Search

This study attempts to explore the export potential and competitive position of Pakistan's meat sector versus the World's leading meat exporters using RCA scores of 26 meat products lines at HS 6-digit code from 2009-2018. The study also explores the untapped Halal Meat export potential for UAE and Saudi Arabia by using indicative trade potential. The findings of the study reveal that Pakistan possesses strong comparative advantage in low value-added bovine meat products while has a weak comparative advantage in high value-added categories of the same product line against its leading competitors like Brazil, USA, Netherlands and Australia. Poultry comes out to be an emerging sub sector, while the meat of goat, lamb and sheep witnessed a decreasing RCA score post 2013 and are categorized as the threatened products. The untapped Halal meat export potential to Saudi Arabia and UAE comes out to be worth $ 132 million. To become a global market player in high value-added meat products and to realize untapped export potential, Pakistan needs to address the issues of traceability, weak supply chains, insufficient number of local meat brands, weak infrastructure, improperly managed marketing strategies, noncompliance to international standards, and halal meat certifications. [ABSTRACT FROM AUTHOR]

Abstract Background We investigated the differences between the preferential primary therapy conceived by the primary doctors and the primary therapy actually conducted for prostate cancer patients in Nara, Japan. Methods The distribution of primary therapy and clinical characteristics of 2303 prostate cancer patients - diagnosed between 2004 and 2006 at Nara Medical University and its 23 affiliated hospitals - were assessed. Moreover, the preferential primary therapy for the patients at each clinical stage (cT1-T3bN0M0) conceived by the primary doctors was investigated and compared to the actual therapy. Results Of all patients, 51% received primary androgen deprivation therapy (PADT), 30% underwent radical prostatectomy (RP), and 14% received radiation therapy (RT). The preferential primary therapy for cT1-2N0M0 was RP (92%) while 38% of the patients actually received PADT (RP: 40%). For cT3aN0M0, the preferential primary therapy was both RP and external beam radiation therapy (EBRT) while 58% of the patients actually received PADT (RP: 16%, EBRT: 24%). For cT3bN0M0, the most preferential primary therapy was EBRT (46%) while 67% of the patients actually received PADT (EBRT: 21%). This trend was more notable in the affiliated hospitals than in the University hospital. The hospitals with lower volume of RP per year significantly conducted PADT compared with those with higher volume of RP. Conclusions PADT was commonly used to treat localized prostate cancer as well as locally advanced prostate cancer in Japan. There was a definite discrepancy between the preferential primary therapy conceived by the primary doctors and the actual therapy provided to the patients.

This study quantified hazardous heavy metals (Cu, Cr, and Pb) in soil and vegetables (potato, tomato, pepper, cauliflower, and cabbage) across six upazilas (Kahaloo, Bogura Sadar, Shajahanpur, Shibganj, Nandigram, and Dupchanchia) in Bogura district, Bangladesh, assessing their health and environmental impacts. The detection method was validated for its accuracy and precision with QC samples. Results indicated that Cu levels in all samples were within safe limits set by BFSA and FAO/WHO, whereas Cr and Pb in vegetables exceeded permissible levels, though soil concentrations remained within limits. Pb contamination was particularly severe in vegetables (CF > 6), and all vegetables showed significant contamination degrees (CD), highlighting extensive heavy metal pollution. The Pollution Load Index (PLI) identified Kahaloo and Bogura Sadar as the most polluted, whereas Nandigram and Dupchanchia were the least. Bioaccumulation factors (BF) for all metals were <1, suggesting minimal transfer to edible parts. However, the ecological risk index (ERi) and potential ecological risk index (PERI) suggested low ecological risks, but health risk assessments indicated that vegetable consumption poses significant carcinogenic and non-carcinogenic risks (CHR > 10 -4 , HI > 1) across all upazilas. The findings underscore the urgent need for measures to mitigate heavy metal pollution in these areas to safeguard environmental and public health., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: Endocrinopathies and metabolic complications are common in beta thalassemia major patients receiving blood transfusions. Chelation therapy has a role in preventing or delaying such complications. However, patients may face difficulties adhering to chelation therapy for several reasons., Aim: To evaluate endocrine complications in beta thalassemia major patients (2-30 years) in the Eastern Province of Saudi Arabia and compare the onset of endocrine complications among compliant and noncompliant patients. Moreover, we assessed the barriers that hinder compliance with chelating therapy., Methods: A cross-sectional study was conducted on 89 patients (43 males and 46 females) aged 2 to 30 years attending different hospitals in the Eastern Province of Saudi Arabia. A semi-structured questionnaire was used to collect demographic data and medical histories. The questionnaires were completed by face-to-face interviews with the patients or their caregivers, and the required laboratory data were retrieved from the medical records of patients., Results: The most prevalent abnormality was underweight detected in (40.9%) of patients, followed by subclinical hypothyroidism (37.7%), short stature (35.2%), hypothyroidism in (17.0%) and diabetes mellitus in (13.6%). A significant difference between those who were compliant with iron chelation therapy and those who were not in terms of the prevalence of short stature ( P value= 0.05 ) and hypothyroidism ( P value= 0.05 ). The percentage of patients who were not compliant with chelation therapy was 21.6% and 9.1% of patients were not taking them at all., Conclusion: Despite the role of chelation therapy in the management of iron overload, the risk of secondary endocrine and metabolic complications remained considerable. Subclinical hypothyroidism and short stature were the most frequent endocrine complications encountered in this study., Competing Interests: The authors have declared that no competing interests exist. The products used for this research are commonly and predominantly used products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Additionally, the research was not funded by the producing company rather it was funded by the personal efforts of the authors., (© 2022 Habbash et al.)

Occlusion of internal ureteral stents commonly called double-J (DJ) stent leads to renal dysfunction, urinary tract infection, and difficulty in replacing the stent. We investigated the cause of stent occlusion and whether DJ stent occlusion persisted with change in the type of stent. The internal ureteral stent, Bird® Inlay™ Optima or Boston Scientific® Tria™, was inserted in 43 ureters of 33 patients who underwent replacement more than three times between September 2017 and June 2020. We defined stent occlusion as follows: a guide wire could not be passed through a stent during the replacement. In the first occlusion, the type of stent was changed. In the second occlusion, the stent placement interval was shortened from 12-13 weeks to 6-8 weeks. The presence of urinary stone and insertion of a urethral catheter had a high risk of DJ stent occlusion. Stent occlusion was observed in 20 of the 43 ureters. After the type of stent in 20 ureters with stent occlusion was changed, there were no DJ stent occlusions in 16 of the 20 ureters. Nevertheless, in 4 of the 20 ureters, even if we changed the type, DJ stent occlusion was still present; hence, the replacement interval was shortened. Therefore, changing the type of stent may be a recommended intervention for DJ stent occlusion.

(Purpose) Our hospital plays the role of a prefectural core hospital for COVID-19 and mainly accepts moderate and severely ill patients. In addition, our hospital is also actively responsible for regional emergency medical care, and is designated as a cancer treatment cooperation base hospital. We started accepting patients with COVID-19 in April 2020, and 2 out of 10 wards of our hospital are in operation as exclusive wards for COVID-19 at the time of May 31, 2021. In this study, we compared the effects of the spread of COVID-19 on our urological practice with those before the spread. (Materials and methods) The number of urological operations, their types and average length of stay, the number of outpatients / inpatients, the unit cost of medical treatment income, the referral rate, and the reverse referral rate were calculated based on the in-hospital clinical statistics. (Results) The number of urological operations decreased to 847, 862, and 768 in fiscal year 2018, 2019, and 2020, respectively. There was no significant change in the number of surgeries for malignant tumors in fiscal year 2020, but the number of surgeries for benign diseases decreased. The number of emergency operations tended to increase in fiscal year 2020. The number of urological hospitalized patients in fiscal year 2018, 2019, and 2020 decreased to 653, 690, and 533, and the average length of stay was shortened to 8.4, 8.8, and 8.1 days, respectively. The outpatient and inpatient unit prices per patient when fiscal year 2018 was set to 100 were increasing to 119.5 and 104.9, 133.7 and 119.1 in fiscal year 2019 and 2020, respectively. (Conclusion) It is thought that the spread of COVID-19 has clarified the function and characteristics of our hospital in community medicine.

Objectives: To elucidate whether a modified technique for anterior reconstruction could improve urinary continence after robot-assisted laparoscopic radical prostatectomy (RALP)., Methods: Among 325 consecutive patients who underwent RALP at our hospital, 297 patients were included in this retrospective study, who had complete records including the status of postoperative urinary continence. Among these 297 patients, 194 underwent anterior reconstruction by suturing the lateral bladder wall to the arcus tendineus of the pectineal fascia without fixation of the vesicourethral anastomosis site to the dorsal vein complex (DVC) (lateral-suture group). In the remaining 103 patients, simple suturing of the bladder neck muscle layer at the vesicourethral anastomosis site with DVC to immobilize the vesicourethral anastomosis site (immobilized group) was performed. Those who did not required a pad was defined as continent., Results: Operative and console times were significantly shorter in the immobilized group (242 vs. 268 min; p  = 0.03, and 174 vs. 203 min; p  = 0.009, respectively). Although there was no significant difference between the groups regarding the recovery of urinary continence within 3 months after RALP (21 vs. 22% at 1 month; p  = 0.77, and 54 vs. 60% at 3 months; p  = 0.33, respectively), more patients achieved urinary continence in the immobilized group than lateral-suture group after 6 months (71 vs. 83% at 6 months; p  = 0.03 and 82 vs. 96% at 12 months; p  = 0.001, respectively)., Conclusions: Simple suture of the bladder neck muscle layer at the vesicourethral anastomosis site to DVC led to a better urinary continence status 6 months or later after RALP.

Objectives: To analyze the correlation between periprostatic fat thickness on multiparametric magnetic resonance imaging and upstaging from cT1/2 to pT3 in robot-assisted radical prostatectomy., Methods: We retrospectively evaluated data from men with cT1/2 prostate cancer treated with robot-assisted radical prostatectomy at Nara Prefecture General Medical Center, Nara, Japan, between March 2013 and December 2017. We calculated the periprostatic fat thickness and subcutaneous thickness from preoperative multiparametric magnetic resonance imaging. We divided the cohort into two groups for analysis. Group 1 included patients upstaged from clinical to pathological stage, whereas group 2 included those without upstaging., Results: Data on 220 patients meeting the inclusion criteria were included in the analysis. A total of 36 patients were upstaged from clinical T1 or T2 to pathological T3, whereas 184 patients were not upstaged. The upstaging was associated with prostate volume, Gleason score, prostate-specific antigen density, periprostatic fat thickness, Prostate Imaging Reporting and Data System score based on univariate analysis. Multivariate analysis showed prostate volume (P = 0.03, odds ratio 0.958, 95% confidence interval 0.921-0.996), Gleason score (P = 0.022, odds ratio 2.676, 95% confidence interval 1.153-6.213) and periprostatic fat thickness (P = 0.004, odds ratio 1.26, 95% confidence interval 1.079-1.471) as independent risk factors of upstaging., Conclusions: Prostate volume, Gleason score and periprostatic fat thickness on multiparametric magnetic resonance imaging are significantly associated with and independent risk factors for upstaging from cT1/2 to pT3 in patients undergoing robot-assisted radical prostatectomy., (© 2020 The Japanese Urological Association.)

We aimed to investigate whether preoperative MRI findings could predict the bladder neck location on postoperative cystography and recovery of urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP). We retrospectively reviewed 270 consecutive patients who had complete preoperative data, including MRI, and underwent postoperative observation for more than three months. Preoperative MRI parameters consisted of the membranous urethral length (MUL) and pubic symphysis-prostate apex length (PAL) on sagittal images. The bladder neck location on a postoperative cystography was defined as the lowest extension of the tapering contrast medium in the bladder, and its relation to the pubic symphysis (above (higher group) and below (lower group) the middle of the pubic symphysis height) was evaluated. Those who required no pad or a safety pad were defined as being continent. PAL was significantly shorter in the higher group than that in the lower group (25.5 vs. 29.1 mm; p < 0.0001). The continent group at three months had a significantly longer MUL and shorter PAL than those in the incontinent group (8.1 vs. 6.7 mm; p < 0.05, and 26.0 vs. 28.1 mm; p < 0.05, respectively). Preoperative MRI parameters could predict the bladder neck location on postoperative cystograms and the recovery of urinary incontinence after RALP.

Objectives: To evaluate the clinical benefit of bone-modifying agents and identify the risk factors of skeletal-related events in patients with genitourinary cancer with newly diagnosed bone metastasis., Methods: This was a multicenter retrospective study including a total of 650 patients with bone metastasis of the following cancer types: hormone-sensitive prostate cancer (n = 443), castration-resistant prostate cancer (n = 50), renal cell carcinoma (n = 80) and urothelial carcinoma (n = 77). Clinical factors at the time of diagnosis of bone metastasis were analyzed. Early treatment with bone-modifying agents was defined as follows: administration of bone-modifying agents before the development of skeletal-related events and within 6 months from the diagnosis of bone metastasis., Results: During the follow-up period (median 19.0 months, interquartile range 6.0-43.8 months), skeletal-related events were reported in 88 (20%) patients with hormone-sensitive prostate cancer, 17 (34%) patients with castration-resistant prostate cancer, 58 (73%) patients with renal cell carcinoma and 34 (44%) patients with urothelial carcinoma. Early treatment with bone-modifying agents significantly prolonged the time to the first skeletal-related event in castration-resistant prostate cancer, renal cell carcinoma and urothelial carcinoma, but not in hormone-sensitive prostate cancer. Bone pain and elevated alkaline phosphatase levels were independent predictive risk factors of the first skeletal-related event. The subgroup analysis showed that early treatment with bone-modifying agents was associated with prolonged time to the first skeletal-related events in patients with bone pain or elevated alkaline phosphatase levels., Conclusions: Early treatment with bone-modifying agents should be considered, especially for patients with bone pain and elevated alkaline phosphatase levels, to prevent skeletal-related events in patients with genitourinary cancer with bone metastasis., (© 2019 The Japanese Urological Association.)

Objectives: To assess the association between postoperative cystogram findings and subsequent outcomes on urinary continence after robot-assisted laparoscopic radical prostatectomy (RALP)., Methods: A retrospective review of 250 consecutive patients who were observed for at least 12 months after RALP. The postoperative cystogram findings examined were: the location of the bladder neck, degree of bladder abnormalities, and presence of outflow of contrast medium into the urethra during the filling phase of cystography. The continence status based on pad usage was recorded. Those who required no pad or only a safety pad were defined as continent., Results: Patients with a bladder neck location above the middle of the pubic symphysis height exhibited significantly higher continence levels than those with a lower bladder neck location at both postoperative 3 and 12 months (P < 0.0001 and P = 0.0002, respectively). The higher a bladder neck was located, the earlier the urinary continence was achieved after RALP (P < 0.0001). Patients without contrast outflow into the urethra during cystogram demonstrated a significantly more favorable continence status at the 3-month follow-up (P = 0.004). Patients without bladder abnormalities on postoperative cystogram demonstrated a significantly more favorable continence status at the 12-month follow-up than those with bladder abnormalities (P = 0.01)., Conclusions: Postoperative cystogram findings may predict recovery of urinary continence after RALP., (© 2019 John Wiley & Sons Australia, Ltd.)

Recently, robot-assisted laparoscopic prostatectomy (RALP) has become a widely accepted surgical alternative for the treatment of prostate cancer. The intravesical migration of clips is a rare surgical complication of RALP. From March2013 to July 2018, 320 patients underwent RALP at our hospital. Migration of a Hem-o-Lok clip into the urinary bladder occurred in 4 of the 320 patients (1.3%). We analyzed these 4 patients in terms of subjective symptoms, intra- and post-operative findings, site of the migrated clip, and its treatment. The mean duration from RALP to the diagnosis was 13.8 months (2-26 months). The main symptoms due to migrated clips were : narrowed urinary stream, perineal pain, gross hematuria, and painful urination. In all cases, the size of the migrated clip was medium-large, and the events developed on the side contralateral to the first assistant. The clips were transurethrally removed using a Holmium-laser in 2 patients, and spontaneous excretion was observed in 1. The remaining patient has been asymptomatic and is being conservatively observed. In order to prevent the migration of clips used during RALP, the size of the clips and direction of the clip tail may be important. The first assistant should place the clips carefully, especially on the contralateral side.

Background: Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. Treatment of unresectable retroperitoneal lesions requires pathological diagnosis. Here, we report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers., Methods: We analyzed 47 patients consisting of 23 (49%) and 24 (51%) cases that underwent retroperitoneoscopic tissue biopsy and open biopsy, respectively. The clinicopathological features, including postoperative complications, were compared between the two groups., Results: Tumor pathology was diagnosed successfully with a single operation in all patients. Malignant pathology (68%) was more common than benign pathology (32%). The most common pathology was malignant lymphoma, which accounted for about 50% of all cases. There was no significant difference with respect to the age, sex, tumor size, presence of tumor-related symptom, histopathology, operative time, and complications. Three (13%) of 23 patients in the retroperitoneoscopic biopsy group received percutaneous needle biopsy before laparoscopic excisional biopsy because the evaluation of needle cores failed to confirm subclasses of diagnosed pathologies. One patient was converted to open surgery just after the initiation of operation due to severe adhesion of adjacent structures. We had two cases with iatrogenic urinoma due to ureteral injury after retroperitoneoscopic biopsy., Conclusions: We conclude that retroperitoneoscopic biopsy is a safe and useful tool for benign and malignant retroperitoneal lesions, in comparison to open biopsy. It is critical to carefully examine the preoperative imaging for the location of tumors, especially those close to the renal pelvis and ureter.

A 72-old man had undergone robot-assisted laparoscopic prostatectomy for localized prostate cancer (cT2aN0M0). He was referred to us with a complaint of lower abdominal pain, pain at the bilateral inner thigh, gait disturbance and persistent pyuria three months after surgery. A pelvic MRI revealed inflammation of the pubic area, and pubic bone osteomyelitis was suspected. He was admitted and administered doripenem hydrate (DRPM) intravenously for 3 weeks. The symnptoms of gait disturbance, pain at the bilateral inner thigh, and lower abdominal pain were improved gradually. Levofloxacin hydrate (LVFX）wa s administered orally for 8 weeks subsequently. He has been followed and has had no recurrence of these symptoms.

A 69-year-old man who had a history of several nasal hemorrhages and transfusions presented with hereditary hemorrhagic telangiectasia. He was referred to the previous hospital due to the elevation of prostate specific antigen (PSA) to 17.2 ng/ml, and was diagnosed with prostate cancer (cT3aN0M0, Gleason 4 + 5). He was referred to our hospital for the treatment of prostate cancer. Contrast lung computed tomography and brain magnetic resonance imaging did not show arteriovenous fistula in either the lung or brain. Upper gastrointestinal endoscopy showed capillary dilatations in the gastric mucosa. Robot-assisted laparoscopic prostatectomy with Trendelenburg position under general anesthesia was performed. Tracheal intubation was made using bronchofiberscopy. A gastric tube was not inserted. Intra- and postoperative course was uneventful, and there has been no elevation of PSA during the eight months followed.

Objectives: Several studies have shown the relationship between lower urinary tract symptoms and autonomic imbalance. We investigated the relationship between detrusor overactivity (DO) or urgency, and transient increase in blood pressure as a type of hypertension related to sympathetic hyperactivity. Study 1: we enrolled 14 male patients with DO and 10 without DO. We measured the overactive bladder symptom score (OABSS) and blood pressure during cystometry. Study 2: we enrolled 14 men patients with overactive bladder (OAB) and 8 without OAB. We measured OABSS and blood pressure using a 24-h ambulatory device., Results: Study 1: the mean systolic pressure was significantly higher at urgency or SDV than at the other measurement points in the DO group (161.3 ± 23.2 vs. 134.5 ± 16.3, 137.8 ± 15.3, or 139.5 ± 14.8 mmHg). Study 2: the mean systolic pressure was significantly higher at the measurement points before micturition than at the points unrelated to micturition in the OAB group (159.7 ± 24.9 vs. 124.9 ± 13.8 mmHg). In conclusion, DO or urgency induces a transient increase of blood pressure, suggesting that OAB induces a type of hypertension before micturition.

Iatrogenic urinary tract injuries are known complications of digestive and pelvic surgeries. We retrospectively reviewed 13 patients with bladder injuries and 16 patients with ureteral injuries requiring surgical repair or stent placement in our hospital between 2013 and 2016. Obstetric-gynecologic surgery accounted for 10 bladder injuries and 11 ureteral injuries on hysterectomy and Cesarean section. Digestive surgery led to 1 bladder injury and 5 ureteral injuries on colon resection, and urologic surgery resulted in 1 injury on biopsy of a retroperitoneal tumor. Regarding bladder injuries, 10 patients underwent cystorrhaphy, and 3 patients received indwelling of a transurethral Foley catheter alone. Concerning ureteral injuries, 7 patients underwent repair of the injured ureter (ureteroneocystostomy in 5, and ureteroureterostomy in 2), and 9 patients received ureteral stent placement after postoperative retrograde urography. Repair failure was defined when urine leakage, urinary fistula, or urinary stricture requiring ureteral stent placement still existed at 90 days after the repair treatment. The bladder injuries in all 13 cases were successfully repaired. The ureteral injury treatments in 7 out of 16 patients (43.8%) were judged as being unsuccessful because of the condition requiring a ureteral stent at 90 days. There was a correlation between the delayed diagnosis of ureteral injury and unsuccessful repair. The present study showed that the prompt identification of urinary tract injuries, especially ureteral injuries, can result in decreased morbidity andsubsequently improved outcomes.

Ureteral cancer in the retrocaval ureter is rare. We herein report a patient with this condition laparoscopically treated. A 69-year-old man was referred to us because of right ureteral cancer diagnosed during ureteroscopic surgery for a ureteral calculus. Histological diagnosis of the ureteroscopically biopsied material was non-invasive papillary urothelial carcinoma, low grade (G2). Computed tomography (CT) demonstrated a retrocaval ureter : a double J stent placed during ureteroscopy assisted the diagnosis. The patient underwent retroperitoneoscopic complete nephroureterectomy on the right side. Sufficient separation of the right ureter and the inferior vena cava under retroperitoneoscopic procedures facilitated en bloc extirpation of the kidney and ureter with a minimal lower abdominal incision. The surgical procedures for ureteral cancer in the retrocaval ureter, should be preoperatively considered with care.

An 11-year-old boy was referred to our department with the chief complaint of acute urinary retention. He had had a history of viral enteritis a few days before the onset of dysuria. He presented with a slight fever, mild headache and weakness of the extremities. A cerebrospinal fluid examination showed the elevation of cell number (cell number : 158/3, polynuclear cells : 29/3, and mononuclear cells : 129/3). Although spinal magnetic resonance imaging (MRI) did not show abnormal findings, fluid attenuated inversion recovery (FLAIR) image of the brain MRI showed a high signal area on the cerebral cortex. Acute disseminated encephalomyelitis (ADEM) was suspected from the clinical course, the cerebrospinal fluid examination, and brain MRI findings. A urethral catheter was indwelled for urinary retention, and steroid pulse therapy was promptly started. After removal of the urethral catheter seven days after the therapy initiation, normal urination without residual urine was observed. Findings of a cerebrospinal fluid test and brain MRI also showed improvement.

A 69-year-old man received transurethral resection (TUR) ofbladder tumor. The histopathological diagnosis was urothelial carcinoma, high grade, pT1＋pTis. The surgical specimens obtained by second TUR showed no residual malignancy histopathologically. Intravesical Bacillus Calmette-Guerin (BCG) instillation therapy was initiated 2 months after the second TUR. He complained of lower abdominal pain and painful urination on the day following the second instillation of BCG. Computed tomography and cystography demonstrated rupture ofthe urinary bladder. During 2 weeks ofconservative treatment, the symptoms persisted. Then, open repair ofthe bladder was performed. Intravesical BCG therapy has been a widely accepted treatment for bladder cancer with high grade Ta and T1, and carcinoma in situ. In the present case, thinning ofthe bladder wall, delayed wound healing caused by 2 TURs, and abdominal pressure may have been the factors leading to the bladder rupture in addition to inflammation of the bladder due to BCG instillation. Although bladder rupture caused by intravesical BCG therapy has not been reported, we must be aware ofthe possibility ofthis rare condition, especially after 2 consecutive TURs.

We retrospectively investigated the surgical outcomes of renal cell carcinoma (RCC), perioperative complications, and residual renal function in patients receiving laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator (MTC). Between January 2002 and December 2015, laparoscopic non-ischemic partial nephrectomy using MTC was performed in 49 patients. The histological diagnosis was RCC in 38 patients, angiomyolipoma in 4, oncocytoma in 2, and others in 5. A histologicallyproven positive surgical margin was observed in 1 (2.0%). Postoperative urine leakage occurred in 1, and it was treated conservatively. The mean follow-up period was 32.0 months. Although there was no patient who died of RCC, local recurrence occurred in 2 patients (4.1%) during the follow-up period. One of these 2 patients had a positive surgical margin. Deterioration of the residual renal function was not observed. Laparoscopic non-ischemic partial nephrectomy using MTC was safe and useful in terms of cancer control and preservation of renal function.

A 9-year-old boy was referred to us with an acute pain attack of the left scrotal contents. Ultrasonography showed a normal blood supply to the left testis, suggesting an incarcerated left inguinal hernia. Surgical exploration did not demonstrate an incarcerated left inguinal hernia. After exploration of the left testis, a dark red pedunculated cystic mass, separate from the left testis, was found to be twisted. Immunohistochemical studies of the excised cyst demonstrated torsion of the hernia sac of the peritoneum. In conclusion, we encountered a case of acute scrotum which was probably caused by torsion of the hernia sac., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: The aim of this study is to investigate the prognostic relevance of the best objective response of metastatic target lesions during sunitinib treatment in patients with metastatic renal cell carcinoma., Methods: Radiographic analysis of the best objective response according to the Response Evaluation Criteria in Solid Tumors was assessed in 50 patients. Clinicopathological characteristics including the Heng risk classification and sunitinib-related adverse reactions were compared among four patient subgroups [complete response or partial response (CR/PR), stable disease (SD), progressive disease (PD), and those without treatment evaluation (NE)]. Kaplan-Meier and Cox proportional regression analyses of progression-free survival and overall survival were performed to identify prognostic variables., Results: The best objective response was CR/PR in 12 (24 %) patients, SD in 22 (44 %), PD in 6 (12 %), and NE in 10 (20 %). The incidence of hypertension and hypothyroidism was associated with a better objective response. Progression-free survival was 15.0, 9.2, 6.8, and 2.2 months in the CR/PR, SD, PD, and NE groups, respectively (P = 0.0004, log-rank test), while the corresponding median overall survival was 59.7, 24.2, 17.1, and 18.1 months, respectively (P = 0.007). Multivariate analysis revealed that hazard ratios for risk of death of the SD, PD, and NE groups were 4.51 (P = 0.06), 7.93 (P = 0.02), and 4.88 (P = 0.04), respectively, as compared to the CR/PR group., Conclusions: Our findings suggested that the best objective response of target lesions was a prognostic marker for both progression-free survival and overall survival in sunitinib treatment. Furthermore, the incidence of sunitinib-induced hypertension was associated with a longer progression-free survival.

A 64-year-old Japanese man had started molecular-targeted therapy with sunitinib for lymph node metastasis 5 years after nephrectomy for left renal cell carcinoma (clear cell carcinoma, G2, pT2N0M0). He was transported to our emergency department because of generalized tonic-clonic seizure, vision loss, and impaired consciousness with acute hypertension after 8 cycles of treatment (2 years after the initiation of sunitinib therapy, including a drug withdrawal period for one year). MRI of the brain (FLAIR images) showed multiple high-intensity lesions in the white matter of the occipital and cerebellar lobes, dorsal brain stem, and left thalamus. Reversible posterior leukoencephalopathy syndrome caused by sunitinib was suspected. In addition to the immediate discontinuation of sunitinib therapy, the administration of antihypertensive agents and anticonvulsants improved the clinical symptoms without neurological damage. Physicians should be aware that sunitinib causes reversible posterior leukoencephalopathy syndrome. The early recognition of reversible posterior leukoencephalopathy syndrome is critical to avoid irreversible neurological damage.

We investigated the incidence of granuloma and its related factors in 180 patients with prostate cancer who showed subcutaneous granuloma formation during androgen deprivation therapy with subcutaneously administered leuprorelin acetate. A granuloma was defined as a persistent induration over 30 mm in diameter in the injected portion. Small indurations which often developed and disappeared after every injection were excluded. The survey was performed using a questionnaire after receiving written informed consent. Among the 180 patients with prostate cancer, 21 (11.7%) developed a granuloma at the injection portion, and subsequently the injection of leuprorelin acetate had to be discontinued. Eighteen of the 21 patients alternatively received goserelin acetate. Three patients had high-grade granulomas with ulcer and abscess formation, and were successfully treated with oral antibiotics. The average duration between the first injection of leuprorelin acetate and granuloma formation was 20.2 months (range : 4 to 62 months). There was no association between granuloma formation and patient backgrounds, such as allergic predisposition and past history. Twenty-one of the 180 prostatic cancer patients developed subcutaneous granuloma induced by the injection of leuprorelin acetate. The investigation showed an unexpectedly high incidence of granuloma formation. We must explain the risk of developing subcutaneous granuloma to the patients before introducing leuprorelin acetate.

Introduction: We aimed to investigate the long-term outcome of trimodality therapy consisting of transurethral resection of bladder tumor, external beam radiation therapy, and concurrent intra-arterial low dose cisplatin for patients with muscle invasive bladder cancer., Materials and Methods: We retrospectively reviewed the medical records of 37 consecutive patients (28 men and 9 women) who underwent trimodality therapy for T2-3N0M0 bladder cancer at our hospital between 1996 and 2011. A total of 60Gy of external beam radiation therapy was administered. A daily low dose of cisplatin was administered intra-arterially through a subcutaneously placed reservoir on the days of radiation therapy. Complete response was defined as no residual cancer in transurethral resection specimens and negative cytology. When a complete response could not be achieved, patients underwent additional intra-arterial chemotherapy., Results: Five-year cause specific, disease free, and overall survival rates were 86.4%, 69.7%, and 69.6%, respectively, with a mean follow-up period of 56.5 ± 6.1 months. Five-year cause specific survivals of the complete response group after the trimodality therapy, the complete response group after additional intra-arterial chemotherapy and the non-complete response group were 100% (n = 21), 85.9% (n = 9) and 0% (n = 7), respectively. Five-year overall survivals of the complete response group after the trimodality therapy, the complete response group after additional intra-arterial chemotherapy and the non-complete response group were 82.8%, 85.3% and 0%, respectively., Conclusions: This trimodality therapy for muscle invasive bladder cancer could achieve favorable survival rates with bladder preservation and minimal adverse events. This trimodality therapy can be one of the useful treatment options.

A 69-year-old woman was referred to us because a cyst in the lower pole of the left kidney had been pointed out on screening ultrasound. Computed tomography (CT) demonstrated a mural nodule of the wall of the cyst with an enhancement effect, suggesting cystic renal cell carcinoma (cT1aN0M0). The patient underwent retroperitoneoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator. A hematoxylin-eosin-stained specimen showed that the wall of the cystic tumor consisted of the proliferation of large cells with rich eosinophilic granules in the cytoplasm and round-shaped nuclei, which were the characteristics of oncocytoma. This was followed by immunohistochemical studies, because of findings of local cell invasion, mitosis, and necrosis, suggesting malignancy. The results were: CK7, strongly positive; PAX2, negative; colloidal iron stain, negative; c-kit, weakly positive; vimentin, positive; and RCC marker, negative. Thus, although the tumor showed characteristics of oncocytoma and/or chromophobe renal cell carcinoma (pT1a), it could not be classified according to the known categories: it should be designated as renal cell carcinoma (neoplasm) of oncocytosis, a novel category of unclassified renal cell carcinomas. The present case indicated the fact that renal cell carcinomas resembling oncocytoma certainly exist.

Background: Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare tumor predisposition syndrome characterized by cutaneous and uterine leiomyomas and papillary type 2 renal cell cancer. Germline mutation of the fumarate hydratase (FH) gene is known to be associated with HLRCC., Case Presentation: We describe a 64-year-old father and his 39-year-old son with HLRCC who developed papillary type 2 RCCs lacking cutaneous leiomyomas at any site. A common missense mutation in the FH gene, (c.1021G > A, p.D341N) in exon 7, was detected in the 2 cases. Functional prediction with the bioinformatics programs, SIFT and Polyphen-2, reported "damaging (SIFT score 0.00)" and "probably damaging (PSIC score 1.621)" values, respectively. In 162 healthy individuals, there were no cases of a G transition to any base. Finally, (c.1021G > A) in exon 7, was identified as a point mutation., Conclusion: We report a family with HLRCC in which a novel missense mutation was detected. A familial papillary type 2 renal cancer should be considered HLRCC unless typical cutaneous leiomyomas do not occur.

A 70-year-old male was referred to our hospital because of an abnormally high prostate specific antigen (PSA) level (4.4 ng/ml) associated with lower urinary tract symptoms. Needle biopsy of the prostate did not reveal any malignant tissue. Four months later, the patient presented again with hydronephrosis, which was diagnosed using ultrasonography. Furthermore, contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed left hydronephrosis caused by a soft tissue mass around the left iliac artery compressing the left ureter. Serum IgG4 level was 918 mg/dl. On immunohistochemical reevaluation of the prostate biopsy specimens, the samples were positive for IgG4 immunostaining. The patient was finally diagnosed with IgG4-related prostatitis with retroperitoneal fibrosis. With steroid therapy, the hydronephrosis and urinary symptoms were ameliorated. Our experience with this case suggests that in a male patient with urinary symptoms, biopsy of the prostate may be useful for exact diagnosis when IgG4-related disease is suspected.

A 62-year-old man had undergone retroperitoneoscopic radical nephrectomy for left renal cell carcinoma at the age of 57 years. The histopathological diagnosis was clear cell carcinoma of the kidney (G2, pT2a, INF β). Five years postoperatively, enhanced computed tomography demonstrated strongly enhanced tumors on the pancreatic head and body. No other metastatic lesion was detected. Pancreatic endocrine tumors were not ruled out. The patient underwent enucleation of the pancreatic head tumor and distal pancreatectomy. The histopathological diagnosis of the tumors was metastatic renal cell carcinoma. Patients with renal cell carcinoma should receive a long-term follow-up to detect possible metastatic lesions other than the common metastatic sites such as the lung and bones.

A 5-year-old boy was diagnosed with febrile urinary tract infection (UTI) at the age of 2 months. Voiding cystourethrography (VCUG) showed grade IV reflux on the left side. Left ureterocystoneostomy was performed at 11 months because of recurrent febrile UTI under antibiotic prophylaxis. VCUG 1 year after surgery showed no reflux. The patient developed acute focal bacterial nephritis (AFBN) when he was 4 years and 2 months of age, and experienced 3 episodes of AFBN during the following 9 months. The patient had normal urinary and bowel habits. Although VCUG showed no recurrence of reflux, AFBN developed in spite of antibiotic prophylaxis. Positioning the instillation of contrast (PIC) cystography under general anesthesia demonstrated the left occult reflux. Endoscopic injection with Deflux○R was performed simultaneously. PIC cystography is a useful examination in patients with persistent, repeated UTI episodes without any signs of reflux employing conventional diagnostic modalities.

Background: Bilateral breast reconstruction utilising autologous free tissue transfer is a complex procedure with multiple options for donor tissue available. Autogenous breast reconstruction techniques have evolved over the last three decades to meet this goal. The aim of this study was to determine the outcomes of patients undergoing bilateral breast reconstruction with DIEAP, TRAM or SIEA flaps., Material and Methods: A prospective study was performed in our Interdisciplinary Breast Centre from July 2004 until December 2011 in 144 patients. Demographic information, diabetes mellitus type I status, tobacco use, tumor stage, primary/secondary reconstruction, operative technique, adjuvant therapy received, length of follow-up, and complications were evaluated. Complications were divided into donor site and recipient site. To investigate which risk factors were independently related to flap loss (complete or partial), multiple linear regression analysis was performed., Results: The study identified 144 patients who had bilateral breast reconstruction with DIEAP, TRAM or SIEA flaps. For all flaps (n=248), outcome included 98.4% survival and 0.7% vein microanastomosis revision. Recipient site complications included 1.6% complete flap loss, 0.8% fat necrosis, 2.9% partial skin loss/dehiscence flap necrosis and 2.0% haematoma rate. Donor site complications included 3.7% partial skin loss/dehiscence. There was evidence of abdominal bulges in TRAM patients (1.1%) but no hernias in any patients. BMI is a major determinant of flap loss (complete or partial) in these patients., Conclusions: The primary goal of bilateral breast reconstruction is to provide a treatment option that can create a natural, symmetric breast mounds with minimal donor-site morbidity following bilateral mastectomies. These results support weight loss therapy prior to bilateral breast reconstruction.

Thirty patients with histologically proven prostate cancer whose prostate specific antigen values were under 20 ng/ml received magnetic resonance imaging (MRI) at 1.5 T before transrectal ultrasound-guided systematic transrectal 10-core needle biopsy. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) on MRI were retrospectively analyzed by a single radiologist without any information of the results of the biopsy. The locations of cancer, indicated by the results of biopsy, coincided with the findings of MRI in 25 patients (83.3%). The characteristics of DWI and ADC in the lesion with a cancer focus could be analyzed in 21 patients. The mean ADC of cancer lesions was 0.96 ± 0.36 × 10⁻³ mm²/sec (± SD). The mean ADC of cancer lesions with a Gleason score of 6 was 1.14 ± 0.40 × 10⁻³ mm²/sec, while that of lesions with Gleason scores of 7 and 8 was 0.77 ± 0.20 × 10⁻³ mm²/s (p = 0.008, unpaired t test). DWI and ADC would be useful parameters in the diagnosis of prostate cancer. ADC of a cancer lesion may indicate the malignant potential of cancer cells represented by the Gleason score.

Objective: • To confirm the recurrence-preventing efficacy and safety of 18-month bacillus Calmette-Guérin (BCG) maintenance therapy for non-muscle-invasive bladder cancer., Patients and Methods: • The enrolled patients had been diagnosed with recurrent or multiple non-muscle-invasive bladder cancer (stage Ta or T1) after complete transurethral resection of bladder tumours (TURBT). • The patients were randomized into three treatment groups: a maintenance group (BCG, 81 mg, intravesically instilled once weekly for 6 weeks as induction therapy, followed by three once-weekly instillations at 3, 6, 12 and 18 months after initiation of the induction therapy), a non-maintenance group (BCG, 81 mg, intravesically instilled once weekly for 6 weeks) and an epirubicin group (epirubicin, 40 mg, intravesically instilled nine times). The primary endpoint was recurrence-free survival (RFS)., Results: • Efficacy analysis was performed for 115 of the full-analysis-set population of 116 eligible patients, including 41 maintenance group patients, 42 non-maintenance group patients and 32 epirubicin group patients. • At the 2-year median point of the overall actual follow-up period, the final cumulative RFS rates in the maintenance, non-maintenance and epirubicin groups were 84.6%, 65.4% and 27.7%, respectively. • The RFS following TURBT was significantly prolonged in the maintenance group compared with the non-maintenance group (generalized Wilcoxon test, P= 0.0190)., Conclusion: • BCG maintenance therapy significantly prolonged the post-TURBT RFS compared with BCG induction therapy alone or epirubicin intravesical therapy., (© 2010 THE AUTHORS. BJU INTERNATIONAL © 2010 BJU INTERNATIONAL.)

Background: The clinical outcome of ureteral obstruction secondary to gastric cancer remains unclear. The present study was designed to evaluate the clinical outcome and predictive factors of survival in patients with ureteral obstruction secondary to gastric cancer., Methods: Twenty-five consecutive patients with ureteral obstruction secondary to gastric cancer between January 1998 and December 2007 were retrospectively analyzed. All patients had hydronephrosis; 13 patients had bilateral hydronephrosis, and 12 patients had unilateral hydronephrosis., Results: Ten patients presented with pain, 3 patients with urinary tract infection, and 2 patients with acute renal failure. Seven (58%) of 12 patients with unilateral ureteral obstruction experienced progression to bilateral ureteral obstruction during the follow-up period. Eighteen patients (61%) were eventually managed with urinary diversion. In total, 5 patients were managed with percutaneous nephrostomy, and 15 patients with retrograde ureteral stenting. All symptomatic patients responded to urinary diversion. The overall median survival was 5.8 months, and the 6-month and 1-year survival rates were 48 and 32%, respectively. Chemotherapy was found to be the only independent predictor of survival (p=0.0498). Median survival in patients who received chemotherapy was 11.2 months, in comparison to 3.1 months in patients who did not receive chemotherapy (p=0.0002)., Conclusions: The prognosis of ureteral obstruction secondary to gastric cancer was extremely poor, particularly when chemotherapy was not administered. The indications for palliative urinary diversion should be determined after considering the patient's symptoms, the expected survival time, the possibility of further chemotherapeutic options, and the current quality of life.