(Purpose) We retrospectively reviewed 107 patients of upper urinary tract carcinoma to determine the overall outcome, prognostic factors, frequency of subsequent bladder cancer and role of adjuvant therapy. (Materials and methods) 107 patients of upper urinary tract carcinoma, who underwent surgical treatment at Sumitomo Hospital between January 1992 and June 2007 were reviewed. The Kaplan-Meier method and Cox's proportional hazard model were used. (Results) Five-year disease specific survival, progression free survival and bladder recurrence free rates in all patients were 88.1%, 51.2% and 64.9% respectively. Multivariate analysis revealed squamous differentiation to be the most important prognostic factor. Five-year disease specific survival in locally advanced upper urinary tract carcinoma treated with adjuvant chemoradiation was 74.0%, which was not statistically different from it without chemoradiation. (Conclusion) Our series suggests that the adjuvant chemoradiation does not improve the outcome in patients with locally advanced upper urinary tract carcinoma.
(Purpose) To investigate the outcomes for single institution with prostate cancer treated with radical prostatectomy (RP). (Materials and methods) A retrospective analysis was performed on 406 patients who underwent RRP from January 1991 to December 2005 for cT1-3N0M0 prostate cancer. To evaluate the change of the patient background, we divided the 15 years into the 5periods whose span was 3years each and examined. Biochemical recurrence was defined as a prostate-specific antigen (PSA) of >/=0.2ng/ml. Clinical recurrence was defined as metastases or local recurrence. Actual probability of cancer specific mortality was estimated using the Kaplan-Meier method. The Log rank test was used to determine statistical difference between actual curves. Preoperative parameters analyzed were patient age, preoperative PSA, clinical stage, Gleason score, and Neoadjuvant hormonal therapy. Multivariate analyses (logistic regression and Cox proportional hazard model) for the dependent variables (organ-confined prostate cancer, clinical recurrence free survival and cancer specific mortality) were performed. Perioperative complications between cT1/2 with cT3 were compared. (Results) The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Median follow-up and median patient age were 55month and 69year. Of the 406 men, 35 (8.6%) developed clinical recurrence, 15 men (3.7%) died from prostate cancer within the follow-up period. For pT0/2, pT3a, pT3b and pN+, the 10-yr cancer specific survival rate was 100%, 92%, 81% and 67%, respectively. Preoperative PSA (p< 0.0001), clinical stage (p=0.004), Gleason score (p< 0.0001) and neoadjuvant hormone therapy (p=0.0003) are predictive variables for organ confined prostate cancer. Preoperative PSA (p=0.002) and clinical stage (p=0.03) are prognostic variables for cancer specific mortality. There was significant difference in surgery time (p=0.04) and blood loss (p=0.0007) in cT1/2 cases compared with cT3 cases. (Conclusion) The number of the operation increased every period. High recurrence risk group and cT3 were tended to decrease. Neoadjuvant hormone therapy prior to prostatectomy was a significant improvement in the organ confined rates. However neoadjuvant hormone therapy did not improve patient prognosis. Preoperative PSA and clinical stage are prognostic variable for cancer specific mortality.
(Purpose) To determine the efficiency of slow delivery rate of shockwaves (SW) on stone fragmentation and treatment outcomes in patients with renal and ureteral calculi. (Patients and method) Using the Siemens Lithostar Multiline, we treated 843 patients (229 renal and 614 ureteral stones) at a fast delivery rate (120 SW/min, between October 2003 and August 2006), 448 patients (139 renal and 309 ureteral stones) at a slow delivery rate (90 SW/min, between September 2006 and August 2008). (Results) The stone free rates at 3 months after treatment of fast rate group and slow rate group were 60% and 53% (renal stones, P=0.858), 82% and 91% (ureteral stones, P< 0.001), respectively. The average numbers of sessions required were 2.02 and 1.59 (renal stones, P=0.018), 1.61 and 1.49 (ureter stones, P< 0.001), respectively. The mean total shots were 8,718 and 4,679 (renal stones, P< 0.001), 7,684 and 4,928 (ureteral stones, P< 0.001), respectively. The mean treatment times were 80 and 60 minutes (renal stones, P< 0.001), 72 and 62 minutes (ureteral stones, P< 0.001), respectively. The slow delivery group patients included more number of elders, stones located on lower renal calices and less frequency of pain at onset than the fast delivery group. Multiple logistic regression analysis revealed that slow delivery rate (90 SW/min) as well as age (younger), symptom (painful) at onset, stone location (middle and distal ureter) and size (small) was a independent (better) prognostic factors determining stone clearance after ESWL of upper urinary tract stones. (Conclusion) Slow rate shock wave delivery not only improved efficacy at ESWL treatments of upper urinary stones, but also decreased number of sessions, shock waves and treatment time required.
Two cases with a urethrovesical foreign body in adolescent boys are reported. Case 1 was a 12-year-old boy with a stretched safety pin, 7 cm in length, in the urethra. This was probably introduced by him. Case 2 was a 14-year-old boy with a self-introduced metallic bar, 5 cm in length, in the urinary bladder. The foreign bodies were endoscopically removed. Both of the boys had grown in fatherless families. In Case 1, his father had died in a traffic accident while trying to save the patient at the age of 5 years. In case 2, the parents had been divorced. These episodes could have resulted in mental instability in the boys, which possibly led to the self-introduction of the foreign body. Urethrovesical foreign bodies are not rare. However, a foreign body in adolescents under 15 years of age is very rarely reported. It is incumbent upon urologists to thoroughly investigate the psychological conditions in such cases, and to properly judge whether psychiatric cares and follow-up are necessary.
A 48 years-old man had undergone transurethral lithotripsy (TUL) and Extracorporeal Shockwave Lithotripsy (ESWL) for bilateral ureteral stones and bilateral ureteral stents had been placed in 2001. He was lost to the follow-up for about 7 years after the removal of left ureteral stent. He had complained of right back pain and fever for two months. KUB showed right ureteral stones and encrustation along the ureteral stent. We performed TUL extracting the ureteral stent by silk, referring to silk loop technique. All stones and the encrusted ureteral stent were removed. This was very effective for patients with encrusted ureteral stent.
A 78-year-old female complained high fever and vomiting. The ultrasonographic examination revealed a giant tumor above the left kidney. She was referred to our hospital for further examinations and treatments. Radiographic examination showed a solid mass of 10 cm in diameter, smooth surface, and sharply-delimited, above the left kidney corresponding to the left adrenal gland. Other organs showed no evidence of disease. Hormonal examination was normal. She was diagnosed as left non-functioning adrenal tumor, and underwent surgery. The resected specimen was 11×10×7 cm, 460 g with a part of normal adrenal tissue on the surface. Histopathological examination revealed it as leiomyosarcoma. She has no evidence of disease twenty months after the operation. Primary adrenal leiomyosarcoma is extremely rare. To the best of our knowledge, there were only 22 reported cases including ours in the English and Japanese literature.
A 17-year-old boy who received a kick on his right back during the training of karate complained of gross hematuria. Computed tomography revealed slight bleeding at the lower pole of right kidney. His general condition was stable and the gross hematuria was improved immediately. After one month, CT revealed a large right subcapsular renal fluid accumulation with parenchymal compression and his blood pressure became elevated. We diagnosed as Page kidney associated with subcupsular renal lymphocele after trauma. Percutaneous drainage and laparoscopic cyst fenestration were performed. After the procedures, the fluid accumulation was recurred and the blood pressure became elevated again. We disclosed a case of Page kidney associated with subcupsular renal lymphocele and propose that careful management should be needed in a patient like our case.
A 58-year-old man was referred to our hospital for investigation and treatment of a retrovesical cystic tumor that was detected during his annual health check-up. Computed tomography and magnetic resonance imaging (MRI) showed a 5 cm cystic mass including a 1.5 cm solid mass between the bladder and rectum. Transrectal biopsy was performed successfully, and did not show any evidence of malignancy. Six months later, the cystic mass enlarged, and video-assisted laparoscopic excision of the cystic mass was performed. The mass was pathologically diagnosed as a seminal vesicle cyst. Because of the rarity of this lesion, only 11 cases of laparoscopic excision have been reported and, to our knowledge, this is the first case in the Japanese literature. Under the laparoscopic prostatectomy approach, we could safely resect the lesion.