The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
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Showing 1-11 articles out of 11 articles from the selected issue
Original Articles
  • Ryotaro Tomida, Ousuke Arai, Shunsuke Iuchi, Masafumi Matsumura, Katsu ...
    2020 Volume 111 Issue 4 Pages 107-113
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    (Objectives) Investigation of patient-reported outcome (PRO) after ileal neobladder for bladder cancer.

    (Patients and methods) Forty patients who underwent radical cystectomy and ileal neobladder between July 2007 and December 2017 were asked to complete a questionnaire. PRO was evaluated using the Medical Outcomes Study Short Form-8 (SF-8) for general health-related quality of life (QOL) and the Bladder Cancer Index and the Japanese version of the Functional Assessment of Cancer Therapy-Bladder for disease specific QOL. Patients were divided into two groups according to the postoperative period (early and late), and the differences in questionnaire results between the groups were evaluated.

    (Results) All scores on the SF-8 were over 50 points, exceeding the Japanese national standard of 50 points for all items. The physical and mental summary scores were also favorable. For disease-specific QOL, only daytime incontinence was significantly higher in the late group, with daytime incontinence two or more times per week at 42.1%, compared to 20.0% in the early group (P=0.0403). A comparison of daytime urinary incontinence in four groups during the postoperative period showed that urinary incontinence was least frequent among patients between 64 and 101 months after surgery; patients in this group were also the youngest in age at the time of surgery.

    (Conclusions) Cross-sectional analysis of PRO revealed that patients with ileal neobladder had good general health-related QOL after surgery, but urinary incontinence was a significant problem.

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  • Syunsuke Nobata, Syoutarou Kiuchi, Megumi Watanabe, Atsuyoshi Mori, Si ...
    2020 Volume 111 Issue 4 Pages 114-119
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    (Objective) We studies morbidity and risk factors related to urinary cancers (renal, bladder, and prostate) from health screening interviews and results.

    (Subjects and Methods) We extracted data from 48,454 adults who underwent health screenings between April 2006 and March 2008.

    Of particular interest were examinees who were newly diagnosed with urinary cancer after the consultation. The data examined included factors such as sex, age, total years of smoking, body mass index (BMI), drinking status, weight gain (>10 kg from the age of 20), accumulation of stress, sleep condition/habits, adequate dairy product intake, hypertension, diabetes mellitus, and dyslipidemia.

    (Results) The numbers of patients who were diagnosed with renal, bladder, or prostatic cancer were 45, 47, and 215, respectively. The corresponding morbidity rates were 0.093%, 0.097%, and 0.721%. From the results of the univariate analysis, renal cancer was found to be significantly correlated with the male gender, old age, high BMI, drinking, weight gain, and hypertension. In addition, we found a significant correlation between bladder cancer and male gender, old age, total years of smoking, and drinking. Prostate cancer was significantly correlated with old age, total years of smoking, weight gain, accumulation of stress, and dyslipidemia. The multivariate analysis demonstrated a significant correlation between renal cancer and old age, between bladder cancer and both male gender and old age, and between prostatic cancer and both old age and dyslipidemia.

    (Conclusion) Old age was identified as a common risk factor that is significantly and independently correlated with urinary cancers.

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  • Tomoyuki Shimabukuro, Chietaka Ohmi, Ryoko Nagamitsu, Koji Shiraishi, ...
    2020 Volume 111 Issue 4 Pages 120-129
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    (Background) Currently, luteinizing hormone-releasing hormone (LH-RH) agonists and antagonists are used for androgen-deprivation therapy (ADT). However, they are associated with subcutaneous granuloma, rubor, dolor, calor, and eventual ulcer and/or abscess formation. The prevalence of these adverse effects, causes and mechanisms, and effects on serum testosterone levels and clinical outcomes are poorly understood.

    (Method) We collected the clinical records of men with pathologically diagnosed prostate cancer who were followed in our hospital. The primary aim of the study was to determine the prevalence of granuloma formation, its causes, and the mechanisms involved. The secondary aim was to analyze the effects of subcutaneous induration on serum testosterone levels and clinical outcomes.

    (Results) Overall, 185 men using leuprorelin (n=161; median age, 75 years), degarelix (n=21; median age, 76), or goserelin (n=3; median age, 76) were analyzed. In the leuprorelin cohort, 51 patients (33.5%) had subjective and/or objective subcutaneous induration and 2 (1.2%) had a large lesion (diameter > 3.0 cm). In the degarelix cohort, 18 patients (85.7%) developed induration and 8 (38%) had a large lesion. One month after the start of ADT, patients in the leuprorelin and degarelix cohorts had median serum testosterone levels that reached the same level as that after castration. There was no significant difference in the overall survival rate between the leuprorelin and degarelix cohorts. There was no significant difference in the serum testosterone level or overall survival rate between patients with or without induration.

    (Conclusions) The local adverse effects of LH-RH agents are prevalent, but we can regulate the adverse effects by understanding the mechanism involved. The formation of subcutaneous induration did not affect the serum testosterone level or clinical outcome.

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Case Reports
  • Akiyuki Asano, Ryo Ishida, Hiroko Morikami, Tomoyoshi Ohashi, Yushi Ya ...
    2020 Volume 111 Issue 4 Pages 130-133
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    A 50-year-old man was admitted to our hospital for urinary retention. Computed tomography revealed a spherical intravesical foreign body, measuring 1.7cm in diameter, and cystoscopy revealed glass ball in the bladder. Considering the shape of the object and the possibility of self-insertion, we used a flexible cystoscope, foreign body forceps, and a transvaginal echo probe cover to remove the intravesical foreign body. The end of the echo probe cover was grasped with the foreign body forceps, and a glass ball was inserted into the probe cover and extracted manually with a scooping action similar to using a landing net. No intraoperative hemorrhage was observed, and the glass ball was safely removed with good visual field.

    The patient's postoperative courses was uneventful, and he has shown no recurrence one year postoperatively.

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  • Mio Tanigawa, Toru Huruuchi, Koetsu Tamura, Fumio Nakajima, Hideharu D ...
    2020 Volume 111 Issue 4 Pages 134-139
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    Renal cell carcinoma (RCC), the most common solid lesion of the kidney, accounts for approximately 2%-3% of all malignancies among adults. Clear cell carcinoma and papillary cell carcinoma are the most common types of renal tumors. Some case reports have described synchronous benign and malignant tumors in the same kidney. In particular, angiomyolipoma and RCC in patients with tuberous sclerosis (TSC) and non-TSC have been reported many times in the literature. However, unilateral concordance of malignant renal tumors is very rare; thus, only few cases have been reported in the literature.

    Here we report the case of a 58-year-old male who had ipsilateral synchronous mucinous tubular and spindle cell carcinoma (MTSCC) and clear cell papillary renal cell carcinoma (CCPRCC). Both cancers are rare and relatively recently defined subtypes of RCC. Additionally, both were successfully treated using partial nephrectomy. MTSCC has been a distinct entity in the World Health Organization classification of kidney tumors since 2004. The classic type of MTSCC is characterized by small elongated tubules lined with clear cuboidal or spindle cells with mucinous stroma. Neoplastic cells always exhibit low-grade histological features. However, unclassified variants of MTSCC, such as mucin-poor, papillary, high-grade, and sarcomatoid variants, have also been reported. MTSCC is considered to have a relatively good prognosis, but some patients with poor prognoses have recently been reported. CCPRCC is a recently recognized entity and represents the fourth most common variant of RCC. It has unique morphological and immunohistochemical features and shows indolent clinical behavior. Microscopically, CCPRCC may mimic other RCCs with clear cell features, such as clear cell RCC, translocation RCC, and papillary RCC, with clear cell changes. In 2006, CCPRCC was described as a subtype of renal tumors in patients with end-stage renal disease. However, currently, CCPRCC has also been shown to occur in kidneys with normal function.

    To the best of our knowledge, this is the first report of ipsilateral synchronous MTSCC and CCPRCC, which we present with a review of the pertinent literature.

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  • Yusuke Yagihashi, Tomotsune Toyosato, Shuichi Shimabukuro, Haruaki Kat ...
    2020 Volume 111 Issue 4 Pages 140-144
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    Calcified ureteral obstruction is a rare complication of vasculitis. Only a few cases of eosinophilic granulomatosis with polyangiitis (EGPA) have been published. We herein report a case of successful surgical repair of bilateral ureteral strictures in a patient with EGPA. A retrograde pyelogram revealed complete bilateral ureteral obstruction in the patient. Bilateral nephrostomies were placed because we were unable to introduce a double-J stent. The vasculitis and eosinophilia both responded to immunosuppressive therapy, but ureteral obstruction persisted. Surgical reconstruction was elected in order to eliminate the need for permanent external drainage. A combined nephrostogram/retrograde ureterogram revealed a 10 cm right ureteral gap and a 3 cm left ureteral gap. The left ureter was amenable to end-to- end anastomosis, pyeloureteroplasty, but repair of the right ureter required interposition of intestinal tissue. Right ureteral reconstruction was performed by combining the Yang-Monti ileal ureteral substitution and appendiceal interposition with a psoas hitch. The isolated appendix was interposed in an antiperistaltic fashion between the Yang-Monti tube and bladder. His kidney function has remained normal, and he is without vasculitic symptoms.

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  • Yuma Kujime, Atsunari Kawashima, Nobuhiko Kawata, Kentaro Takezawa, Ta ...
    2020 Volume 111 Issue 4 Pages 145-149
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    We present a case in a 74-year-old female patient whose initial symptom was right flank pain. Enhanced computed tomography showed a mass (about 15×12 cm) in the retroperitoneum, inferior vena cava tumor thrombus (Level III: Neves and Zincke system) and liver metastasis. The primary tumor exploded and inferior vena cava tumor thrombus caused congestive liver one and a half month later. Preoperative diagnosis was right adrenocortical carcinoma (cT4N0M1 stage IV). We performed complete resection of tumor including metastasis. Pathological findings on the resected specimen revealed pleomorphic leiomyosarcoma, which was discontinuous tumor from the right normal adrenal grand. There was no evidence of local recurrence or metastasis after 6 months with no additional treatment.

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  • Takeshi Fukazawa, Tadashi Tabei, Takuma Nirei, Risa Shinoki, Sogo Tsut ...
    2020 Volume 111 Issue 4 Pages 150-153
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    An 84-year-old woman was referred for lower abdominal pain lasting more than six months. Computed tomography showed a left ovarian varicose vein and a peri-uterine venous plexus. Due to suspected pelvic congestion syndrome, left ovarian venography and left ovarian embolization were performed. Blood flowed back through the dilated left ovarian vein and through the uterine venous plexus to the right ovarian vein. Embolization of the left ovarian vein with a sclerosing agent resulted in the disappearance of the venous congestion. Preoperative Visual Analogue Scale was 7, which decreased to 3 after the operation. As a result, improvements in QOL were recognized. Although pelvic congestion syndrome is a treatable disease, its recognition as a urological disease is low. Here, we have reported a case of pelvic congestion syndrome in which symptoms improved with treatment and have discussed its pathophysiology and treatment.

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  • Yusuke Fukiage, Takafumi Kabuto, Ryusei Yokokawa, Manabu Kurosawa
    2020 Volume 111 Issue 4 Pages 154-158
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    Mucin-producing urothelial-type adenocarcinoma of the prostate (MPUAP) is a very rare disease. MPUAP has been reported to progress faster than the rate at which normal prostate cancer progresses. We report a case of MPUAP with long-term survival. The patient was a 65-year-old man. Computed tomography and magnetic resonance imaging showed a cystic lesion extending from the prostate to the urethra. We performed transrectal prostate biopsy and transurethral resection of the tumor, and the pathological diagnosis was adenocarcinoma. Subsequently, we performed total cystectomy, ureterostomy, and pelvic lymphadenectomy. Based on the pathological and immunostaining findings (prostate-specific antigen negativity, CDX-2 positivity, cytokeratin 20 positivity, 34β-E12 positivity), the patient was diagnosed with MPUAP. Four years after the surgery, recurrence or metastasis was not observed.

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  • Shota Fukae, Yuki Horibe, Yohei Yamanaka, Tetsuji Soda, Sachiko Hongo, ...
    2020 Volume 111 Issue 4 Pages 159-163
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    Case 1 was a 71-year-old female who had been examined by her primary care physician for palpitation and hypertension. Urinary hormone test results revealed elevated urine metanephrine at 0.20 mg/day, urine normetanephrine at 0.45 mg/day and urine noradrenalin at 234.9 μg/day. 123I-MIBG scintigraphy showed uptake in the right suprarenal area, thus she was referred to our department because of pheochromocytoma. She underwent a laparoscopic right adrenalectomy and pathological results led to a diagnosis of adrenocortical adenoma. Case 2 was a 70-year-old female who had been examined at our hospital for hypertension. Blood hormone test results revealed elevated noradrenalin at 0.70 ng/ml. 123I-MIBG scintigraphy showed uptake in the left suprarenal area and she was referred to our department because of pheochromocytoma. She underwent a laparoscopic left adrenalectomy, thus pathological results showed no tumor lesion.

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  • Kazuki Takekawa, Akio Horiguchi, Koetsu Hamamoto, Yuji Hirano, Mina Ha ...
    2020 Volume 111 Issue 4 Pages 164-168
    Published: October 20, 2020
    Released: October 20, 2021
    JOURNAL FREE ACCESS

    Surgical resection is the standard treatment for the management of localized penile cancer and a neo-urethral meatus is generally created on the penile stump or perineum. Neo-urethral meatus is often stenosed and requires repeated transurethral manipulations such as dilation and urethrotomy. These procedures are generally futile and are associated with poor quality of life. Here, we report a case of penile cancer that developed a neo-meatal stenosis after total penectomy, which was subsequently salvaged by perineal urethrostomy using Blandy technique. A 72-year-old male who was diagnosed with localized penile cancer, underwent total penectomy and creation of neo-meatus on the perineum. Neo-meatus stenosis had developed in the patient and he received repeated urethral dilations without any success. Finally, when the patient was unable to void, he was referred to us for the amelioration of meatal stenosis through the placement of a suprapubic catheter. Because the condition of the residual bulbar urethra was adequate and its length was enough, we planned to create a non-transecting perineal urethrostomy by Blandy technique. An inverted U-shaped perineal incision was made, and a skin flap was created. The scarred neo-meatus and spongiofibrosis at the distal bulbar urethra were completely excised. The residual bulbar urethra was exposed, and a longitudinal ventral incision of 4 cm was made. The edge of the bare urethral mucosa and tunica albuginea of the corpus spongiosum were sutured by 4-0 PDS for hemostasis. The apex of the U-shaped skin flap was brought to the proximal margin of the urethrotomy and a tension-free anastomosis was created between the skin flap and the urethral plate. Thereafter, the skin of the perineum was sutured to the open longitudinal urethrotomy. The patient started to void on the 5th day post-surgery. The subject could void without the help of any intervention and did not require any instrument, sixteen weeks after the surgery.

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