(Introduction) Low-dose desmopressin is now available for the treatment of nocturia associated with nocturnal polyuria in men, and its usefulness in a dose-dependent manner has been reported. Since side effects such as hyponatremia have reported frequently, the initial dose has been set at 25 μg in many cases considering age and other factors. In the present study, we investigated the efficacy and safety of an initial dose of 50 μg in elderly patients.

(Subjects and methods) At Chikugo city hospital, 45 patients were started on desmopressin at an initial dose of 50 μg for nocturia with nocturnal polyuria. Efficacy and safety after one and four weeks were evaluated based on bladder (micturition) diary. The investigated parameters included frequency of nocturnal urination, nocturnal polyuria index, time to first nocturnal void, first nocturnal urine volume, nocturnal urine volume, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale. Physical examinations were also carried out, along with blood tests.

(Results) The mean age of the patients was 78.3 years, which was higher than that reported in prior studies. After one week of treatment, there was a significant decrease in the frequency of nocturnal urination and nocturnal urine volume, as well as a prolongation of the time to first nocturnal void, improvement in nocturnal polyuria index, and improvement in IPSS, IPSS-QOL, OABSS, and Athens Insomnia Scale. In terms of safety, adverse events were observed in eight patients (17.8%), and hyponatremia was observed in seven patients (15.6%), which was comparable to the findings of prior reports.

(Conclusion) Good therapeutic results were obtained in elderly patients at an initial desmopressin dose of 50 μg, indicating that the drug could be safely administered to elderly patients with regular follow-ups and appropriate withdrawal and dose reductions.

(Objectives) To analyze the early observations in intravesical instillation of dimethyl sulfoxide (DMSO) 50% solution for Hunner-type interstitial cystitis (HIC) in our clinic and discuss possible factors affecting outcomes and future tasks.

(Materials and methods) Seven patients who received DMSO therapy upon HIC relapse after transurethral resection of Hunner lesions with hydrodistension were enrolled for this study. For DMSO, 50 mL of 50% intravesical solution was administered six times every two weeks. Treatment evaluation was conducted using O'Leary & Sant Interstitial Cystitis Symptom and Problem Indexes (ICSI and ICPI), numerical rating scale (NRS) for bladder pain (0-10 points), and the post-treatment variations for which the pre-treatment values of the 24-hour urinary frequency, the average voided volume, and the maximum voided volume were used. The patient satisfaction survey was conducted with a questionnaire, and cystoscopy was conducted for all cases before and after treatment.

(Results) All the patients were females with an average age of 58.3 years old. According to the Society of Interstitial cystitis of Japan Severity Criteria, 5 of the 7 cases showed a moderate level. No severe side effects were observed, and all the patients achieved six times administration. Changes in the points from the pre-treatment baseline values to the post-treatment values were −6.1, −9.1, and −10.0 for Pain NRS, ICSI, and ICPI, respectively. In addition, the 24-hour urinary frequency decreased by 5.34 times, while the average voided volume and the maximum voided volume increased to 60.3 mL and 75.7 mL, respectively. Subjective symptoms of all the patients improved, and cystoscopy revealed the disappearance or remission of Hunner lesions.

(Conclusions) If Hunner lesions can be diagnosed, DMSO therapy could be used effectively and safely for HIC. The therapy is also promising for use as a future initial therapy. Therefore, the accurate diagnosis of Hunner lesions will be more important in the future.

(Objectives) We measured the incidences of surgical site infections (SSIs) and remote infections (RIs) in patients undergoing laparoscopic pyeloplasty to treat ureteropelvic junction obstruction, and the effects of prophylactic antimicrobial agents.

(Patients and Methods) We compared the incidences of SSI and RI, risk factors for such infections, and differences in the prophylactic antimicrobial protocols in 94 patients who underwent laparoscopic pyeloplasty at our hospital from August 2009 to June 2021.

(Results) Two patients experienced SSIs (2.1%) and three had RIs (3.2%). There were no significant differences in the incidence of either infection type in those who complied and did not comply with the prophylactic antimicrobial guidelines.

(Conclusions) Laparoscopic pyeloplasty is associated with low incidences of both SSI and RI; prophylactic antimicrobials may not be required. A large multicenter survey is required for continuous evaluation of SSIs and RIs and to accumulate data.

A 36-year-old woman was operated on at the age of 29 years for cervical cancer, and bilateral ureteral stents were inserted during radical hysterectomy. Subsequently, total pelvic irradiation and para-aortic lymph node irradiation were administered as postoperative radiation therapy. Four years following the surgery, the patient visited previous hospital for ureteral stent replacement; however, following this visit, there was no further contact with her. Seven years after the surgery, the patient presented with gross hematuria. Removal of right ureteral stent led to the observation of severe bleeding. The patient was, thus, transferred to our hospital because of suspected right ureteroarterial fistula. Angiography and intravascular ultrasonography showed a pseudoaneurysm at the distal end of the right common iliac artery. Thus, an endovascular stent graft was placed in the right common iliac artery, which led to resolution of the gross hematuria. One month after discharge, the patient developed right pyelonephritis and hydronephrosis; thus, she underwent right nephrostomy. Six months after undergoing right nephrostomy, the patient developed a fever of 39°C and started bleeding from the site of the right nephrostomy. A computerized tomography scan revealed a pseudoaneurysm in the right common iliac artery, and the endovascular stent graft was seen sliding into the artery. Thus, endovascular stent graft removal, pseudoaneurysm resection, and femoral-femoral artery bypass surgeries were performed. Thereafter, the patient showed no recurrence of infection or hematuria and no evidence of blood flow disorder to the lower extremities. In recent years, endovascular treatment for ureteroarterial fistulas is considered as the first-line treatment modality. However, in cases with infection, there is a possibility of vascular wall weakening, resulting in the formation of pseudoaneurysms, and sliding of the endovascular stent graft.

This case is a 62-year-old man diagnosed with metastatic renal cell carcinoma. He was referred to our department due to the left renal mass pointed with ultra sound examination. Radiographical examination showed left-side 42 mm renal tumor with multiple lung tumors, suggesting renal cell carcinoma, cT1bN0M1 (pul). As an induction therapy, we selected Pembrolizumab plus Axitinib combination therapy. After 4 course of the therapy, the left kidney tumor shrank to 27 mm, and the lung metastasis disappeared with computed tomography imaging. For the next step, we performed laparoscopic partial nephrectomy. The pathological diagnosis was clear cell carcinoma, grade 2 with central necrosis. Since then, complete remission has been maintained without any treatment for 21 months.

Transverse testicular ectopia is a condition in which a testicle crosses the midline and descends through the contralateral inguinal canal, with both testes in the same scrotal compartment. It is reported to be present in about 2% of persons who present with non-palpable testicles. Most transverse testicular ectopia patients undergo orchiopexy in early childhood; however, in rare cases, they are diagnosed in adulthood upon detection of testicular tumors.

A 40-year-old man visited our hospital complaining of right abdominal pain. His right testis was palpable in the right scrotum; however, the left scrotal compartment seemed empty and there was a painful mass on the upper part of the right scrotal compartment. Computed tomography showed that both spermatic cords traversed through the right inguinal canal, and transverse testicular ectopia was diagnosed. Ultrasonography showed absent left testicular circulation on the upper part of the right scrotum. Upon diagnosis of left testicular torsion, emergency surgery was conducted. In the right scrotum, there was a normal right testicle, and a necrotic left testicle which was twisted 180 degrees on its axis, towards the cranial side. Histopathology of the excised left testicle revealed an incidental seminoma, pT1. Tumor markers following surgery were negative, and there was no evidence of recurrence observed with two years and five months of follow-up.

Non-palpable testicular torsion may also be a transverse testicular ectopia. Therefore, it is necessary to consider malignant tumors based on the patient's age.

A 48-year-old woman underwent total hysterectomy and oophorectomy for uterine fibroids and bilateral ovarian cysts. Postoperatively, her renal function worsened, and the histological specimen contained ureteral tissue. She was referred to our department for left ureteral injury repair. An anterograde pyelogram revealed a ureteral defect, 9.5 cm in size. We considered ureteral bladder anastomosis to be complicated. She underwent kidney autotransplantation into her right iliac fossa to repair the ureteral injury. Six months after the operation, renal function was preserved, no hydronephrosis was observed by ultrasonography, and renal blood flow was good. Based on the literature on the difficulty of reconstructing ureteral injury, we developed an algorithm based on the length of ureteral injury.