(Purpose) Recently, various types of radical surgery have been performed in Japan. To elucidate the surgical consequences, morbidity and mortality, and perioperative care, we conducted a nationwide survey. (Materials and methods) Assisted by the Japanese Society of Endourology, perioperative data from 156 hospitals participating in this survey in 2007 were analyzed. Using a spreadsheet database, data were collected from each institution. (Results) Open radical prostatectomy was performed in 3,138 patients at 143 hospitals, minimum incision endourological radical prostatectomy in 361 at 15 hospitals, laparoscopic radical prostatectomy via transperitoneal approach in 143 at 11 hospitals and laparoscopic radical prostatectomy via extraperitoneal approach in 337 at 13 hospitals. For open and minimum incision endourological radical prostatectomy, the surgical duration was shorter but the bleeding volume was greater than that in laparoscopic radical prostatectomy via both approaches. As a whole, perioperatvie mortality rate was 0.05% and morbidity rate was 23.4%. Rectal injury was similarly infrequent among the four types of surgery. Superficial surgical site infection was most frequent in open radical prostatectomy. Perioperative management significantly varied among the four types of surgery. In laparoscopic radical prostatectomy via extraperitoneal approach, urethral catheter was removed earlier but acute urinary retention frequently occurred. (Conclusions) In Japan, open radical prostatectomy was the most frequently performed surgery for prostate cancer. Surgical volume per hospital was small, however, mortality was low and morbidity was acceptable. Comparisons of complications and outcomes among the types of currently performed surgery should be useful to promote standardization of the perioperative care.
Malakoplakia is a rare chronic inflammatory condition characterized by defective macrophage function, most of which involve the genitourinary tract, and renal parenchymal involvement is uncommon. We present a case of malakoplakia affecting renal parenchyma. A 46-year-old woman with pyrexia and jaundice was referred to our department. Abdominal enhanced CT scan revealed a left pyelonephritis with ureteral stone and bilateral renal abscesses. Despite the insertion of a left ureteral stent and administration of antibiotics, the patient showed persistent high fever and elevated CRP, and no obvious improvement in clinical and imaging data. In view of the limited effectiveness of the conservative treatment in this case, we decided to perform left nephrectomy. The diagnosis of malakoplakia was made based on the histopathological findings of von Hansemann cells and Michaelis-Guttmann bodies detected in the nephrectomy specimen. She is clinically healthy up to the present (50 months after surgery) with normal clinical indicators and CT findings.
A 64-year-old woman presented with recto-cutaneous fistula after tension-free vaginal mesh reconstruction using polypropylene mesh for pelvic organ prolapse. Eleven months after the operation, an ulcerative lesion with stools smell secretion developed in the left hip. Magnetic resonance imaging and colonoscopy revealed a migration of the left arm of the mesh and a recto-cutaneous fistula. The patient underwent excision of the infected mesh and rectal wall closure together with transient colostomy. After 8 months, colonoscopy revealed a new migration of the mesh in the rectum, which was also removed. The colostomy was closed one year later and rectal erosion has not reccurred since then. The possibility of developing a rare but severe mesh-related complication as presented here should always be kept in mind.
A 11-year-old boy showed gross hematuria and left flank pain. Ultrasonography and CT revealed left hydroureteronephrosis, and he was referred to us for the further evaluation. MRI revealed left hydroureteronephrosis with filling defect at the distal end of the dilated ureter suggesting ureteral polyp. Open surgery was performed with the diagnosis of mid-ureteral obstruction. In the operative findings, multiple stalks of ureteral polyps arose from the entire ureteral wall over 5cm in length at the site of ureteral obstruction. Mid-ureter with polyps was completely resected, and end-to-end anastomosis was performed. The pathological diagnosis was fibroepithelial polyp of the ureter.
We report an extremely rare case of a 69-year-old man having a retroperitoneal carcinoid tumor associated with multiple endocrine neoplasia (MEN) type 1. The patient whose son and daughter were previously diagnosed with MEN type 1 was admitted to the Department of Endocrinology at our hospital for evaluation of this disorder. Computed tomography (CT) and ultrasonography revealed a parathyroid and retroperitoneal tumor (43mm×34mm). The patient did not consent to surgical management of the tumor; however three years later, a follow-up CT revealed tumor enlargement (55mm×50mm). We were unable to rule out a malignancy, and subsequently resected the tumor. A pathological diagnosis of retroperitoneal carcinoid was made. No local recurrence or metastasis have been observed for 21 months.