(Objective) The prostate cancer detection rates on initial transrectal ultrasound guided prostate biopsies were investigated and the clinicopathological features of prostate cancer patients were examined.

(Methods) A retrospective review was performed. From 2003 to 2015, 2,246 patients received initial prostate biopsy in Tochigi Cancer Center. Prostate cancer detection rates and clinicopathological features of the prostate cancer patients in relation to prostate-specific antigen levels were evaluated.

(Results) Of the biopsies, 1,294 cases (57.6%) were diagnosed as prostate cancer. The prostate cancer detection rates were 27.8%, 39.8%, 53.6%, 67.4%, 88.4%, 100% in the groups with PSA levels 0.0-3.0, 3.1-4.0, 4.1-10.0, 10.1-20.0, 20.1-100.0, >100.0 ng/ml, respectively. Of all 1,294 cases in prostate cancer, patients rates with the low risk were 0%, 30%, 22%, 0%, 0%, 0% in the groups with PSA levels 0.0-3.0, 3.1-4.0, 4.1-10.0, 10.1-20.0, 20.1-100.0, >100.0 ng/ml, respectively.

(Conclusions) From the results of the prostate cancer detection rates and the low risk rates, it seems difficult to determine diagnosis and treatment of prostate cancer only with PSA values.

(Objective) The objective of this study was to survey cases of acute scrotum examined at the pediatric emergency room (ER).

(Subjects and methods) All patients examined for acute scrotum at the emergency outpatient unit between March 2010 and March 2014 were designated subjects of the study. Medical records were used to retrospectively investigate the final diagnoses including testicular torsion (TT), torsion of the testicular appendage, epididymitis, orchitis, incarcerated inguinal hernia, idiopathic scrotal edema, Schönlein-Henoch purpura, hydrocele, external trauma, as well as those with no confirmed diagnosis.

(Results) A total of 257 patients presented with acute scrotum at the emergency outpatient unit. The patients had an average age of 6.7 years, with symptoms present on the right side in 120 cases (47%), left side in 108 cases (42%), and both sides in 29 cases (11%). Observing the frequency of each condition, TT was present in 33 cases (13%), torsion of the testicular appendage in eight cases (3%), epididymitis in 85 cases (33%), orchitis in four cases (2%), incarcerated inguinal hernia in 59 cases (23%), idiopathic scrotal edema in six cases (2%), Schönlein-Henoch purpura in nine cases (4%), hydrocele in 10 patients (4%), external trauma in 12 patients (5%), and unconfirmed diagnosis in 31 cases (12%). Average time between onset and presentation at the ER was 0.6 days for TT, with patients having previously been examined at other hospitals before coming to this institution in 12 cases (36%). Emergency urological surgery was performed in 31 cases (12%), with TT comprising 28 cases (90%), and orchiectomy performed in six cases (21%).

(Conclusion) Of all patients examined for acute scrotum, epididymitis were high and TT in 13% at the pediatric ER. Average time for TT patients from symptom onset to ER presentation were longer, we must ensure that patients present at earliest possible opportunity requires educating the general population.

A 55-year-old man underwent right radical nephrectomy after the diagnosis of right renal cell carcinoma (RCC). He did not show any relapse or metastasis for 3 years and 5 months after surgery. He was admitted to the hospital in April 2014 with a throat discomfort. Laryngoscopy revealed a 5 mm supraglottic mass. The tumor was locally excised and pathology revealed metastatic RCC. While RCC frequently metastasizes to the lungs, bones, lymph nodes, and brain, an isolated metastasis of RCC to the larynx is an extremely rare event. We report a case of isolated RCC metastasis to the supraglottic larynx 3 years and 5 months after radical nephrectomy.

Primary bladder amyloidosis is a rare disease, with approximately 200 cases documented in the literature. We herein present a 85-year-old Japanese man who has undergone a transurethral resection of a bladder tumor (TURBT) and has regularly been followed up after surgery. Since cystoscopy revealed mucosal irregularity, he has got a TURBT again for a suspicion of recurrence. There were no malignant findings in pathological diagnosis and we diagnosed as amyloidosis because it showed positive by Congo-red staining. We added immunohistological diagnosis to diagnose as localized AL amyloidosis of the bladder finally.

A 72-year-old man presented with the chief complaint of asymptomatic macroscopic hematuria. Cystoscopy revealed a non-papillary sessile tumor in the left bladder wall. Computed tomography revealed a large invasive tumor in the bladder and left hydronephrosis; no metastases were observed. Laboratory examination showed leukocytosis (27,600 /μl) and a high serum level of granulocyte-colony stimulating factor (G-CSF; 158 pg/ml). A diagnosis of locally advanced bladder cancer producing G-CSF was made; therefore, the patient underwent a total cystectomy and urinary diversion with an ileal conduit. Histopathological examination of the surgical specimen revealed a urothelial carcinoma with squamous differentiation (pT3a, pN0, ly1, v1). In terms of their immunohistochemistry, the tumor cells were shown to express G-CSF. After surgery, the leukocyte count and serum level of G-CSF decreased to normal values. No recurrence was observed in the 41 months after surgery without adjuvant therapy. We reviewed 73 cases of bladder cancer producing G-CSF reported in the literature in Japan.

The patient was a 53-year-old man who was referred to the department of urology of our hospital after screening results indicated elevated prostate-specific antigen (PSA) levels. The PSA level was 5.33 ng/ml, and rectal examination revealed that the prostate was elastic and hard with mild prostatic hyperplasia. Because magnetic resonance imaging revealed abnormal signals in the prostatic transition area, prostate cancer was suspected and the patient underwent transrectal prostate needle biopsy. The pathological diagnosis was adenocarcinoma (Gleason score 5+5 = 10). After using thoracic, abdominal, and pelvic computed tomography (CT) and bone scintigraphy to confirm that metastasis had not occurred, robot-assisted radical prostatectomy (RARP) was performed. Prostate cancer was not detected during pathologic diagnosis of the surgical specimen, and on the basis of the results of re-examination with immunostaining, a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma was made. In addition, an upper and lower endoscopy examination, positron emission tomography (PET) -CT, and bone marrow biopsy confirmed that generalized tumor lesions and lymph node swelling were not present, and the patient was diagnosed with primary MALT lymphoma of the prostate. Currently, 12 months since surgery, the patient continues to undergo follow-up as an outpatient and no recurrence has been observed. There have been only a few reports of primary MALT lymphoma of the prostate, in English or Japanese, and herein, we present our experience with a patient for whom a definitive diagnosis was difficult, along with a review of the literature.

Visual disturbance following non-ophthalmologic surgery under general anesthesia is rare but can be devastating both socially and medicolegally. Immediate salvage intervention as well as prevention is of utmost importance since this can be a serious blow to patient's functional outcome postoperatively. We experienced a case of temporary but significant visual disturbance right after transperitoneal laparoscopic radical prostatectomy for localized prostate cancer. We need to raise our levels of vigilance to this condition since it can be avoided and prevented with immediate therapeutic intervention and decent clinical awareness.

We report a case of bilateral synchronous testicular tumors, which was difficult to differentiate from malignant lymphoma. A 56-year-old man with a left scrotal mass was referred to our hospital. Ultrasonography revealed a uniformly hypoechoic mass in bilateral testes. Magnetic resonance imaging also revealed a homogeneously low-intensity lesion in the bilateral testes on T2-weighted images. Abdominal and chest computed tomography showed no lymphadenopathy or metastasis. The image findings at that time suggested a malignant lymphoma, and consequently, we performed a right radical orchiectomy. Histopathological examination revealed typical seminoma in the right testis; following this observation, left radical orchiectomy was performed, and the patient was diagnosed with synchronous bilateral testicular germ cell tumors. No recurrence or metastasis has been detected postoperatively. We recommend that the diagnosis of bilateral testicular tumors be made on the basis of patients' age, tumor marker level, and image findings.

A 64-year-old man was diagnosed as having Cushing's disease due to multiple lumbar compression fracture in 2009. Although various treatments including three times transsphenoidal surgery and twice radiotherapy were performed, his serum cortisol level rose again and intractable cutaneous ulcer occurred. Just after discontinuation of medication to treat the progression due of severe hepatic dysfunction, deep vein thrombosis and pulmonary artery embolism occurred. To control the Cushing's disease, laparoscopic bilateral adrenalectomy was performed.

Stent encrustation is one of the most serious complications of using double J stents. The management of encrusted stent is challenging, especially in children. To date, only two pediatric cases of stent encrustation, at the expected timing of removal after pyeloplasty, have been reported. In this report, we present a case of ureteral stent encrustation after laparoscopic retroperitoneal pyeloplasty in an 11-year-old girl. She underwent dismembered pyeloplasty for pelvi-ureteric junction obstruction on the left side using a double J stent (6 F, 24 cm, Polaris ™ Ultra). Postoperative course was uneventful, except for mild bladder irritability and asymptomatic pyuria. Nine weeks later, an attempt to remove the stent was made under general anesthesia. This attempt was unsuccessful as the renal coil got stuck in the anastomotic position. A retrograde 6 F flexible ureteroscopy revealed an encrusted stent with calculi. After transurethral lithotripsy with a holmium: yttrium aluminum garnet (YAG) laser, the stent was extracted. Stone analysis showed struvite. At 8-months follow-up, she was stone-free and doing well with resolution of hydronephrosis.

Pelvic fracture urethral injury (PFUI) is relatively rare injury, and delayed urethroplasty is the gold standard for its repair. Because a failed urethroplasty results in increased scarring and reduced length of the available urethral segment, the salvage urethroplasty is a urologic challenge. We herein report the case of male patient with PFUI who could be salvaged after three failed urethroplasties. A 22-year-old male who had received a PFUI when he was 4 years old was referred for salvage urethroplasty after two perineal anastomotic urethroplasties and one transpubic urethroplasty had failed, leaving him unable to void and forced to keep having a suprapubic tube placed. The meatus was iatrogenically obliterated due to repeated treatments. Through an incision from the scrotum and right side of the root of the penis to the lower abdomen, the anterior urethra was circumferentially mobilized and transected at the distal urethral stump. The proximal urethral end was identified by palpitation with a metallic sound inserted through the suprapubic tube tract. The covering fibrotic scar tissue was completely removed and 8 anastomotic 4-0 polydioxanone sutures were placed to reapproximate the urethral mucosa. A pedicled gracilis muscle flap was created and wrapped around the anastomosis site and intrapelvic segment of the mobilized anterior urethra. A urethrogram 8 months after urethroplasty showed a wide caliber at the anastomosis site and a ventral midline meatotomy was subsequently performed. He is currently free from any instruments and can void well without the need for further intervention.