low-, intermediate- and high-risk groups, respectively.We identified risk factors and developed a risk stratification model for UTUC recurrence in the bladder after RNU. This model could be used to provide both an individualised strategy to prevent recurrence and a risk-stratified surveillance protocol.

To assess the general applicability of TNM-C scoring, which consists of TNM classification and preoperative C-reactive protein concentration, the predictive ability of the TNM-C score was externally validated for patients with clear cell renal cell carcinoma (ccRCC) at three community hospitals.Seven hundred patients underwent radical or partial nephrectomy after being diagnosed with RCC. Out of the 700 patients, 518 with clear cell carcinoma served as the current study cohort. The predictive ability of the TMN-C score for cancer-specific survival (CSS) was estimated using Harrell's concordance index (c-index).The c-index of the TNM-C score was 0.85 in the entire data set. CSS rates were clearly stratified according to the scoring model (p0.001).Since TNM-C score alone (without pathological details) has a high predictive ability for the prognosis of ccRCC patients, it is generally applicable for use in community hospitals.

UTUC database and the UTUC collaboration (n 4137). After excluding the nine patients who we previously reported on [5], 28 patients (0.7%) with pT0 tumor were included in this report. All patients had undergone cystoscopy, urine cytology, intravenous urography and/or abdominalpelvic CT-scans, and diagnostic ureteroscopy prior to RNU. None of the patients underwent preoperative radiotherapy and none of the patients had metastasis at time of RNU. Due to the low number of patients, only descriptive results are shown. RESULTS: The median age at diagnosis was 68 years (IQR: 57-74) and the male-to-female ratio was 2:1. Six patients had evidence of non-organ confined UTUC on pre-RNU imaging and received neoadjuvant cisplatin-based combination chemotherapy. Regional lymphadenectomy was performed in the six patients who had received neoadjuvant chemotherapy (median: 10 lymph nodes, IQR 6-14). On final pathology, all patients had pT0N0 except one patient who had two positive renal hilar lymph nodes (pT0 N1). Overall, 4 patients experienced disease recurrence (median time to recurrence : 38 months, IQR: 24-48). Three of these patients developed metastatic disease and one had a relapse in the operative field. The three patients with metastasis died from UTUC within a median time of 10 months from their disease recurrence. Within a median follow-up of 40 months (IQR: 22-64), nine patients developped intravesical recurrence (median time: 35 months, IQR: 14-54). The 5-year recurrence-free and cancer-specific survival rates were 77% (95% CI, 72-81.3) and 78% (95% CI, 69-83.8), respectively. CONCLUSIONS: pT0 UTUC may be the result from effective neoadjuvant chemotherapy, complete endoscopic treatment, misinterpretation of the pathologic specimen (i.e, false pT0), or overtreatment. Our limited data shows that post-RNU prognosis of pT0 patients is highly variable as some patients experience disease progression needing more stringent follow-up.

Yuma Waseda*, Kazutaka Saito, Junichiro Ishioka, Yoh Matsuoka, Noboru Numao, Fumitaka Koga, Hitoshi Masuda, Yasuhisa Fujii, Tokyo, Japan; Yasuyuki Sakai, chiba, Japan; Tetsuo Okuno, Ibaraki, Japan; Chizuru Arisawa, Tokyo, Japan; Shigeyoshi Kamata, Saitama, Japan; Katsuji Nagahama, Chiba, Japan; Junji Yonese, Tokyo, Japan; Akira Noro, Saitama, Japan; Toshihiko Tsujii, Tokyo, Japan; Shinji Morimoto, Ibaraki, Japan; Yotsuo Higashi, Saitama, Japan; Iwao Fukui, Kazunori Kihara, Tokyo, Japan

To develop and validate predictive models for postoperative estimated glomerular filtration rate and risk of chronic kidney disease after radical nephrectomy in Japanese patients.The present retrospective study included a development cohort of 209 patients without preoperative chronic kidney disease who underwent radical nephrectomy between 1994 and 2008, and were followed up for longer than 3 years, and a validation cohort of 144 similar such patients. Univariate and multivariate linear regression or logistic regression analyses were carried out to identify the independent predictors of estimated glomerular filtration rate or chronic kidney disease 3 years after radical nephrectomy. Incorporating all independent predictors, predictive models for postoperative renal function were developed and externally validated.Age, the presence of diabetes mellitus, and preoperative estimated glomerular filtration rate were independent predictors of both postoperative estimated glomerular filtration rate and chronic kidney disease. A formula for predicting the postoperative estimated glomerular filtration rate and a nomogram for predicting the risk of postoperative chronic kidney disease were developed. The adjusted R(2) of the formula and area under the receiver operating characteristic curves of the nomogram were 0.446 and 0.865 in the development cohort, and 0.396 and 0.787 in the validation cohort, respectively.We developed and validated novel predictive models for the postoperative renal function 3 years after radical nephrectomy in Japanese patients.

Evaluation of the malignant potential of a pheochromocytoma (PCC) remains controversial. PCC is regarded as a neuroendocrine tumor (NET), and the classification of NETs has gradually been defined over the last decade, particularly for gastroenteropancreatic NET. The present study describes a case of locally advanced, carcinoma-like, nonfunctional PCC, which may be regarded as neuroendocrine carcinoma (NEC) rather than a malignant PCC. A 72-year-old man was referred to Saitama Red Cross Hospital (Saitama, Japan), presenting with a 2-month history of right flank pain. Computed tomography revealed a right adrenal gland tumor, which measured 6.0 cm in diameter, invading the hilum of the right kidney, liver and inferior vena cava (IVC). Radical surgery was performed with en bloc resection of the right kidney, and adjacent parts of the liver and IVC. Immunohistochemical examination demonstrated that all of the resected tissues were positive for cytokeratin AE1/AE3, chromogranin A, synaptophysin, cluster of differentiation 56 and Ki-67, and the specimen had a Ki-67 index of 80%. A diagnosis of carcinoma-like PCC or NEC of the adrenal gland was confirmed. Reports of NEC of the adrenal gland are extremely rare in the literature, and classification of PCC as a NET has not yet been fully discussed. The present case may therefore contribute to the classification of NETs in the adrenal gland.

INTRODUCTION AND OBJECTIVES: Many patients develop chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m after radical nephrectomy (RN) which is the most commonly performed surgery for kidney cancer even today. We recently reported that 35% of Japanese patients who underwent RN developed CKD within 2 years after surgery (J Urol, 2011). However, predictive models for post-nephrectomy renal function have not been established. In this study, we investigated the predictors of post-nephrectomy renal function in a Japanese patient cohort. We then developed a nomogram to predict the risk of CKD after RN and a formula to predict postoperative eGFR. We validated these predictive models in an external cohort. METHODS: This retrospective study included 257 patients that underwent RN between 1994 and 2009 in a development cohort and 76 in a validation cohort. In the development cohort, univariate and multivariate logistic regression or linear regression analyses were performed to identify the independent predictors for CKD or eGFR 2 years after RN. Then, a logistic regression-based nomogram to predict postoperative CKD and a linear regression-based formula to predict postoperative eGFR were developed. These predictive models were subsequently validated in the external cohort. RESULTS: Age, presence of diabetes mellitus (DM), and preoperative eGFR were significant and independent predictors of both postoperative CKD and eGFR. In a logistic regression-based nomogram (Figure 1), the probability of developing CKD within 2 years after RN (P) was given by the following formula with an area under the receiver operating characteristic curve (AUC) of 0.876: P 1 / (1 exp(Y)), where Y 5.438 0.048 age (years) 0.094 preoperative eGFR (ml/min/1.73 m) 1.633 (if DM was present). The predicted eGFR value 2 years after RN was given by the following formula with adjusted R of 0.483 (p 0.001): postoperative eGFR (ml/min/1.73 m) 35.05 0.228 age (years) 0.450 preoperative eGFR (ml/min/1.73 m) 9.446 (if DM was present). In the validation cohort, the AUC of the nomogram and the adjusted R of the formula were 0.857 and 0.584 (p 0.001), respectively. CONCLUSIONS: We developed and validated novel predictive models for CKD and eGFR 2 years after RN with high predictive accuracy.

Mycobacterium tuberculosis infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is rare, and its diagnosis and treatment are difficult because numerous cysts are exposed to infection and antibiotics do not easily penetrate infected cysts. Here, we report the case of a 43-year-old Japanese man with disseminated urogenital tuberculosis (TB) and ADPKD without human immunodeficiency virus (HIV) infection. Delayed diagnosis and ineffective anti-TB chemotherapy worsened his condition. Finally, he underwent bilateral nephrectomy but experienced postoperative complications. In conclusion, kidney TB should be recognized as a cause of renal infection in ADPKD, and surgical treatment should be instituted without delay. The importance of early diagnosis and treatment cannot be overemphasized to prevent kidney TB deterioration.

In renal infections, lack of peculiar symptoms and consequent delay of diagnosis can sometimes lead to a critical condition of the patient. We report three cases of life-threatening renal infections in female patients, two of which were subsequently fata. One patient died of left emphysematous pyelonephritis with bilateral pleuritis. The patient was correctly diagnosed 13 days after the onset of symptoms and expired 2 months later despite nephrectomy on the day of diagnosis. The second patient died of septic shock 3 days following the onset of symptoms. Autopsy revealed multiple perinephric abscess of the left kidney. The non-fatal case was a perinephric abscess spread to the iliopsoas muscle. The patient was diagnosed with perinephric abscess 11 days after the onset of symptoms and eventually underwent nephrectomy 9 days later. Two of the patients were diabetics and the third was a probable diabetic, who died too suddenly to confirm the diagnosis. Herein, we review the literature of, and discuss the diagnosis and management of serious renal infection.

Clinical courses of 293 patients with superficial papillary bladder tumors were analysed on the basis of tumor number at the first presentation. The follow-up period ranged from 6 to 266 months with a median of 59 months. 171 patients (58%) had a single tumor, while 122 (42%) had multiple tumors. Those older than 60 years occupied 68% in the latter group and 51% in the former (p less than 0.01). High grade tumors were more frequent in the latter than the former (p less than 0.05). The five-year recurrence rate was 68% for the latter and 39% for the former single tumor group (p less than 0.01). Malignant progression was observed in 3.6% of patients with a single tumor and 13.4% of those with multiple tumors (p less than 0.01). The results would offer a theoretical background to the finding of a poor ten-year actuarial survival rate of 54% for multiple tumor group compared with 76% for the single tumor group (p less than 0.05). However, the rate of primary cancer death was similar in both groups.