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A 71-year-old man underwent a radical nephrectomy for right renal cell carcinoma in April, 2005. Pathological findings revealed clear cell carcinoma, G3＞G2, pT3a. Three years later, he underwent a craniotomy for tumor resectionof solitary brainmetastasis. InOctober, 2008, he came to our hospital because of urinary retention. Benign prostate hypertrophy was diagnosed by ultrasonography and digital rectal examination. Serum prostate specific antigen level was 2.55 ng/dl. While he was treated with oral α 1-blocker initially, a urethral catheter was inserted in December, 2009. Because of frequent obstruction of the catheter by hematuria, transureathral prostectomy was performed. Pathological findings revealed prostatic metastasis of renal cell carcinoma. Metastasis of renal cell carcinoma to the prostate is rare, and only 7 cases including the present case have been reported.

We report a case of marginally resectable gastrointestinal stromal tumor (GIST) in the pelvis treated with neoadjuvant intent before subsequent successful surgical resection. A 46-year old man presented with urinary frequency and rectal discomfort with tenesmus. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 12 cm diameter mass between the bladder and rectum and the margin of the tumor and prostate was unclear. No metastases were evident. Trans-rectal needle core biopsy confirmed c-kit positive GIST. Because of the locally advanced nature of the tumor, immediate surgical resection would have required total pelvic exenteration with eternal colostomy and urinary diversion. Therefore, the patient was treated with imatinib mesylate 400 mg daily in anticipation of adequate tumor size reduction to enable a more simplified surgical approach. After 3 months of imatinib therapy, MRI demonstrated a reduction in tumor size of 60%. Consequently, a complete surgical resection including the bladder, prostate and part of the sigmoid colon with temporary ileostomy and ileal conduit was performed. Pathological findings of the resected specimen showed widespread degeneration with cystic changes, necrosis, and hypocellularlity, as well as nodules of residual viable c-kit positive tumor cells. The patient has been treated with imatinib mesylate for 39 months following the operation without tumor recurrence.

2002年4月～2005年3月に腹腔鏡下前立腺全摘除術を行った104例(平均年齢64.6歳)中70例(67.3%)を対象に術後尿失禁実態調査の回答を得て検討した。70例中ほとんどが術後6ヵ月以内に尿失禁は消失しており, そのうち3ヵ月以内の早期消失は40.0%であった。早期消失群と3ヵ月目持続群における患者要因パラメーターでは両群間に有意差はなく9.5%例を認め, 神経温存手技は早期消失群42.8%, 3ヵ月持続群59.5%に行われた。さらに尿失禁持続群42例中36例を経過観察期間で3～11ヵ月(S群), 12ヵ月～23ヵ月(IM群), 24ヵ月以上(L群)に分類し検討した。尿失禁の誘因項目数は1症例あたりS群の平均5.0で5例全例が複数誘因を持っており, IM群は平均1.6項目で複数誘因は47.1%, L群は平均1.2項目で複数誘因は14.3%と経時的に減少した。パット使用状況における各群のパットフリー症例はS群0%, IM群29.4%, L群83.3%と術後経過に伴い増加した。腹圧性尿失禁に認められる誘引については経時的に減少したが切迫性, 反射性尿失禁に認められる誘因はS群では0%であるがIM群5.9%, L群28.6%と増加した。極少量の尿失禁であっても患者のQOLは著しく損なわれ, 医師側のそれとは必ずしも一致しておらず正確に把握することが重要と考えられた。, A cross-sectional study for certain symptoms of postoperative incontinence was done for patients who underwent laparoscopic radical prostatectomy (LRP) using our original self-administered questionnaire. A total of 104 patients, who underwent LRP from April 2002 to March 2005 in our institute and related hospitals, participated in our questionnaire study. Mean age and median observation period was 64.6 years old (range 51-74) and 18 months (range 3-36). The patients were classified into "D group" (disappearance of incontinence during 3 months after LRP) and "C group" (continuous incontinence more than 3 months). Then age, body mass index, preoperative PSA level, status of voiding, defecation and potency were compared. Patients with incontinence were divided according to observation period into "short period group" (S group; 3-11 months), "intermediate period group" (IM group; 12-23 months) and "long period group" (L group; more than 23 months). Incitant factors of incontinence, status of taking pads and QOL score were compared. There were no differences between the D and C groups at any measurements. About 40% of incontinence patients were pad-free, although most of these patients did not satisfy the status of voiding. The incitant factor in 90% of the S group was "cough or sneeze", but that in the L group was "without notice" (about 40%) and "too late to toilet (voiding)" (about 25%). After all, postoperative QOL score was still lower in the patients with incontinence regardless of its volume. Further study to revolutionary improve incontinence is required.

A 29-year-old woman was hospitalized in our institute with the diagnosis of a right renal mass by ultrasonography on medical checkup. Computerized tomography showed a lower pole solid mass (9 cm in diameter), which was enhanced homogeneously, as well as the renal cortex in the arterial phase. The tumor was excised using radical nephrectomy based on the preoperative diagnosis of renal cell carcinoma, and thus lymph node dissection was also performed. The excised tumor was isolated from the kidney in a thin capsule, macroscopically. Postoperative pathological diagnosis revealed hyaline vascular type Castleman's disease. There was no recurrence at 1 year after the operation without any adjuvant therapy because of the complete resection., 29歳, 女性。健診超音波検査で右腎腫瘍を指摘され当科を受診した。CTでは右腎下極に径9cm, 内部均一で動脈相にて腎実質と同等に造影される腫瘍を認めた。腎細胞癌の術前診断にて根治的腎摘除術およびリンパ節郭清術を施行した。切除標本肉眼所見では腫瘍は薄い被膜を有し腎と完全に隔てられていた。術後病理診断はCastleman病(hyaline vascular type)であった。術後1年を経過した時点で再発は認められていない。(著者抄録)

症例1(63歳男).levofloxacin(LVFX)を予防投与し経直腸的生検を施行したが, 急性前立腺炎の診断で入院した.敗血症に伴う播種性血管内凝固症候群(DIC)と診断し膀胱瘻造設をし治療を開始した.敗血症性ショックと診断しdopamineを投与し, 徐々に安定4日目に中止したが全身の炎症所見に改善は見られず, 5日目に多剤耐性大腸菌が原因と判明した.抗生剤をmeropenem(MEPN), teicoplanin(TEIC)に変更したが7日目も改善は認められず, エンドトキシン検査結果の陽性からエンドトキシン吸着療法を施行後, 全身状態, 炎症所見は改善傾向となった.12日目に抗DIG療法を中止し, 14日目に抗生剤をcefdinir(CFDN)に変更し投与継続のまま27日目に退院となった.症例2(64歳男).cefazolin(CE2)の予防抗生剤を投与後, 経直腸的前立腺生検を実施した.翌日退院したが2日目に生検後前立腺炎の診断で入院となった.敗血症に伴うDICと判断し, 膀胱瘻造設し抗DIC療法を開始し, 5日目に全身状態改善で抗DIC療法を中止した.原因菌は多剤耐性大腸菌で6日目から抗生剤をLVFXに変更した.17日目にLVFXを中止したが19日目に再然した.MEPNの治療開始後, 主症状改善が見られ27日目にLVEXへ変更し投与継続で退院した, We report two cases of sepsis and disseminated intravascular coagulation (DIC), potentially fatal complications, following transrectal prostate biopsy. We also review similar cases reported in Japan. Case 1: A 63-year-old man received a cathartic and levofloxacin (LVFX) for prophylaxis. After transrectal prostate biopsy, he presented with fever and chills. Blood cultures grew Escherichia coli resistant to LVFX. Under a diagnosis of sepsis, he received intensive management that included endotoxin removal therapy. The patient was hospitalized for 27 days. Case 2: A 64-year-old man received a cathartic and cefazolin (CEZ) for prophylaxis. He presented with fever and chills after biopsy, and was admitted to hospital. Blood cultures grew E. coli resistant to CEZ. Under a diagnosis of sepsis, he received intravenous antibiotics, transfusion, and anti-DIC drugs. The patient was hospitalized for 11 days.

A 40-year-old woman was referred to our hospital with right lower back pain as the chief complaint. Contrast-enhanced computed tomography (CT) showed a partially-solid tumor within a cyst measuring approximately 6 cm in diameter in the right renal hilum. The solid part was enhanced in the early phase and contrast medium was washed out earlier in the solid part than in the parenchyma in the equilibrium phase. Plain CT revealed partial cyst wall calcification. A soft tissue shadow approximately 10 mm in diameter in the dorsal inferior vena cava at the upper pole of the kidney and a solid tumor adjacent to the iliopsoas muscle and the kidney were detected. We performed radical nephrectomy and lymph node dissection with transperitoneal approach. The histopathological diagnosis was neuroendocrine tumor. Her clinical course has since been observed on an outpatient basis, for nearly 10 months to date, without any recurrence.

We present a case of laparoscopic radical nephrectomy in right renal cell carcinoma with left inferior vena cava in a 65-year-old male. Abdominal contrasted CT scan revealed that the left inferior vena cava crossed the aorta at the level of third lumbar vertebra. Laparoscopic radical nephrectomy was performed transperitoneally. A right gonadal vein drained into the right renal vein. We indentified a right renal vein easily with tracing the right gonadal vein. Left inferior vena cava is a very rare congenital anomaly among malformation of inferior vena cava. Recognition of such venous anomalies and making a detailed strategy before operation is important especially in laparoscopic surgery.

We report a case of marginally resectable gastrointestinal stromal tumor (GIST) in the pelvis treated with neoadjuvant intent before subsequent successful surgical resection. A 46-year old man presented with urinary frequency and rectal discomfort with tenesmus. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 12 cm diameter mass between the bladder and rectum and the margin of the tumor and prostate was unclear. No metastases were evident. Trans-rectal needle core biopsy confirmed c-kit positive GIST. Because of the locally advanced nature of the tumor, immediate surgical resection would have required total pelvic exenteration with eternal colostomy and urinary diversion. Therefore, the patient was treated with imatinib mesylate 400 mg daily in anticipation of adequate tumor size reduction to enable a more simplified surgical approach. After 3 months of imatinib therapy, MRI demonstrated a reduction in tumor size of 60%. Consequently, a complete surgical resection including the bladder, prostate and part of the sigmoid colon with temporary ileostomy and ileal conduit was performed. Pathological findings of the resected specimen showed widespread degeneration with cystic changes, necrosis, and hypocellularlity, as well as nodules of residual viable c-kit positive tumor cells. The patient has been treated with imatinib mesylate for 39 months following the operation without tumor recurrence.

A 71-year-old man with dysuria was referred to our hospital. The level of serum prostate specific antigen was slightly elevated (4.66 ng/ml), and digital rectal examination revealed a stony hard prostate mass. We performed a transrectal prostate biopsy because malignancy was suspected. Histological examination revealed leukemia-like cells, and bone-marrow examination (aspiration) was performed to determine the location of the original lesion. However, no leukemia-like cells or any other form of malignant cells were identified. Clinical imaging confirmed the absence of any other lesions, and granulocytic sarcoma of the prostate was subsequently diagnosed. We treated the cancer with radiotherapy at a dose of 40 Gy and dysuria improved. Furthermore, significant reduction in prostate volume was confirmed. Four months after initial presentation, the patient developed acute myeloid leukemia [M2 by French-American-British classification]. Induction chemotherapy was initiated, and the patient was successfully induced to complete remission. Twenty months later, the patient showed relapse. Despite salvage chemotherapy, he died of brain hemorrhage twenty-four months after complete remission.

A 39-year-old man visited our clinic with gross hematuria. Cystoscopy revealed a papillary tumor at the urinarybladder dome. Abdominal magnetic resonance imaging (MRI) and computed tomography(CT) demonstrated a tumor extending from the umbilicus to the bladder dome. Transurethral resection of bladder tumor (TUR-Bt) was performed and histopathological findings revealed adenocarcinoma. Chest CT and examination of the upper gastrointestinal did not reveal anyabnormal findings. The tumor was diagnosed as stage IIIA urachal carcinoma, and en bloc segmental resection was performed. About 10 months later, chest CT demonstrated multiple lung metastases. After two courses of combination chemotherapywith methotrexate (MTX), 5-fluorouracil (5-FU), epirubicin (epiADM), and cisplatin (CDDP), the multiple lung metastases completelydisappeared. The patient has survived 23 months to date with no evidence of disease and is receiving adjuvant chemotherapywith tegafur uracil.

We present a case of laparoscopic radical nephrectomy in right renal cell carcinoma with left inferior vena cava in a 65-year-old male. Abdominal contrasted CT scan revealed that the left inferior vena cava crossed the aorta at the level of third lumbar vertebra. Laparoscopic radical nephrectomy was performed transperitoneally. A right gonadal vein drained into the right renal vein. We indentified a right renal vein easily with tracing the right gonadal vein. Left inferior vena cava is a very rare congenital anomaly among malformation of inferior vena cava. Recognition of such venous anomalies and making a detailed strategy before operation is important especially in laparoscopic surgery.

A cross-sectional study for certain symptoms of postoperative incontinence was done for patients who underwent laparoscopic radical prostatectomy (LRP) using our original self-administered questionnaire. A total of 104 patients, who underwent LRP from April 2002 to March 2005 in our institute and related hospitals, participated in our questionnaire study. Mean age and median observation period was 64.6 years old (range 51-74) and 18 months (range 3-36). The patients were classified into "D group" (disappearance of incontinence during 3 months after LRP) and "C group" (continuous incontinence more than 3 months). Then age, body mass index, preoperative PSA level, status of voiding, defecation and potency were compared. Patients with incontinence were divided according to observation period into "short period group" (S group; 3-11 months), "intermediate period group" (IM group; 12-23 months) and "long period group" (L group; more than 23 months). Incitant factors of incontinence, status of taking pads and QOL score were compared. There were no differences between the D and C groups at any measurements. About 40% of incontinence patients were pad-free, although most of these patients did not satisfy the status of voiding. The incitant factor in 90% of the S group was "cough or sneeze", but that in the L group was "without notice" (about 40%) and "too late to toilet (voiding)" (about 25%). After all, postoperative QOL score was still lower in the patients with incontinence regardless of its volume. Further study to revolutionary improve incontinence is required.

We report two cases of sepsis and disseminated intravascular coagulation (DIC), potentially fatal complications, following transrectal prostate biopsy. We also review similar cases reported in Japan. Case 1: A 63-year-old man received a cathartic and levofloxacin (LVFX) for prophylaxis. After transrectal prostate biopsy, he presented with fever and chills. Blood cultures grew Escherichia coli resistant to LVFX. Under a diagnosis of sepsis, he received intensive management that included endotoxin removal therapy. The patient was hospitalized for 27 days. Case 2: A 64-year-old man received a cathartic and cefazolin (CEZ) for prophylaxis. He presented with fever and chills after biopsy, and was admitted to hospital. Blood cultures grew E. coli resistant to CEZ. Under a diagnosis of sepsis, he received intravenous antibiotics, transfusion, and anti-DIC drugs. The patient was hospitalized for 11 days.