(Purpose) Adrenocortical carcinoma (ACC) is a rare condition associated with poor prognosis. This study aimed to evaluate the clinicopathologic characteristics and prognosis of 7 patients with ACC. (Patients and methods) The clinicopathologic characteristics, treatment, and survival of 7 patients with pathologically confirmed ACC treated at our institution between January 2002 and December 2012 were retrospectively examined. (Results) The study cohort comprised 4 male and 3 female patients (median age at diagnosis, 63 years [range, 36-71 years]). The median tumor size was 7.0 cm (range, 4.0-13.0 cm), and the median follow-up duration was 22 months (range, 9-107 months). One patient had stage I ACC, 4 had stage III, and 2 showed metastasis. The patient with stage I disease underwent laparoscopic adrenorectomy and those with stage III disease underwent adrenorectomy with the excision of adjacent organs. Four of these 5 patients are alive without recurrence at a median of 55 months (range, 22-107 months) after surgery. Of the 2 patients with metastases, 1 received combined chemotherapy with etoposide, adriamycin, and cisplatin plus mitotane without surgical resection but died 19 months later, and the other, with a solitary lung metastasis, underwent adrenorectomy and metastatectomy followed by adjuvant treatment with mitotane and is alive without recurrence at 9 months after treatment. The 3-year cause-specific survival rate was 56%. (Conclusions) Patients with advanced-stage tumors showed long-term survival with complete tumor resection at diagnosis; hence, this seems to be most beneficial treatment option for patients with ACC.
(Purpose) We have performed non-ischemic partial nephrectomy for clinical T1 renal tumors using microwave tissue coagulation (MTC group) or soft coagulation (soft coagulation group). The clinical outcomes were retrospectively compared between the two groups. (Materials and methods) A total of 36 patients were analyzed in this study (22 in the MTC group and 14 in the soft coagulation group). The anatomical characteristics of the renal tumors were assessed using the R.E.N.A.L Nephrometry Score. Renal function was assessed by the estimated glomerular filtration rate. (Results) The preoperative estimated glomerular filtration rate was 72.1 ml/min in the MTC group and 65.6 ml/min in the soft coagulation group (p=0.05). The R.E.N.A.L Nephrometry Score was not significantly different between the two groups. Clavian grade ≥2 postoperative complications occurred in one patient (4.5%) in the MTC group and one patient (7.1%) in the soft coagulation group. Postoperative local recurrence and distant metastasis occurred in one patient (8.3%) in the soft coagulation group and no patients in the MTC group, which was not a significant difference between the two groups. The median postoperative decrease in estimated glomerular filtration rate was 11.5% in the MTC group and 3.6% in the soft coagulation group. Postoperative renal preservation tended to be better in the soft coagulation group than in the MTC group, but this difference was not significant. (Conclusion) The use of soft coagulation in non-ischemic partial nephrectomy for the treatment of clinical T1 renal tumors is as effective as that of MTC.
(Purpose) We reviewed our retrospective surgical database and assessed the outcome after radical prostatectomy (RP) in patients with clinical T3 (cT3) prostate cancer (PC). (Material and methods) Sixty four men underwent RP for cT3 PC in our hospital from 1995 to 2011. Clinical stage was diagnosed with MRI and rectal digital examination in all cases. We investigated the postoperative outcome, cancer specific survival and overall survival of all patients. We also investigated the risk factors of biochemical recurrence (BCR) in the patients without any adjuvant therapy. All survival was estimated using Kaplan-Meier plots. We performed univariate analysis by Mann-Whitney test, Fisher exact test and Log-Rank test, and multivariate analysis by Cox regression analysis. (Results) Median age at RP was 67 years (range: 48-74), and median initial PSA was 14.1 ng/ml (2.2-76.2). Sixty cases (93.8%) were classified into cT3a, and 4 cases (6.3%) into cT3b. Median follow-up period after RP was 62 months (3-172). Fifty three (83%) patients received neoadjuvant hormonal therapy. Median duration of neoadjuvant hormonal therapy was 7 months (3-31). Adjuvant therapy underwent in 20 cases. Of the 64 patients, overall survival and cancer specific survival rates at 10 years were 98%and 100%, respectively. Of the 44 patients who didn't receive any adjuvant therapy, BCR free survival rates at 5 and 10 years was 59%and 51%, respectively. Univariate analysis revealed that both PSA≥15 ng/ml and GS≥8 were associated with a significant risk of BCR. Any significant risk factor was not identified by multivariate analysis. In 16 patients who have cT3a, PSA<15 ng/ml and GS<8, BCR free survival rate at 5 years was 78%. On the other hand, that of the other patients was 37% (p=0.009). (Conclusions) It is suggested that RP is effective for some patients with locally advanced prostate cancer, especially who have cT3a diagnosed by MRI, PSA<15 ng/ml and GS<8.
(Background) Extracorporeal shock wave lithotripsy (SWL) is a wide spread option for the treatment of the upper urinary tract urolithiasis. EAU guideline recommends the treatment with 60-90 shots per minute for the optimal frequency of SWL, but there is no report on the efficiency of SWL with the frequency less than 60 shots per minute. (Purpose) To determine the optimal shock wave frequency of SWL, we prospectively randomized total 247 patients with ureteral stone to the four different treatment groups: group A (76 pts.), group B (68 pts.), group C (55 pts.) and group D (48 pts.). These groups were treated with the frequencies of 80, 60, 45 and 30 shots per minute respectively using Dornier Lithotripter D. One treatment took forty minutes, resulting in the total shock waves per session of 3,200, 2,400, 1,800 and 1,200 for group A, B, C and D, respectively. (Results) The total numbers of the SWL sessions were statistically not different among the four groups. Importantly, there was statistically no difference among the four groups about the stone clearance rates and the stone reduction efficiencies on the next day, after one week and after one month of the treatment. In addition, only two additional ureteral stenting for pyelonephritis and one renal subcapsular hematoma were observed. (Conclusion) This study suggests that the efficiency of SWL with the frequency of 30 or 45 shots per minute is similar to that of 60 or 80 shots for stone reduction and clearance.
(Purpose) To translate the Prolapse/Urinary Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) into Japanese and evaluate the linguistic validation of the translated PISQ-IR. (Methods) The translation and evaluation of PISQ-IR were performed through 3 steps: forward translation based on 2 urologists and discussed by another 4 urologists, 1 pharmacoeconomist and 1 nurse; the community review process consists of conducting one-on-one cognitive interviews with 20 patients by a professional interviewer; backward translation by a native English speaker, which was negotiated with the PISQ-IR Working Group comprised original authors in International Urogynecological Association (IUGA). (Results) The PISQ-IR Working Group generally approved our translation and had 2 major concerns in the Japanese version; 1) "disagree" in every sentence of English version was not translated into Japanese, and 2) the Japanese expression in "sexual desire" should be more emotional. The former concern was approved by explaining that Japanese does not have the word which is the equivalent of "disagree", and "don't agree" is always used instead of "disagree". The latter concern was compromised by switching to a translation using emotional words. (Conclusion) The Japanese version of PISQ-IR was translated in a linguistically valid manner. It would be equivalent to the original English questionnaire. It may provide a tool to assess sexual function for Japanese women with prolapse, urinary incontinence and/or fecal incontinence in an internationally harmonized fashion.
(Purpose) Validated questionnaire for evaluation of pediatric lower urinary tract symptoms (LUTS) is of a great need. We performed cross-cultural validated adaptation of Dysfunctional Voiding Symptom Score (DVSS) to Japanese language, and assessed whether children understand and respond to questionnaire correctly, using cognitive linguistic approach. (Methods) We translated DVSS into two Japanese versions according to a standard validation methodology: translation, synthesis, back-translation, expert review, and pre-testing. One version was written in adult language for parents, and the other was written in child language for children. Pre-testing was done with 5 to15-year-old patients visiting us, having normal intelligence. A specialist in cognitive linguistics observed the response by children and parents to DVSS as an interviewer. When a child could not understand a question without adding or paraphrasing the question by the parents, it was defined as 'misidentification'. (Results) We performed pretesting with 2 trial versions of DVSS before having the final version. The pre-testing for the first trial version was done for 32 patients (male to female ratio was 19 : 13). The pre-testing for the second trial version was done for 11 patients (male to female ratio was 8 : 3). In DVSS in child language, misidentification was consistently observed for representation of time or frequency. We completed the formal validated translation by amending the problems raised in the pre-testing. (Conclusion) The cross-cultural validated adaptation of DVSS to child and adult Japanese was completed. Since temporal perception is not fully developed in children, caution should be taken for using the terms related with time or frequency in the questionnaires for children.
(Objectives) Congenital midureteral stricture (CMS), which develops from obstructive lesion between pyeloureteral junction and ureterovesical junction, is relatively rare and its clinical condition and therapeutic strategy have not yet been established. We analyzed the clinical characteristics and surgical outcomes of CMS. (Patients and methods) From November 2006 to December 2012, out of 137 patients presented with congenital hydrohephrosis, we identified 4 pediatric patients diagnosed with CMS at our institutions. We retrospectively investigated clinical characteristics and surgical outcomes in these 4 patients. (Results) Three boys and one girl were identified in this study. All patients were detected hydronephrosis by fetal ultrasonography. The median age at the diagnosis of CMS was 1 year and 11 months. Three patients had obstructive lesion in left side and 1 patient in right. CMSs were located at the level of L4 in 2 patients, and at the level of L5 and S1 in each 1. Split renal function was decreased less than 45%in 3 of 4 patients. Ipsilateral pyeloureteral junction obstruction and ipsilateral hypoplastic kidney were identified in 2 and 1 patient, respectively. One patient developed urosepsis and underwent nephrostomy. Partial ureterectomy and ureteroureterostomy, pyeloplasty were performed in 3 and 1 patient, respectively. Extrinsic obstruction was detected in just 1 patient intraoperatively. In all patients, there were no protruded lesion and atrophied, fibrotic and ischemic muscles were not detected in pathological finding. Neither urinary tract infection nor recurrence of obstructive lesion was detected in all patients at the mean follow-up period of 3 years and 1 month. (Conclusion) We analyzed the clinical characteristics of 4 pediatric patients with CMS. In order to prevent critical infection and maintain renal function, it could be considered that surgical intervention is undertaken just after making the diagnosis of CMS.
According to previous studies, papillary renal cell carcinoma (pRCC) type 2 is known to have a poor prognosis, especially in cases with metastases. We report a case of pRCC that responded well to axitinib administered as second line therapy. The patient was a 52-year-old woman who presented at our hospital with an incidental tumor on the left kidney. She underwent laparoscopic radical nephrectomy, and the pathological diagnosis was pRCC type 2, grade 3 pT1b. Multiple lung and bone metastases were observed following the four months, and histological findings of lung metastases was metastatic RCC. Although sunitinib was administered as first line therapy, tumor progression was observed after the first cycle of treatment. Therefore, axitinib (10 mg/day) was administrated as second-line therapy and was gradually increased to 14 mg/day. Five months after the administration of axitinib, the maximum tumor diameter of the lung metastases reduced by 83%. At present, eight months have passed since the start of axtinib administration, but the response was still maintained and the adverse events were generally tolerable.
A 77-year-old female was indicated pelvic mass and hydronephrosis when her examination of advanced gastric cancer. Computed tomography revealed left ureteral dilatation and mass around the left ureter. Laparotomy biopsy was abandoned because of her low cardiac function. Thereafter, hemorrhagic stool was observed and colonoscopy revealed hemorrhagic mucosal protrusion at sigmoid colon. This lesion was diagnosed as squamous cell carcinoma by pathology of biopsy specimen. Colonic invasion of other organ carcinoma was suspected by colonoscopic findings. Retrograde pyelogram revealed a defect of left lower ureter. Positron emission tomography revealed the mass excluding sigmoid colon and high value (SUV max was 10.3) at the mass. Therefore, it was diagnosed invasive ureteral squamous cell carcinoma and she was treated with 2 cycles of combination chemotherapy consisting of gemcitabine (800 mg/m2: day1 and 8) and nedaplatin (60 mg/m2: day1). During the chemotherapy, only cytopenia (grade 4: CTCAE guidelines) was observed. About 4 months after 2 courses of chemotherapy, the tumor size was reduced by almost 100% (CR; RECIST guidelines). Thereafter, recurrence of pelvic mass was not observed.
A 36-year-old female received protocol biopsy at 1 month after living donor kidney transplantation. At 3 months post-transplantation, presence of a growing cystic mass in the kidney graft which had not been detected preoperatively, was demonstrated by ultrasound and computed tomography. The patient had an abdominal pain around the graft. Percutaneous drainage and sclerotherapy with minocyclin were performed twice, but the cystic mass, nevertheless, became enlarged and the abdominal pain recurred again. Laparoscopic fenestration was then performed. Immunohistochemistry of the cystic mass wall showed that it was CD34 (-), EMA (-), Megalin (-), but D2-40 (+). These results suggested that the cystic mass was derived from lymphatic vessels, which developed into lymphocele in the graft. We concluded that lymphatic vessels could have been injured and obstructed by the protocol biopsy. This is the first report of successful laparoscopic fenestration for lymphocele in the kidney graft.
Leiomyoma of the seminal vesicle is a rare tumor with only scattered reports in the literature. We report a case of leiomyoma of the seminal vesicle. A 65-year-old man presented with lower abdominal discomfort. Abdominal computed tomography scan and magnetic resonance imaging revealed a mass measuring 9.3×4.4×4.0 cm posterior to the seminal vesicle. The patient underwent ultrasound guided transrectal needle biopsy of the mass, and histological findings showed leiomyoma and no evidence of malignancy. To relieve persistent lower abdominal discomfort, the resection of the tumor was performed through a lower abdominal midline incision. The tumor was not adhered to surrounding tissue without the seminal vesicle and completely removed with a portion of the seminal vesicle. The mass weighing 115 g was histologically diagnosed as leiomyoma of the seminal vesicle with no evidence of malignancy. The symptom of lower abdominal discomfort promptly improved after the surgery, and the postoperative course was uneventful. The patient has been clinically free from the disease after three years of follow-up.