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Background/Aim: To evaluate whether whole-pelvis (WP) volumetric modulated arc therapy (VMAT) is associated with increased late toxicity compared with prostate-only (PO) VMAT in patients with localized prostate cancer. Patients and Methods: Participants comprised 384 consecutive patients treated with definitive VMAT to 78 Gy in 39 fractions from July 2011 to August 2016. Of these, 183 patients received PO-VMAT and 201 patients received initial WP-VMAT to 46.8 Gy in 26 fractions using a simultaneous integrated boost technique. Gastrointestinal (GI) and genitourinary (GU) toxicities were prospectively scored using Common Terminology Criteria for Adverse Events version 4.0. Results: Median follow-up was 49 months (range=16-88 months) in the PO-VMAT group and 52 months (range=10-85 months) in the WP-VMAT group. Frequencies of Grade 3 late GI and GU toxicities were ≤3% across both groups. No patients experienced Grade 4+ toxicity. Cumulative incidences of Grade 2+ late GI and GU toxicities were similar between PO- and WP-VMAT groups (p=0.508 and p=0.838, respectively). Five-year cumulative incidences of Grade 2+ late GI and GU toxicities were 12.2% and 6.6% for the PO-VMAT group and 12.3% and 8.9% for the WP-VMAT group, respectively. Conclusion: WP-VMAT did not increase late GI and GU toxicities. This suggests that concerns about increasing toxicity profile are insufficient reason for omitting WPRT for patients with high-risk prostate cancer.

First-line pembrolizumab is available for recurrent disease within 12 months after the receipt of platinum-based perioperative chemotherapy. However, the benefit of first-line pembrolizumab is unclear. This study evaluated the oncological outcome of patients treated with pembrolizumab compared with chemotherapy as first-line therapy for early relapsing disease after the receipt of platinum-based perioperative chemotherapy.Data from a multicenter study included 454 patients diagnosed with unresectable or metastatic UC from November 2006 to July 2021. We identified patients with early and non-early relapsing disease. Oncological outcomes were evaluated using progression-free survival, overall survival, and survival with disease control.Fifty-three patients with early relapsing disease and 15 patients with non-early relapsing disease were identified. Of 53 patients with early relapsing disease, 26 (49.1%) were treated with pembrolizumab and 27 (50.9%) were treated with chemotherapy as first-line therapy. Fifteen patients with non-early relapsing disease were treated with chemotherapy. Early relapsing disease was associated with shorter progression-free survival and overall survival than non-early relapsing disease. Pembrolizumab was associated with longer progression-free survival and survival with disease control than chemotherapy in patients with early relapsing disease. There was no significant difference in overall survival between pembrolizumab and chemotherapy, but overall survival plateau with a long tail was observed in pembrolizumab.First-line pembrolizumab in earlier clinical settings for highly malignant tumors might improve the prognosis of patients with early relapsing disease after the receipt of platinum-based perioperative chemotherapy.

A 57-year-old woman was referred to our hospital with a palpable mass in the left lumbar area. Computerized tomography revealed a diffusely enlarged destructed left kidney with impacted ureteropelvic junction stones and intense inflammatory stranding of the perirenal fat. This infiltration extended into the subcutaneous tissue. Since she refused to undergo nephrectomy, we performed transurethral ureterolithotripsy (TUL) two times. Retrograde ureterography before the third TUL showed communication between the renal pelvis and the jejunum. We performed a left-sided nephrectomy with a wedge resection of the jejunum. This is a rare case of nephrocutaneous and enterorenal fistula caused by pyonephrosis.

The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16–40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n = 220, 67.9%), S. saprophyticus (n = 36, 11.1%), and K. pneumoniae (n = 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan.

OBJECTIVES To investigate long-term chronological changes in functional renal volume and renal function after nephron-sparing surgery, and factors that contribute to the progression of postoperative chronic kidney disease. METHODS A total of 80 patients who underwent nephron-sparing surgery were enrolled in this prospective observational study. The renal function deterioration group was defined as patients whose estimated glomerular filtration rate at 5 postoperative years decreased by ≥20% relative to that before surgery. RESULTS The predicted estimated glomerular filtration rate, calculated based on the functional renal volume at 5 postoperative years, was strongly correlated with the postoperative estimated glomerular filtration rate (Spearman's ρ = 0.89, P

Highlight • Bone is one of major metastatic site in patients with genitourinary (GU) cancer. • Accurately predicting survival of patients with bone metastasis (BM) is essential. • This external validation study proved high predictive accuracy of B-FOM score. • B-FOM score is a simple scoring model based on five prognostic factors. • B-FOM score is higher accurate tool comparing to other previously reported scores., Objective We previously developed genitourinary (GU) cancer-specific scoring system for prediction of survival in patients with bone metastasis (the Bone-Fujimoto-Owari-Miyake [B-FOM] scoring model) based on five prognostic factors: the type of primary tumor (prostate cancer (PCa) vs renal cell carcinoma (RCC) and PCa vs urothelial carcinoma (UC)), poor performance status (PS), visceral metastasis, high Glasgow-prognostic score (GPS), elevated neutrophil-to-lymphocyte ratio (NLR). The aim of this study was to externally validate and further improve the performance of the B-FOM score. Methods The external validation cohort comprised 309 patients with GU cancer with bone metastasis from multiple institutions. Clinical factors were analyzed using Kaplan-Meier method and COX regression hazard model. Performance of a modified B-FOM score was compared to that of other scoring models by the Kaplan-Meier method and the area under the curve (AUC) of receiver operating characteristic curves. Results The median follow-up period of development and validation cohort were 25 and 17 months, respectively. Kaplan-Meier curve demonstrated that the type of primary tumor (RCC and UC vs PCa), poor PS, presence of visceral metastasis, high GPS, elevated NLR were significantly associated with shorter cancer-specific survival. Risk groups were successfully stratified by the modified B-FOM score classification. Moreover, the AUC of the modified B-FOM scoring model for predicting mortality at 6, 12, and 24 months were 0.895, 0.856, and 0.815, respectively, which were the highest among evaluated models. Conclusions The B-FOM scoring model is a simple and accurate prediction tool. By using this scoring model at the time of the diagnosis of bone metastasis in patients with GU cancers, an individualized optimal treatment strategy can be selected.

This study aimed to evaluate the concordance of the microbiologic findings of preoperative urine cultures and intraoperative stone cultures in patients undergoing transurethral lithotripsy (TUL). A total of 164 patients treated with TUL for whom preoperative urine cultures and intraoperative stone cultures were performed were included in this study. The preoperative urine cultures were positive in 57 patients (34.8%) and the stone cultures were positive in 58 patients (35.4%). Enterococcus faecalis was the most common organism detected in the intraoperative stone cultures (22. 9%). The concordance rate between the preoperative urine cultures and intraoperative stone cultures was 45.6%. Eleven patients (6.7%) developed a fever of38.5°C postoperatively. Among the 11 patients, 9 patients showed positive preoperative urine cultures and 10 patients showed positive stone cultures. The results of the urine culture performed when the patient had a fever of 38.5°C or higher showed 54.5% consistency with the results of the preoperative urine culture or stone culture. Although the results of the preoperative urine cultures and intraoperative stone cultures may not be highly consistent, these cultures should be actively performed because they provide useful information regarding postoperative infections.

Purpose This study aimed to compare bowel and urinary health-related quality of life (HRQOL) between prostate-only (PO) volumetric modulated arc therapy (VMAT) and whole-pelvis (WP) VMAT in patients with localized prostate cancer. Methods and materials A total of 234 patients treated with definitive VMAT to 78 Gy in 39 fractions were enrolled. Of these, 108 patients received PO-VMAT and 126 patients received initial WP-VMAT to 46.8 Gy in 26 fractions using a simultaneous integrated boost technique. HRQOL was prospectively assessed before radiation therapy (baseline), and 3, 6, 12, and 24 months after treatment using the Expanded Prostate Cancer Index Composite (EPIC). Results Baseline HRQOL scores did not differ significantly between the 2 groups. No significant between-group differences in HRQOL change from baseline were observed for all bowel and urinary EPIC domains. The proportion of patients showing a clinically relevant decrease in bowel and urinary HRQOL scores from baseline was similar between the groups throughout the follow-up period. An analysis of individual HRQOL items showed that patients undergoing WP-VMAT were more likely to report moderate/big problems with bloody stools (P = .039) and overall bowel problems (P = .008) than those undergoing PO-VMAT at 12 months. There was no significant between-group difference in any individual items at 24 months, however. Conclusions Bowel and urinary HRQOL is largely similar for patients receiving PO-VMAT and WP-VMAT during 24 months of follow-up, with the only differences seen in responses to specific bowel HRQOL items at 12 months.

Aims We aimed to compare the efficacy and safety of mirabegron, a β3-adrenoceptor agonist, and imidafenacin, an anticholinergic agent, in overactive bladder patients. Methods We conducted a multicenter, prospective randomized cross-over study at 5 hospitals in Japan from December 2012 to June 2015. We enrolled female patients with overactive bladder aged ≥50 years, who had never received treatment for the condition. The patients were assigned to Group A or B. Group A patients were administered mirabegron (50 mg per day) for 8 weeks, followed by a 2-week washout period, and then imidafenacin (0.2 mg per day) for 8 weeks. This order of drug administration was reversed in Group B. Results A total of 33 and 18 patients in Group A and 37 and 26 patients in Group B continued to receive treatment at weeks 8 and 18, respectively. Mirabegron administration significantly improved overactive bladder symptom score (OABSS), the urinary frequency per 24 hr, voided volume per micturition, and number of nocturia episodes per night at week 8. Moreover, imidafenacin administration improved all these variables, except for the number of nocturia episodes per night at week 8. No significant difference was observed in the drug effects between mirabegron and imidafenacin. Although imidafenacin administration significantly increased the scores for dry mouth, blurred vision, and constipation, mirabegron administration did not. Conclusions Mirabegron and imidafenacin have the same efficacy. Imidafenacin administration is associated with a higher rate of dry mouth, blurred vision, and constipation as compared to mirabegron administration. Neurourol. Urodynam. 36:1097–1103, 2017. © 2016 Wiley Periodicals, Inc.

The change in functional renal volume (FRV) has an absolute influence on renal function after nephrectomy (Nx) or nephron-sparing surgery (NSS). In this study, we prospectively examined whether the postoperative renal function following Nx and NSS could be accurately predicted and assessed the reproducibility of our newly developed 3-D image reconstruction system (Kashihara) to measure the FRV. We enrolled 98 patients who underwent Nx and 41 patients who underwent NSS from April 2006 to September 2009 to predict postoperative FRV and renal function. FRV was measured before and after (1 month and 1 year) renal surgery. The postoperative estimated glomerular filtration rate (eGFR) was predicted from the preoperative eGFR calculated from the serum creatinine (sCr) level and the ratio of the postoperative/preoperative FRV. To assess the reproducibility and accuracy of our newly developed 3-dimensional (3-D) image reconstruction system, FRV was measured by five examiners using images obtained by CT (five cases) and MRI (five cases). Significant correlation was found both for FRV and for renal function between the predictive values and the actually measured values at 1 month and 1 year after surgery, not only in the Nx group, but also in the NSS group. The accuracy and reproducibility could be confirmed both with CT and MRI studies. The postoperative FRV and renal function could be predicted preoperatively using a 3-D image reconstructive system, preoperative routine diagnostic imaging, and preoperative sCr level.

We clinicaliye valuated 355 patients with urinarytract infections (UTI), suspected of having urosepsis at Tane General Hospital, and determined the usefulness of the biomarker procalcitonin (PCT) as an aid in predicting urosepsis. Clinical and microbiological data were collected. The logistic regression analysis was used to determine the risk factors of urosepsis. Of 355 patients, 169 patients (47.6%) were diagnosed with urosepsis. C-reactive protein (CRP) (OR 2. 633, p＜0. 001), PCT (OR 2. 153, p＝0. 003) and clinical diagnosis (calculous pyelonephritis OR 1. 886, p＝0. 019, acute prostatitis OR 3. 614, p＜0. 001) were established as the independent risk factors of urosepsis. Of 169 patients with urosepsis, 43 patients (25.4%) were diagnosed with severe urosepsis. In the severe urosepsis group, 2 patients with a PCT value ＜2.0 ng/ml were included. The mortalityrate in patients with severe urosepsis was 4.65% (2/43) in this study. We concluded that the PCT level could be a reliable marker suggestive of urosepsis. However, patients very early in the onset of infection mayhave a normal PCT value. It is essential to use all available clinical information when interpreting the results of a PCT measurement.

The objectives of this study were to evaluate dosimetric quality and acute toxicity of volumetric-modulated arc therapy (VMAT) and daily image guidance in high-risk prostate cancer patients. A total of 100 consecutive high-risk prostate cancer patients treated with definitive VMAT with prophylactic whole-pelvic radiotherapy (WPRT) were enrolled. All patients were treated with a double-arc VMAT plan delivering 52 Gy to the prostate planning target volume (PTV), while simultaneously delivering 46.8 Gy to the pelvic nodal PTV in 26 fractions, followed by a single-arc VMAT plan delivering 26 Gy to the prostate PTV in 13 fractions. Image-guided RT was performed with daily cone-beam computed tomography. Dose–volume parameters for the PTV and the organs at risk (OARs), total number of monitor units (MUs) and treatment time were evaluated. Acute toxicity was assessed using the Common Terminology Criteria for Adverse Events, version 4.0. All dosimetric parameters met the present plan acceptance criteria. Mean MU and treatment time were 471 and 146 s for double-arc VMAT, respectively, and were 520 and 76 s for single-arc VMAT, respectively. No Grade 3 or higher acute toxicity was reported. Acute Grade 2 proctitis, diarrhea, and genitourinary toxicity occurred in 12 patients (12%), 6 patients (6%) and 13 patients (13%), respectively. The present study demonstrated that VMAT for WPRT in prostate cancer results in favorable PTV coverage and OAR sparing with short treatment time and an acceptable rate of acute toxicity. These findings support the use of VMAT for delivering WPRT to high-risk prostate cancer patients.

A 68-year-old man presented with the chief complaint of swelling of the penis. A pencil had been inserted into his urethra by a commercial sex worker for sexual stimulation. On a computed tomography (CT) scan, a foreign object was visible throughout the urethra and in the urinary bladder. Cystoscopy performed under spinal anesthesia showed a pencil in the urethra. We attempted removing the object endoscopically by using a Holmium laser. However, the endoscopic procedure failed and finally, we removed the object by transvesical open surgery. At the same time, suprapubic cystostomy was performed for the disorder of the urethra. An anterior urethrocutaneous fistula was formed 5 days after the operation. After removal of the urethral catheter, he was managed with only suprapubic cystostomy. Conservative management of the urethrocutaneous fistula was effective. The fistula was completely closed 26 days after the operation. He was discharged 33 days after the operation.

To compare dosimetric parameters and acute toxicity rates between whole-pelvic (WP) and prostate-only (PO) volumetric-modulated arc therapy (VMAT) in patients with localized prostate cancer.A total of 224 consecutive patients treated with definitive VMAT to 78 Gy in 39 fractions were enrolled. Of these, 119 patients received initial WP VMAT at 46.8 Gy in 26 fractions using a simultaneous integrated boost technique, and 105 patients received PO VMAT. Image-guided radiotherapy was practised with daily cone beam CT.The mean rectal dose, the rectal volume receiving ≥30 Gy (V30Gy), rectal V50Gy, the mean bladder dose, bladder V30Gy and bladder V50Gy were significantly increased in the WP group (p 0.05 each); however, the rectal V70Gy did not differ between groups (p = 0.101), and the bladder V70Gy was significantly lower in the WP group (p = 0.029). The WP group experienced a significantly increased frequency of acute grade 2 diarrhoea relative to the PO group (5.9% vs 0%; p = 0.015). No differences were seen between the WP and PO groups in terms of acute grade 2 proctitis (10.1% vs 6.7%; p = 0.360) and genitourinary (GU) toxicity (12.6% vs 10.5%; p = 0.620).Despite larger rectum and bladder volumes at low- and medium-dose levels, WP VMAT resulted in no significant increase in acute proctitis or GU toxicity when compared with PO VMAT.This study demonstrates that whole-pelvic radiotherapy has comparable acute toxicity to those observed with prostate-only radiotherapy when VMAT with daily image guidance is used.

We aimed to compare the efficacy and safety of mirabegron, a β3-adrenoceptor agonist, and imidafenacin, an anticholinergic agent, in overactive bladder patients.We conducted a multicenter, prospective randomized cross-over study at 5 hospitals in Japan from December 2012 to June 2015. We enrolled female patients with overactive bladder aged ≥50 years, who had never received treatment for the condition. The patients were assigned to Group A or B. Group A patients were administered mirabegron (50 mg per day) for 8 weeks, followed by a 2-week washout period, and then imidafenacin (0.2 mg per day) for 8 weeks. This order of drug administration was reversed in Group B.A total of 33 and 18 patients in Group A and 37 and 26 patients in Group B continued to receive treatment at weeks 8 and 18, respectively. Mirabegron administration significantly improved overactive bladder symptom score (OABSS), the urinary frequency per 24 hr, voided volume per micturition, and number of nocturia episodes per night at week 8. Moreover, imidafenacin administration improved all these variables, except for the number of nocturia episodes per night at week 8. No significant difference was observed in the drug effects between mirabegron and imidafenacin. Although imidafenacin administration significantly increased the scores for dry mouth, blurred vision, and constipation, mirabegron administration did not.Mirabegron and imidafenacin have the same efficacy. Imidafenacin administration is associated with a higher rate of dry mouth, blurred vision, and constipation as compared to mirabegron administration. Neurourol. Urodynam. 36:1097-1103, 2017. © 2016 Wiley Periodicals, Inc.

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 62-old-year male presented to our hospital with induration of the prepuce and bleeding from the glans penis that occurred during sexual intercourse. Scrape cytology was performed, which showed class V, suspected squamous cell carcinoma. Computed tomography showed no metastases, and magnetic resonance imaging revealed no invasion of the corpus spongiosum. Circumcision and resection of the glanstumor were performed. Histopathological examination revealed squamous cell carcinoma in situ. We diagnosed the case as penile carcinoma in situ (pTisN0M0, UICC stage 0, and Jackson stage I). At 6 months postoperatively, local recurrence of penile carcinoma was detected by visual inspection after 5% acetic acid staining, and tumor resection was performed. At 9 months postoperatively (after the 2nd resection), the patient has remained disease-free, with no evidence of recurrence.

Inflammatory pseudotumor most commonly involves the lung. However, inflammatory pseudotumor has been reported in various sites in the abdomen, including the kidneys, retroperitoneum and urinary tract. We present a rare case of pathologically proven inflammatory pseudotumor in the renal pelvis. A 45-year-old woman was referred to our hospital with gross hematuria. Computed tomography demonstrated a mass around the right renal pelvocalyceal system suggestive of cystic renal cell carcinoma. Retrogradepyelography was done. Pelvic urine cytology was class III. The possibility of urothelial carcinoma could not be denied. Retroperitoneoscopic nephroureterectomy with open bladder cuff excision was performed. The histological examination revealed an inflammatory pseudotumor. She showed no evidence of disease 44 months after the operation.

Background: Transurethral needle ablation (TUNA) is less invasive than other therapies for benign prostatic hyperplasia (BPH) and produces coagulative necrosis within selected adenoma lesions. The action mechanism of TUNA is still obscure, even though many early studies have demonstrated good clinical results of TUNA. It is of interest and importance to know how TUNA influences the volume of the intraprostatic region responsible for bladder outlet obstruction in order to elucidate the anatomical action mechanism of TUNA. Methods: We retrospectively investigated postoperative variations in volumetric parameters of whole prostate volume (PV), transition zone volume (TZV) and transition zone index (TZI = TZV/PV) in 41 patients with symptomatic BPH who were treated with TUNA. The data were analyzed statistically in relation to the preoperative overall severity and postoperative therapeutic efficacy. Results: Both PV and TZV showed a significant decrease at 3 months after TUNA (P < 0.01) as did the symptom score, quality of life (QOL) score and functional variables, and a decreased level of PV and TZV was sustained until 12 months of follow-up when compared to the baseline (P < 0.01 at 6 months, not significant at 12 months). TZI also showed a similar pattern with a significantly decreased level until the postoperative 6th month (P < 0.05 at 6 months, not significant at 12 months). In ‘moderate’ cases, TZI achieved the minimum value (0.44 ± 0.13, P < 0.05 compared to the baseline) at 3 months of follow-up, but the level immediately increased, while in ‘severe’ cases, TZI gradually decreased and achieved the minimum value (0.44 ± 0.08, P < 0.05 compared to the baseline) at 12 months of follow-up. In the evaluation by postoperative therapeutic efficacy, there were no significant differences in PV, TZV and TZI between ‘excellent and good’ cases (E/G group) and ‘fair and poor/worse’ cases (F/P group) at the baseline or 3 months of follow-up. Both of the efficacy groups showed a significant decrease in PV, TZV and TZI at 3 months when compared to the baseline (P < 0.05). The mean decrease in TZI was significantly larger in the E/G group than in the F/P group (0.064 ± 0.13 vs 0.027 ± 0.12, P < 0.05). Conclusion: Therapeutic efficacy of TUNA did not depend on the baseline value of PV, TZV and TZI, but on variation of a decrease in TZI during follow-up. Moreover, a slow and lasting decrease in TZI seemed to influence durability of the therapeutic efficacy of TUNA, which was clearly observed in ‘severe’ cases with a larger prostatic volume than in ‘moderate’ cases.

Purpose Applying the systemic inflammatory response syndrome (SIRS), we investigated the surgical invasiveness of augmentation ileocystoplasty in patients with spina bifida. Materials and methods A total of 23 patients with spina bifida underwent augmentation ileocystoplasty. We diagnosed the cases as SIRS when they fulfilled at least 2 of the 4 SIRS criteria. We developed SIRS score, the sum of the number of positive items for the duration of SIRS, as a parameter of surgical invasiveness. We investigated the relationships between SIRS score and various factors and compared SIRS scores of augmentation with those of other urological operations as a control, which consisted of radical prostatectomy (25 patients) and radical nephrectomy (20 patients). Results We found a positive relationship between SIRS score and the operation time of augmentation. SIRS scores were significantly higher in the patients who underwent operations diverting ventriculoperitoneal shunt to ventriculoatrial shunt concurrently with augmentation. However, the operation times were not significantly different between the cases with and without shunt operations. SIRS scores in cases of augmentation were significantly higher than those of the major urological operations compared. Conclusion When evaluated by the SIRS score, the factors related to the surgical invasiveness of augmentation ileocystoplasty were a longer operating time and concurrent shunt diversion. The higher invasiveness of this operation compared with major urological operations was also revealed. These facts should be considered carefully when the indications for augmentation ileocystoplasty are determined.

Case 1 : A 60-year-old man presented with right flank pain. A computed tomography (CT) scan revealed a large right renal tumor, multiple lung metastases, multiple liver metastases, and tumor thrombus of the right renal vein. These findings were strongly suggestive of renal cell carcinoma. The patient suddenly complained of dyspnea at night due to bilateral pulmonary embolism, and the patient died 11 days after onset. Needle necropsy showed that the tumors were squamous cell carcinomas of the renal pelvis. Case 2 : A 66-year-old man presented with macrohematuria. An abdominal CT scan revealed a right renal mass and liver metastasis. The differential diagnosis was between renal cell carcinoma and urothelial carcinoma. A renal biopsy revealed urothelial carcinoma of the renal pelvis. The patient died of the disease 3 months after initiation of chemotherapy with gemcitabine and cisplatin. We report these 2 cases to emphasize the importance of renal biopsy and thorough histological analysis for the determination of treatment strategies against unresectable renal tumors.

We report a case of fibrosarcoma of the spermatic cord detected with an inguinal tumor. A 45-year old man was admitted to our hospital for further examination of a right inguinal tumor. Computed tomography (CT) and magnetic resonance imaging revealed a right spermatic cord tumor,45 mm in size, and a retroperitoneal tumor in proximity to the right external iliac artery,55 mm in size. He was clinically suspected as having malignant lymphoma. As the differential diagnosis, liposarcoma and leiomyosarcoma were considered. High orchidectomy was performed for the purpose of diagnosis. The histopathological examination suggested fibrosarcoma, with a positive surgical margin. Six days after high orchidectomy, retroperitoneal tumor extirpation was performed. Total resection was difficult because the adhesion with the external iliac vein was strong. The tumor was extirpated as much as possible. The result of the histopathological examination showed fibrosarcoma. Adjuvant radiotherapy (54 Gy) was performed. After radiotherapy, local recurrence was detected by CT. He underwent systemic chemotherapy with adriamycin (60 mg/m2). After 3 courses, there was a slight reduction in tumor size. However, his general condition rapidly deteriorated with marked cachexy and he died six months from the first medical examination.

We report a case of bilateral pheochromocytoma which was incidentally discovered by ultrasonography at a health check-up. A 46-year-old female was admitted to our hospital for further examination of a right adrenal tumor. Computed tomography and magnetic resonance imaging revealed a right adrenal tumor, 5 cm in size, and a left adrenal tumor, 1.5 cm in size. High serum noradrenaline and urine noradrenaline levels were noted. 131I-MIBG scintigraphy revealed an abnormal accumulation of 131 I in the tumors. Thus, our clinical diagnosis was bilateral pheochromocytoma. Laparoscopic right adrenalectomy was performed. The histopathological examination revealed pheochromocytoma, no capsule injury and no malignancy. We decided to continue watchful waiting of the left adrenal tumor, because the serum and urine levels of catecholamine were within the normal range after the operation. She has been well with no clinical symptoms, no increase in tumor size, and no elevation of catecholamine for 20 months.

We assessed the diagnostic value of procalcitonin (PCT) in urosepsis on 54 patients with urinary tract infections (UTI), suspected of having urosepsis. The results of urine culture, blood culture, and serum concentrations of PCT were analyzed. Overall, the sensitivity and specificity of PCT for bacteremia were as follows : 100 and 31.6% at concentrations of0.5 ng/ml and 75.0 and 78.9% at concentrations of10 ng/ml. we concluded that the PCT level could be a reliable early marker suggestive of urosepsis, and may be helpful when deciding whether to perform immediate urological intervention or not.

A 37-year-old male who had sustained a lumbar vertebral fracture presented with the chief complaint of high fever and urine leakage from the perineal region. Computed tomography and urethroscopy showed a huge prostatic urethral calculus. He had a urethrocutaneous fistula in the perineal region. Transvesical prostate-urethrolithotomy, debridement of perineal abscess and cystostomy were performed. After operation, he had total incontinence during clamping of the cystostomy. Four months later, ileal-conduit formation and simple cystectomy were performed to improve urinary management. The pathogenesis of prostatic urethral calculus and the management of neurogenic bladder patients with spinal cord injury are reviewed.

A 56-year-old man presented with a painless mass in the left scrotum. The mass was first noticed when he was a junior high school student,and it had been left for about 40 years. The intrascrotal tumor of 7 cm in diameter was elastic soft and smooth. The serum levels of α -fetoprotein, β -human chorionic gonadotropin and lactate dehydrogenase were within each individual normal range. He was diagnosed as having a left testicular tumor (cT1N0M0) and underwent left high orchiectomy. Histopathological diagnosis was mature teratoma without any malignant germ cell components. No evidence of recurrence has been observed for 4 years after the operation.

A 64-year-old man presented to our hospital feeling ill with epigastralgia. Computed tomography (CT) showed right suprarenal cystic tumor. High urinary catecholamine level was noted. Based on metaiodobenzylguanidine (MIBG) scintigraphy, magnetic resonance imaging and blood tests, preoperative diagnosis was adrenal pheochromocytoma. En-bloc resection of the tumor and the right kidney was performed. The cyst contained yellowish serous fluid, which had a catecholamine level about 3,000 times that in the blood. The histological diagnosis was cystic pheochromocytoma. Pathogenesis of cystic adrenal tumor is discussed briefly.

A 69-year-old man was admitted for the treatment of muscle-invasive bladder carcinoma. Total cystectomy was performed and an ileal neobladder was constructed by a modification of Studer's method. However, a week later, a subcutaneous abscess occurred withwound dehiscence. Open drainage and wound debridement was carried out. Three weeks later, a neoblader-cutaneous fistula was seen on cystography. We managed it conservatively by means of wound debridement and washing with physiological saline. The fistula was closed on the 95th day after operation. The patient can now pass urine by himself.

A 70-year-old man complaining of fever and chills was admitted to our hospital. A computerized tomography scan revealed a bladder tumor (cT3bN0M0), and urinary cytology demonstrated neuroendocrine carcinoma. Prostate specific antigen (PSA) was 4.089 ng/ml and human cytokeratin 19 fragment (CYFRA 21-1) was 3.8 ng/ml. He underwent transurethral resection of bladder tumor and needle biopsy of the prostate. Pathological examination demonstrated small cell carcinoma in the bladder tumor specimen and well differentiated adenocarcinoma (cT1c) with a Gleason score of 34 in the prostatic specimen. He underwent cystoprostatectomy with bilateral cutaneous ureterostomy. He did not receive adjuvant chemotherapy because of the poor postoperative systemic condition and he died of acute myocardial infarction 5 months later.

A 44-year-old woman was admitted with acute hepatic dysfunction. Screening computed tomography showed an enhancing mass of about 9 cm in the right renal upper pole. An open right nephrectomy was performed for the pre-operative diagnosis of renal cell carcinoma. Pathological examination revealed a perivascular epithelioid cell tumor (PEComa). PEComa is a rare tumor, which includes angiomyolipoma and lymphangiomyomatosis. It is sometimes associated with aggressive clinical behavior such as local recurrence and metastasis. She had no evidence of recurrence at 34 months follow up.

A 65-year old woman underwent retroperitoneoscopic nephrectomy, for left renal mass which was suspected to be renal cell carcinoma. On the 2nd postoperation day, she suddenly complained of dyspnea and chest pain. Enhanced computed tomography revealed a defect of peripheral pulmonary artery, and ventilation-perfusion lung scanning showed large defect of the uptake in bilateral lung fields. Based on the arterial blood gas and imagings, she was diagnosed with a PTE (pulmonary thromboembolism). Thrombolytic therapy and anti-coagulant therapy were started. Thereafter, she recovered from hypoxia. However, these therapies gave rise to postoperative hemorrhage resulting in a massive retroperitoneal hematoma.

A 55-year-old man visited our hospital with left chest and back pain. Computed tomography (CT) showed left retroperitoneal tumor, which was 6 cm in diameter with intratumoral hemorrhage. Based on abdominal CT, magnetic resonance imaging and blood tests, preoperative diagnosis was adrenocortical carcinoma. En bloc resection of the tumor and the left kidney was performed. The histological diagnosis was adrenocortical carcinoma. He rejected adjuvant therapy with mitotane. Bone and liver metastases were recognized 2 months after operation. The patient died three months after operation because of disease progression.

A 57-year-old man was referred to our hospital for bladder tumor. The computed tomographic scan demonstrated an 8 cm solid mass in the posterior wall of the bladder. Cystoscopy revealed a non-papillary large bulky tumor and a necrotic tumor surface. The tumor was transurethrally resected and its histology showed sarcomatoid carcinoma composed of a urothelial cell carcinoma. Total cystectomy was performed and an ileal neobladder was constructed. He now shows no evidence of disease 43 months after the operation.

A 20-year-old woman, who had a history of childbirth, was admitted to the emergency room with an acute abdomen. An abdominal enhanced computed tomography (CT) revealed retroperitoneal hemorrhage, leading to life-threatening, and multiple tumors in the liver. Additionally, chest CT also revealed multiple coin lesions in the lung. These findings strongly indicated a spontaneous rupture of adrenal tumor. We performed exploratory laparotomy. An examination during surgery showed a rupture of adrenal tumor. En bloc resection of adrenal gland, tumor, and the kidney was performed. Pathological finding revealed the adrenal tumor was choriocarcinoma.

Reported herein is a case of serous borderline tumor (SBT, ovarian epithelial type tumor) of the paratestis, involving the tunica vaginalis, in a 64-year-old man. The patient complained of right hydrocele; puncture cytology of the turbid fluid pointed to an adenocarcinoma. Right orchiectomy was performed and multiple micronodules were grossly observed in the paratestis. On microscopy small papillary epithelial lesions were found with psammoma bodies and intraglandular papillary lesions were irregularly recognized in the stroma of the paratestis, similar to SBT of the ovary. The tumor cells had often short microvilli. Mucin production was evident on PAS and colloid iron staining. Both papillary and glandular epithelial cells were positive on immunohistochemistry for Ber-EP4/epithelial antigen, low-molecular-weight cytokeratin (CAM5.2), cytokeratin 7 and estrogen and progesterone hormone receptors, but negative for CEA, cytokeratin 20 and calretinin. The average proliferative index was approximately 10.5% as assessed on Ki-67 (MIB-1) staining. Ultrastructurally, the cells did not demonstrate any well-developed microvilli or secretory granules and immunohistochemical findings supported SBT of Mullerian type (ovarian epithelial type tumor), while excluding a papillary type of malignant mesothelioma. The lesion in the present case was concluded to be a testicular serous tumor of Mullerian type, similar to SBT of the ovary.

There is no consensus on the evaluated efficacy of individual alpha(1)-blockers in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). This study compared the clinical benefits of tamsulosin hydrochloride with those of naftopidil in BPH. Men aged 54-84 years with a main complaint of BPH were randomly assigned to receive consecutive treatment with tamsulosin then naftopidil (T-N group, 25 patients), or naftopidil then tamsulosin hydrochloride (N-T group, 20 patients). The therapeutic effects were compared in a crossover design. Administration was continued for 28 days in each treatment period. Both groups showed similar improvements during the first treatment period. However, during the second treatment period after crossover, therapeutic effects were greater in the N-T group. Tamsulosin was more effective than naftopidil on intermittency, nocturia and quality of life scores. Tamsulosin and naftopidil have different efficacy profiles for LUTS associated with BPH.

We report two cases of acute urinary retention in women with an impacted pelvic mass. In both cases, all urinary symptoms resolved completely after the surgical removal of the mass.

Various toxicities have been observed during the treatment of advanced renal cell carcinoma with interferon-alpha (IFN-alpha) and/or interleukin-2 (IL-2). We report a case of severe anemia, which responded well to steroid therapy, in a patient receiving IL-2 plus IFN-alpha for metastatic renal cell carcinoma.

A 48-year-old man, who previously had normal erectile function, visited our hospital complaining of a painless erection that had persisted for 6 days. He had suffered perineal trauma in a traffic accident 9 days earlier. A diagnosis of post-traumatic high-flow priapism was suggested from the findings on penile blood gas analysis. Selective internal pudendal arteriography showed an arterial blush along the bilateral cavernous arteries. Subsequently, embolization of a cavernous fistula was performed with an autologous clot. However, the embolus was removed within a minute, so the procedure was repeated with Gelfoam. This patient had normal erectile function after 11 months, with no recurrence of priapism.

Transurethral needle ablation (TUNA) is less invasive than other therapies for benign prostatic hyperplasia (BPH) and produces coagulative necrosis within selected adenoma lesions. The action mechanism of TUNA is still obscure, even though many early studies have demonstrated good clinical results of TUNA. It is of interest and importance to know how TUNA influences the volume of the intraprostatic region responsible for bladder outlet obstruction in order to elucidate the anatomical action mechanism of TUNA.We retrospectively investigated postoperative variations in volumetric parameters of whole prostate volume (PV), transition zone volume (TZV) and transition zone index (TZI = TZV/PV) in 41 patients with symptomatic BPH who were treated with TUNA. The data were analyzed statistically in relation to the preoperative overall severity and postoperative therapeutic efficacy.Both PV and TZV showed a significant decrease at 3 months after TUNA (P0.01) as did the symptom score, quality of life (QOL) score and functional variables, and a decreased level of PV and TZV was sustained until 12 months of follow-up when compared to the baseline (P0.01 at 6 months, not significant at 12 months). TZI also showed a similar pattern with a significantly decreased level until the postoperative 6th month (P0.05 at 6 months, not significant at 12 months). In 'moderate' cases, TZI achieved the minimum value (0.44 +/- 0.13, P0.05 compared to the baseline) at 3 months of follow-up, but the level immediately increased, while in 'severe' cases, TZI gradually decreased and achieved the minimum value (0.44 +/- 0.08, P0.05 compared to the baseline) at 12 months of follow-up. In the evaluation by postoperative therapeutic efficacy, there were no significant differences in PV, TZV and TZI between 'excellent and good' cases (E/G group) and 'fair and poor/worse' cases (F/P group) at the baseline or 3 months of follow-up. Both of the efficacy groups showed a significant decrease in PV, TZV and TZI at 3 months when compared to the baseline (P0.05). The mean decrease in TZI was significantly larger in the E/G group than in the F/P group (0.064 +/- 0.13 vs 0.027 +/- 0.12, P0.05).Therapeutic efficacy of TUNA did not depend on the baseline value of PV, TZV and TZI, but on variation of a decrease in TZI during follow-up. Moreover, a slow and lasting decrease in TZI seemed to influence durability of the therapeutic efficacy of TUNA, which was clearly observed in 'severe' cases with a larger prostatic volume than in 'moderate' cases.

A 27-year-old man presented to our hospital complaining of multiple mild injuries sustained in an attack of violence at the workplace. He had received chemical burns to the penis induced by hydrochloric acid and had developed severe phimosis. He complained of pain on erection and ballooning during urination. The foreskin was partially resected with foreskin grafting for the stricture. The postoperative outcome was favorable and his symptoms were relieved.

A 36-year-old woman came to our hospital complaining of right flank pain. Computed tomographic (CT) scanning showed a cystic mass, 6 x 9 cm in size, including homogeneous low-density fluid contents, in the right retroperitoneal space. The cyst wall showed partly high-density epithelium, but there was no contrast enhancement. A 7.5 x 12 cm retroperitoneal cyst was easily removed with yellow serous fluid in it. Cytological examination showed no malignant cells in this fluid. The origin of the cyst was unknown. The histopathological diagnosis was retroperitoneal serous cyst with focal ossification in the lining epithelium. Here we report this rare case of retroperitoneal serous cyst and briefly discuss 57 cases reported in Japan.

We report here two patients with angiomyolipoma with minimal fat, who were treated by radical nephrectomy, with a diagnosis of renal cell carcinoma. The tumors in these two patients were hyperattenuated on unenhanced computed tomography (CT) images, but did not show fat components, and were moderately enhanced on contrast-enhanced CT images. The tumor in one patient was homogeneously hypointense on T2-weighted magnetic resonance (MR) images, enhanced during the early phase on dynamic MR images, and, further, showed abundant pulsatile blood vessels on color Doppler examination. These imaging findings of renal tumors suggested the possibility of angiomyolipoma with minimal fat; accordingly, when imaging results suggest this possibility, further careful sampling to identify minimal fat components must be performed by thin-section unenhanced CT.

We report a case of long-term survival in a patient with neuroblastoma treated with conservative therapy. A 2-year-old female patient who presented with a lower abdominal mass was diagnosed with neuroblastoma. Resection of the tumor was not successful because of adhesion. Histopathological diagnosis of para-aortic lymph node was ganglioneuroblastoma. Postoperatively 50 Gy-radiation and chemotherapy were performed. At age 17, needle biopsy of the tumor was performed, and the histopathological diagnosis was ganglioneuroma.

We have reported the favorable therapeutic results of non-ischemic complete enucleation using a microwave tissue coagulator as a method of nephron-sparing surgery for small renal cell carcinoma (RCC). We experienced two elective cases that underwent translumbar nephrectomy subsequent to the tumor enucleation. The first case showed another RCC in a cyst, concomitant with the enucleated RCC. The second case was a pT3a spindle cell carcinoma with high-grade malignancy. We decided to nephrectomize these enucleated kidney after obtaining well-informed consent. Here we report these controversial cases and discuss about the indication and outcomes of complete tumor enucleation for small RCC.