(Objectives) The treatment of adrenal metastases using laparoscopic surgery still remains a matter of considerable controversy. The aim of this study is to present our experience of laparoscopic adrenalectomy for isolated adrenal metastasis. (Methods) From June 2004 to June 2011, 5 adults (4 males/1 female) with isolated metastases to the adrenal glands underwent laparoscopic adrenalectomy. These patients included 3 cases of lung carcinoma, a case of hepatocellular carcinoma, and a case of renal cell carcinoma. The median patient age was 69 (range 61 to 72), and the median tumor size was 3.5 cm (range 2.5 to 7.0). (Results) Laparoscopic adrenalectomies were performed without any complications using transperitoneal and retroperitoneal approaches. The median operative time was 142 minutes (range 126 to 174), and the estimated blood loss was 38 ml (range 25 to 158). The resection margins were free in all cases. A patient with lung cancer has been treated with adjuvant chemotherapy, otherwise, 4 patients have not. Regarding the oncological outcome, 3 of 5 patients were alive without any recurrence at a median follow-up of 14 months. About the rest two cases, one was alive with lung metastasis occurred at 15 months later, the other was died of the cancer at 14 months later. (Conclusions) Laparoscopic adrenalectomy for isolated adrenal metastasis is thought to be feasible. However, the indication of the surgery must be determined depending on tumor size, cancer characteristics, risk factors and so on. Additionally, the operative procedures such as approaches must be discussed sufficiently.

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(Purpose) To validate 2009 TNM classification (7^th edition) of renal cell carcinoma (RCC), we reevaluated our RCC database depends on 6^th and 7^th TNM staging and analyzed a prognostic divergence between subgroups. (Methods) A study population of 350 patients with RCC was retrospectively reviewed based on the TNM classification both 6^th and 7^th editions. Cause-specific survival (CSS) in each group was estimated using Kaplan-Meier method. (Results) Applying the new TNM system, 336 patients were divided into pT1a 131, pT1b 105, pT2a 31, pT2b 13, pT3a 38, pT3b 3, pT3c 0, pT4 14. Previously pT3b-staged 11 cases with renal vein involvement without vena caval extension were included into pT3a. Due to the positive direct invasion into the adrenal gland, previously pT3-staged six patients were changed to pT4.Kaplan-Meier curves revealed no significant differences in CSS between each a/b subgroups from pT1 to pT3. Particularly, no significant statistical value was recognized between pT2a and pT2b subgroups. Patients with direct adrenal invasion tended to show a less favorable prognosis than those with invasion beyond Gerota. (Conclusions) 1) pT2 subdivision does not affect prognostic value. 2) Population imbalance is enhanced due to the pT3 reclassification. 3) Direct adrenal invasion is compatible with pT4 category.

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(Objectives) Recently the incidence of intravaginal ejaculatory dysfunction is increasing among infertile couples in Japan. Some unusual ways of masturbation and psychogenic issues were reported to cause this disorder.Patients, who had done masturbation in an unusual way for long time since their adolescence, were difficult to gain normal intravaginal ejaculation by the behavior therapy which was used for erectile dysfunction. We, therefore, used a masturbation aid (TENGA) for rehabilitation of ejaculation to overcome this condition. (Patients and methods) From January, 2010 through March, 2011, a total of 16 patients with intravaginal ejaculatory dysfunction underwent rehabilitation of ejaculation using TENGA. Patients' satisfaction and achievement of intravaginal ejaculation were evaluated by the questionnaire. (Results) Twelve patients (75%) could ejaculate in the masturbation aid (TENGA). Five patients (31%) succeeded to ejaculate in the partner' s vagina after rehabilitation. (Conclusions) A masturbation aid (TENGA) was a useful tool to correct the way of masturbation and achieve normal intravaginal ejaculation. This masturbation aid can be one of the effective options for the treatment of intravaginal ejaculatory dysfunction.

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(Purpose) To understand the current clinical features of kidney cancers in patients with von Hippel-Lindau (VHL) disease in Japan. (Subject and result) We performed a nationwide epidemiological survey of patients with VHL disease using the epidemiology program for incurable disease by the Ministry of Health, Labour and Welfare. The content of the survey included age of onset of VHL disease, sex, residential area, treatment modalities, kidney function, ECOG performance status, and prognosis. Here, we report the results of kidney cancer. The incidence rate of kidney cancer in VHL disease in Japan is 50.3% (206/409). Males and females are equally affected. The mean age of onset is 37.8#177;0.92 years. The median age of onset is 35 years. The ages of onset are distributed between 15 and 75 years. The mostly affected age of onset is between 20 and 50 years. The incidence rate of patients with metastasis is 11.1% (23/206). The most common site for metastasis is the lung (60%, 14/23). Due to multiple numbers of tumors at initial diagnosis and the metachronous development of tumors, patients received treatment on multiple occasions (mean 1.6 times), including partial nephrectomy (46%), total nephrectomy (31%) or radiofrequency ablation (14%) up to 6 times. The multiple treatments resulted in deterioration of the kidney function, causing chronic dialyses in 7 cases (3%). The ECOG performance status was scored as more than 1 in 42% of patients. The ten-year survival rate in VHL patients with kidney cancer was 94%, which is relatively high compared with that survival rates in sporadic kidney cancers. (Conclusion) The current study indicates that the age of onset of kidney cancers in VHL disease is relatively young, and kidney cancers have features of metachronous development. The clinical features of kidney cancer developed in VHL disease among Japanese population are very similar with those in European countries. Multiple treatments result in deterioration of the kidney function.

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(Purpose) To understand the current clinical status of pheochromocytoma (Pheo) in patients with von Hippel-Lindau disease (VHL) in Japan. (Patients and methods) We picked up and summarized Pheos from a nationwide epidemiologic survey for VHL disease based on the epidemiologic study program for incurable disease by the Japanese Ministry of Health, Labour and Welfare. The details of the survey included age of onset, sex, living area, treatment modalities, functional status of the adrenal gland after surgical treatment, and patient outcome. (Results) The incidence rate of Pheo in VHL disease in Japan was 15.1% (62/409). Males and females were equally affected. The mean and median ages of onset were 29.7 and 31.5 years, respectively. The age of onset was distributed between 10 and 75 years and presented two large peaks between 15-20 and 35-40 years. Twenty-six (41.9%) bilateral cases, 8 (12.9%) paragangliomas, and 4 (6.4%) malignant cases were found. Forty-one (65%) patients underwent surgical resection once and 13 (9%) underwent 2 or 3 times surgeries whereas six (10%) nonfunctional cases were surveyed without surgical treatment. Fourteen of 26 bilateral Pheos (56%) received steroid replacement therapy following surgery. Four cases died from metastases of malignant Pheos and one from a severe infection during steroid replacement therapy. None of the patients died of cardiovascular complication due to Pheo crisis. (Conclusion) It is concluded that Pheos in VHL disease developed from a relatively young age and was associated with 15% of all patients, including a small ratio of malignant cases. More than 40% of cases suffered bilateral adrenal tumors. The clinical features in Japan appear to be similar to those in the Western countries according to the current survey.

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A 63-year-old man with a horse shoe kidney was evaluated after an episode of asymptomatic gross hematuria. Cystoscopy revealed bladder tumor near the right ureteral orifice, and transurethral resection demonstrated high grade pT1 urothelial carcinoma. The patient was started on intravesical BCG instillation therapy at a dose of 81 mg weekly for 8 weeks without fever. 6 months later after the final BCG treatment, CT examination demonstrated a renal hypovascular tumor in an isthmus of a horseshoe kidney. We couldn' t deny malignant tumor and tumorectomy was performed. Histological examination revealed epithelioid cell granulomas and no organisms were identified by Ziehl-Neelsen or Grocott-Gomori stains for acid-fast bacilli and fungi. We reported a rare case of renal tuberculosis in an isthmus of a horseshoe kidney after BCG therapy for bladder cancer that was considered due to vesicoureteral reflux.

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A 54-year-old man presented with the left inguinal swelling. The operation was performed with diagnosis of the hydrocele of spermatic cord. A tumor was 3.0 cm×2.5 cm in size, cystic with yellowish serous fluid. After the operation, this tumor is diagnosed as mesothelial cyst through the histopathologic examination. This is a rare case, however it is worth to consider that there is a possibility to be a mesothelial cyst when the tumor has been found at the inguinal region.

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A 13-year-old girl presented with an occult blood in urine. CT revealed right rudimentary kidney and left hydronephrosis. Renogram demonstrated right poor renal function pattern and left obstructive pattern. She underwent left pyeloplasty. Histologic examination revealed the true ureteral diverticulum. True ureteral diverticulum is a rare congenital anomaly and synonymous with blind-ending bifid ureter. This is a sixth case in the Japanese literature.

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Solitary fibrous tumor (SFT) is a neoplasm of pleura and its occurrence in the retroperitoneal space is rare. We report a case of SFT of the adrenal gland associated with ipsilateral renal cell carcinoma (RCC) and angiomyolipoma (AML).A48-year-old woman was referred to our hospital for a left renal AML. Computed tomography (CT) in our hospital showed a left adrenal mass (25×20 mm). Because the adrenal tumor was nonfunctioning, she was followed at outpatient clinic. Four years later, CT showed an increase in the left adrenal tumor size (42×30 mm) and a left RCC. Left adrenectomy and partial nephrectomy for RCC and AML were simultaneously performed. Histological examination revealed adrenal SFT and clear cell carcinoma and AML of the kidney.We present a brief review on histological characteristics of retroperitoneal SFT and its occurrence in the adrenal grand region.

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A 51-year-old man was referred to our hospital for treatment of left renal pelvic tumor diagnosed with computed tomography (CT) on health screening. Retroperitoneoscopy-assisted radical left nephroureterectomy was performed under a diagnosis of left renal pelvic carcinoma. Histopathological examination showed urothelial carcinoma (UC), Grade 2>>Grade 3, pT3. Subsequently to the radical operation, pulmonary metastasis appeared four times. But the patient with free of recurrence survives 6 years later, treated with chemotherapy and resection of pulmonary metastasis. Although the patient with high grade invasive renal pelvic carcinoma usually has a poor prognosis, it seems to be a possibility that if the lesion is resectable, resection of pulmonary metastasis carries a good prognosis.

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