(Objective) The distribution of intraductal carcinoma of the prostate (IDC-P) and other intraductal lesions associated with IDC-P was evaluated in the cancer foci on radical prostatectomy specimens. (Materials and methods) We reviewed slide in 412 cases treated by radical prostatectomy without neoadjuvant therapy. Mapping study was performed with regard to IDC-P, other intraductal lesions associated with IDC-P and invasive carcinoma. (Results) We identified 98 cases (23.8%) and 102 cancer foci associated with IDC-P. In these all cancer foci, IDC-P was associated with invasive carcinoma and other intraductal neoplastic lesions with tufting, micropapillary and loose cribriform patterns were contiguous and admixed with IDC-P in 83 cancer foci (81.4%). There were lesions with invasive carcinoma around the IDC-P in 95 cancer foci (93.1%) and lesions without invasive carcinoma around IDC-P in 66 foci (64.7%). The latter lesions existed in the marginal areas of the cancer foci in 63 (61.8%) and in the central areas of the cancer foci in 14 (13.7%). In 5 cancer foci (4.9%), volume of IDC-P was larger than that of invasive carcinoma. (Conclusions) The distribution of IDC-P with dense cribriform and solid patterns varied in cancer foci, and intraductal lesions with tufting, micropapillary and loose cribriform patterns were frequently seen in area contiguous and admixed with IDC-P. The latter lesion may be low grade morphology of IDC-P, although the lesions could not be distinguished from high grade prostatic intraepithelial neoplasia.
(Purpose) To evaluate long-term continuous administration of docetaxel (DOC), over survival rate, PSA level and adverse effects were analyzed, retrospectively. We also compared the results of long-term treatment group and short-term treatment group. (Material and methods) This study reported that 14 cases of long-term continuous administration of DOC consisting of 11 or more cycles among 51 patients of castration-resistant prostate cancer (CRPC) treated with DOC from October 2008 to September 2013 at our institution, retrospectively. Nineteen patients who had treated with DOC 10 or less cycles were defined as short-term dose group, and both groups were compared. DOC was administered every 3 to 4 weeks at 60 to 70 mg/m2, and was treated with prednisolone at 10 mg/day as a general. (Results) The median number of treatment cycles was 15. Thirteen cases showed a decrease in PSA levels and 10 cases showed a decrease in PSA levels of 50% or more, the 1-year survival rate of long-term dose and short-term dose group were 100% and 16%. Adverse effects of grade 3 or lower consisted of leukocytopenia in 85% and thrombocytopenia in 28%, however, grade 4 or higher were not observed in long-term dose group. In multivariable analysis of parameters, long-term treatment was related to PSA levels at start of treatment and ALP levels. (Conclusion) Forty-two percent of patients who have CRPC at our institution undergo long-term DOC based chemotherapy treatment. It may be suggested that long-term DOC based chemotherapy for some cases contribute to extend survival time with no serious adverse events.
(Purpose) We examined the complications in the diagnosis and treatment of interstitial cystitis in daily clinical practice. (Materials and methods) The study included 82 patients who were suspected of having interstitial cystitis at our hospital from March 2002 to April 2013. All hydrodistention procedures were performed with the aid of an anesthesiologist, as recommended by the Ministry of Health, Labour, and Welfare since April 2010. (Results) Of the 82, 20 patients were male and 62 were female, (mean age at diagnosis 53 years.) Six of the suspected cases did not have interstitial cystitis. Of the 67 patients diagnosed with interstitial cystitis during hydrodistention, 29 (43%) did not experience pain. The time taken to diagnose these asymptomatic patients was longer than that taken for those who experienced pain. Twenty-eight patients (42%) discontinued treatment because it was ineffective. (Conclusion) Interstitial cystitis has been widely recognized, but general physicians are unable to provide a diagnosis and suggest aggressive treatment because of difficulty associated in the treatment and diagnosis. To resolve these issues, physicians should be keep in mind that interstitial cystitis involves a hypersensitive bladder, and that some patients may not experience pain. Further, knowledge about Hunner's ulcer is essential. We believe that the most important points are improving health insurance about facility criteria of hydrodistention, and evaluating behavioral modification and dietary manipulation.
(Objective) We studied the association between uterine myoma and recurrent pelvic organ prolapse (POP) after transvaginal mesh (TVM) repair. (Methods) Between June 2010 and January 2012, 103 female patients (mean age 67.8 years, mean parity 2.3, mean body mass index (BMI) 23.7) with POP underwent TVM procedures at our hospital. Sixty-nine patients were qualified as stage 3 according to the POP quantification (POP-Q) system and 34 patients were stage 4. Twenty-six patients underwent anterior TVM (A-TVM) and 77 patients underwent anterior and posterior TVM (AP-TVM). All patients underwent a physical examination using the POP-Q system before and 6 month after surgery. Recurrence of prolapse was defined according to the International Continence Society by a measured value ≥-1, as most dependent portion of POP stage 2 or greater. One hundred-three patients were divided into group with uterine myoma larger than 5 cm in diameter and group without uterine myoma. Anatomical outcomes before and after TVM repair were compared between two groups. (Results) Preoperative Aa value, Ba value and gh value in group with uterine myoma were greater than in group without uterine myoma. Postoperative Aa value and Ba value in group with uterine myoma were greater than in group without uterine myoma, too. Postoperative recurrence of prolapse of stage 2 or greater was not found a statistical difference between two groups. (Conclusions) The risks of anterior vaginal wall descent seem to be high in POP with uterine myoma. Therefore it should be kept in mind on treatment choice.
(Objective) The outcome of trial of voiding without catheter in patients treated combination therapy with dutasteride and alpha1-adrenergic receptor blocker for acute urinary retention caused by benign prostatic hyperplasia was not reported. We evaluated the clinical efficacy of combination therapy with dutasteride in patients with unsuccessful trial without catheter after treatment with an alpha1-adrenergic receptor blocker monotherapy for acute urinary retention caused by benign prostatic hyperplasia. (Patients and methods) Patients with acute urinary retention due to prostatic hyperplasia were catheterized and treated alpha1-adrenergic receptor blocker monotherapy. After two weeks later, patients were put on trial without catheter. 52 patients who were unsuccessful trial without catheter administered combination therapy with dutasteride and alpha1-adrenergic receptor blocker. We use criteria that voiding urine volume over 100 ml and post-void residual urine volume below 100 ml in deciding whether catheter should be removed. (Results) 33 (63.5%) men did not require re-catheterization within 7 months after combination therapy. The successful rate of Performance Status (PS) 0-1 group was significantly superior to that of PS 2-4 group. (Conclusions) PS 0-1 men catheterized for AUR can void more successfully after catheter removal than PS 2-4 men if treated with combination therapy.
(Objective) This study was aimed at determining the status of iatrogenic urethral injury associated with insertion of urethral catheters at our hospital. (Subjects and methods) We studied the data of 32 patients with iatrogenic urethral injury at our hospital. We also carried out a questionnaire survey of 150 nurses who could be in charge of urethral catheter insertions, and conducted an analysis based on the answers obtained from 133 of the 150 nurses (response rate 88.7%). (Results) The 32 patients included 14 patients with reduced activity of daily living (ADL) who required assistance in daily life (44%), 4 patients with spinal cord injury (13%), and 4 patients under anesthesia or sedation (13%). Acute complications included sepsis in 5 patients (16%) and septic shock in 3 patients (9%). Long-term urethral catheterization was indicated in all the patients with sepsis. Examination of the responses to the questionnaire showed that while 86% of the nurses said "I inject water to fix the balloon after confirming urine outflow," 7% answered "I inject water into the balloon even if there is no urine outflow"; 46% said "I compress the lower abdomen when there is no urine outflow," 6% said "I perform urinary bladder irrigation," and 48% said "I neither compress the lower abdomen when there is no urinary flow nor perform urinary bladder irrigation." (Conclusion) Nearly half of the patients with iatrogenic urethral injury at our hospital had reduced ADL. In the patients in whom long-term catheterization was indicated, urethral injury at the time of regular replacement of a catheter was associated with a high likelihood of sepsis occurring as a complication. Based on the results of the questionnaire, more than 80% of the nurses complied with the rule that water to fix the balloon must be injected only after confirming urinary outflow at the time of inserting a urethral catheter. However, when there was no urine outflow after insertion of the catheter, there were variations in the procedure to handle the situation. In the education of nurses, training on the appropriate actions that must be taken in this situation appears to be important.
We report a case of a 22-year-old male with juxtaglomerular cell tumor treated with laparoscopic partial nephrectomy. He was referred to our hospital with hypertension, high concentration of plasma renin activity (PRA) and renal mass. Dynamic enhanced computed tomography showed 17-mm weak contrast-enhancing tumor at the upper pole of the left kidney. Renin suppression and stimulation test revealed autonomous renin secretion although renal venous sampling failed to show significant difference in the PRA between the right and left renal vein. We performed laparoscopic left partial nephrectomy. The histological diagnosis was juxtaglomerular cell tumor. After the operation, his blood pressure and PRA were immediately normalized. Juxtaglomerular cell tumor is an important renal tumor as a curable cause of secondary hypertension.
A 70 year-old woman visited our hospital complaining of macrohematuria. She had undergone augmentation ileocystoplasty for tuberculous bladder atrophy 50 years previously. CT and cystoscopy showed tumor at the ileovesical anastomosis. She underwent a partial cystectomy. The pathological diagnosis was adenocarcinoma of the ileal segment. Recurrence was observed with rapid progression. The patient died 8 months after the operation. In Japanese literature, 43 cases of carcinoma arising in augumented bladder have been reported. Average period to the diagnosis of the cancer from the ileocystoplasty is 33 years. The period of our case was 50 years, the longest in 43 cases.
A 62-year-old man were referred our hospital complaining of high prostate specific antigen (PSA) value (32.4 ng/ml) in May 2010. Two sets of biopsies preformed previously at another hospital had not detected any cancers in the prostate. In our hospital, prostate biopsies were performed in July 2010 and February 2011, but cancer was not detected in either occasion. In March 2011, his PSA increased up to 126.7 ng/ml, CT scan showed the swelling of left supraclavicular and para-aortic lymph nodes. Biopsy of the supraclavicular lymph node was performed. Pathology revealed poorly differentiated adenocarcinoma with positive immunohistochemistry for PSA, which was suggestive of metastatic prostate cancer. After 1 year of treatment with androgen deprivation therapy, the patient developed castration resistant prostate cancer and have undergone chemotherapy with docetaxel.
Rhabdomyolysis is a rare perioperative complication, however, potentially lead to fatal outcome. We experienced 2 cases of rhabdomyolysis after radical nephrectomy and nephroureterectomy in the lateral decubitus position. (Case 1) A 40-years old man was seen in our hospital because of asymptomatic grosshematuria. Computed tomography revealed right renal pelvic cancer, cT3N0M0. Right radical nephroureterectomy, lymph node dissection, partial cystectomy was underwent, and the operation was finished without any trouble. At the post-operative day 1, serum creatinine level was elevated to the point of 4.2 mg/dl, and serum creatine kinase was 1,945 IU/l. Continuous hemodiafiltration (CHDF) was done at intensive-care unit (ICU), and serum creatinine and creatine kinase level were decreased. At the post-operative day 1, urine myoglobin level was prominently elevated (2,943.7 ng/ml), so we diagnosed acute renal failure due to rhabdomyolysis. (Case 2) A 40-years old man was incidentally pointed out of right renal tumor that was seen as renal cell carcinoma, cT1aN0M0. Open partial nephrectomy was underwent, and there was no trouble during the operation. After recovering from anesthesia, the patient felt left thigh pain strongly. Serum creatine kinase was 888 IU/L after the operation. At the postoperative day 1, serum creatine kinase level was markedly increased (31,138 IU/L). Serum creatinine level was 1.34 mg/dl. Urine and serum myoglobin level was prominently elevated (89,000 ng/ml and 8,634 ng/ml, respectively). We diagnosed it rhabdomyolysis, and he received large amount of fluid intravenously at intensive-care unit. Serum creatine kinase was peak out at the post-operative day 3 (20,709 IU/L), and hemodialysis was not performed.
We report a 35 month-old boy with acute renal failure caused by an obstructive ureteral stone associated with norovirus gastroenteritis. He visited his family physician because of fever, abdominal pain and vomiting. He was diagnosed as acute gastroenteritis. The symptoms relieved once, but abdominal pain and vomiting recurred two days after the visit and the volume of urine decreased. He was diagnosed as norovirus gastoenteritis and acute renal failure which was unresponsive to fluid replacement. Ultrasound study of the abdomen showed a solitary kidney with mild hydronephrosis. He was then admitted to our hospital. He was finally diagnosed as acute postrenal failure due to obstructive ureteral stone with left solitary kidney by abdominal computer tomography (CT). We performed transurethral catheterization immediately. The creatinine and blood urea nitrogen returned to normal level in 2 days. The CT performed on the 28th day post operation showed disappearance of the stone after uric alkalization. Recently, some cases of postrenal failure due to bilateral obstructive ureteral stones, mainly ammonium acid urate stones, associated with viral gastroenteritis were reported. As clinical features, they are common in boys three years or younger after an episode of rotavirus gastroenteritis with high uric acid concentration. By far, the most common cause of acute renal failure in patients with severe gastroenteritis is prerenal failure resulting from hypovolemia. But postrenal cause due to bilateral obstructive stones should be taken in a consideration.