(Background) The effects of fluctuant patterns of serum alkaline phosphatase (ALP) and lactic acid dehydrogenase (LDH) levels on overall survival of patients with prostate cancer (PC) treated with androgen deprivation therapy (ADT) remain unclear.

(Methods) We enrolled 236 patients with PC and divided into 3 cohorts by fluctuant patterns of serum levels of ALP and LDH between at baseline and at 1 year later, or at diagnosis of castration-resistant prostate cancer (CRPC): intermediate, within interquartile range (IQR) [I]; lower than IQR [L]; higher than IQR [H].

(Results) In the 1 year later ALP cohort, all parameters except age were significantly different. In the L cohort, 75% of patients had bone metastasis and > 50% developed CRPC or died. In the 1 year later LDH cohort, Eastern Cooperative Oncology Group-performance status (ECOG-PS) and clinical metastasis classification were significantly different among the cohorts. In the CRPC/ALP cohorts, baseline prostate-specific antigen values and clinical metastasis classification were significantly different among the cohorts, and all cases had metastasis in the L cohort. In the CRPC/LDH cohort, the L cohort had higher ECOG-PS and shorter time to CRPC. In the 1 year later ALP cohort, the hazard ratio (HR) for death of the L and H cohort to the I cohort was 3.77 and 2.27, respectively and both were significant. In the CRPC/LDH cohort, the HR for death of L cohort to I cohort was 1.99.

(Conclusions) Larger fluctuations in serum ALP and LDH levels were a sign of poorer prognosis, especially for patients in the L cohort.

(Background and methods) Bacillus Calmette-Guérin (BCG) intravesical instillation therapy is used to treat non-muscle invasive bladder cancer. Instilled BCG is typically collected at the time of initial urination and disposed of after sterilization with 10% sodium hypochlorite or household bleach, however, these methods can have unpleasant effects, such as pungent odor, rapid foaming and fever. We investigated whether isopropanol be used to sterilize and dispose of urine after BCG intravesical instillation therapy, because isopropanol at a concentration of 33% or higher (70% isopropanol was used in this study) has the same disinfectant and bactericidal effects against Mycobacterium tuberculosis as 10% sodium hypochlorite or household bleach.

(Results) Use of isopropanol eliminated the unpleasant effects experienced with sodium hypochlorite and no growth of Mycobacterium tuberculosis was observed in culture tests.

(Conclusion) Isopropanol is safer than sodium hypochlorite, and should be considered for sterilizing and disposing of urine after BCG intravesical instillation therapy in the future. However, fire and ventilation precautions are required.

(Objectives)

Factors related to prostate-specific antigen (PSA) recurrence, including PSA at 6 months after radical prostatectomy, were evaluated to determine if the postoperative follow-up period in the cancer regional alliances critical path could be individualized using a coordinated path.

(Patients and methods)

Among 352 patients who underwent laparoscopic radical prostatectomy at our hospital from May 2009 to June 2015, 331 who did not undergo preoperative hormone therapy were examined retrospectively. Cases with PSA < 0.01 ng/mL at 6 months after surgery (group A, n=209) were compared with those with PSA > 0.01 ng/mL at the same time point (group B, n=122).

(Results)

PSA recurrence was significantly higher in group B (n=21 (10.0%) vs. n=70 (57.4%), p< 0.001) and the time to recurrence was significantly shorter (44 vs.12.5 months, p< 0.001). In multivariate analysis within group A, the Gleason Grade Group (GGG) and extraprostatic extension in surgical specimens were predictors of PSA recurrence. In group A, all cases (n=30) of GGG1 in surgical specimens had no extraprostatic extension and no PSA recurrence. There were 90 cases of surgical specimens with GGG2 and no extracapsular infiltration, and only 4 of these cases had recurrence (4.4%).

(Conclusion)

The results of the study indicate that follow-up interval stratification is possible using the PSA level at 6 months after radical prostatectomy, GGG and extraprostatic extension in the surgical specimen.

(Objective) The etiology of acute epididymitis in children remains poorly understood. Several studies have demonstrated that urine tests are negative in the majority of children with acute epididymitis, and the condition is self-limiting. The need for radiological evaluation of the urinary tract in children with acute epididymitis is still debatable. The aim of this study was to describe clinical and imaging findings in children with acute epididymitis.

(Methods) We identified 47 children with acute epididymitis at our institute between 2017 and 2021.

We retrospectively reviewed their clinical features and radiological and laboratory data. All children underwent ultrasonography of the kidney and urinary tract.

(Results) Median patient age was 9 years (range, 6 months-16 years) and 60% of the cases occurred between the ages of 7 and 12 years. Thirteen children (28%) had a past history of genitourinary malformations. The common malformations were hypospadias in eight children and bladder dysfunction in three. Ultrasound revealed no new urinary tract abnormalities in the remaining 34 children. Urinalysis were performed in 27 children, nine of whom (33%) had pyuria. Urine culture was positive in two children. Of the nine children with genitourinary malformations, eight had pyuria. All 18 children without genitourinary malformations had a negative urinalysis except for one patient (p< 0.0001).

(Conclusions) Acute epididymitis is a common cause of acute scrotum in pediatric patients. In this study, one-third of acute epididymitis cases presented pyuria, and about 30% had a past history of genitourinary malformations. The presence of pyuria was associated with a past history of genitourinary malformations. For children with no previous genitourinary malformations, routine use of ultrasound for the detection of urinary tract abnormalities is questionable due to the low yield.

A 68-year-old female presented with macroscopic hematuria. Cystoscopy revealed a wide-based submucosal mass. Computed tomography revealed a 3.5 × 2.5-cm solitary mass situated from the trigone to the left lateral bladder wall and the left hydroureter and hydronephrosis. T2-weighted magnetic resonance imaging (MRI) revealed low intensity, and diffusion-weighed MRI showed increased diffusion without invasion. The bladder tumor was immediately resected transurethrally. Histological diagnosis of the tissue obtained by transurethral resection was extranodal marginal zone B cell lymphoma of MALT. Positron emission tomography-CT showed no lesions other than the bladder tumor. The patient was diagnosed with stage-IE lymphoma of the bladder (Ann Arbor classification). Radiotherapy was performed at the bladder and pelvis (30 Gy) with six courses of rituximab (375 mg/m²). No local or distant recurrence after a 48-month follow-up was noted.

We report the case of a 74-year-old man with metastatic castration-resistant prostatic cancer (CRPC), who underwent treatment with cabazitaxel. Initially, he underwent docetaxel treatment for 2 years and exhibited severe neuropathy in his hands caused by its toxicity. As a result, we replaced docetaxel with cabazitaxel. On receiving 100% of the dose of cabazitaxel in the first course, febrile neutropenia (FN) was observed on the seventh day. However, he soon recovered from the FN and we began relative dose intensity (RDI) treatment with an adequate dose-volume and interval of treatments. He was successfully administered 51 cabazitaxel treatment courses without severe adverse effects. Cabazitaxel is a highly effective drug used as second-line chemotherapy following docetaxel, and it causes fewer adverse effects compared with docetaxel. Cabazitaxel may be a suitable alternative for outpatient treatment. Given that the patient in this case had a long overall survival of more than 3.5 years and received over 50 courses of cabazitaxel, it is crucial for RDI to be taken very seriously.

We report a case of bladder cancer in a 54-year-old woman who underwent renal transplantation for chronic renal failure. Six years after the transplantation, she was diagnosed with muscle-invasive bladder cancer with multiple lung metastases. She received gemcitabine/cisplatin therapy for Stage IV bladder cancer, and the dose of the immunosuppressants was reduced to prevent adverse effects. Since lung metastatic lesions disappeared after four courses of chemotherapy and no new lesions were found, we performed radical cystectomy and right nephroureterectomy with ileal conduit construction. Although she was followed closely without therapy, multiple lung metastases appeared 6 months after the radical cystectomy. Gemcitabine/carboplatin therapy was administered, and the lung metastasis improved slightly until the end of the 4th course, but aggressive growth was observed after the 5th course. She switched to palliative treatment without requesting additional treatment and died of cancer 1 year and 9 months after total cystectomy.

There is no evidence-based treatment strategy for advanced bladder cancer after kidney transplantation. It is necessary to recognize that the patient had renal dysfunction and was in an immunosuppressed state. Thus, it is crucial to select appropriate drug and surgical treatments for each patient.

A 75-year-old man was being followed up at a nearby clinic for hypertension and chronic renal failure. The patient was referred to our department as abdominal ultrasound revealed a left renal tumor. Plain computed tomography (CT) showed a 50 mm complex renal cyst in the upper pole of the left kidney. Plain magnetic resonance imaging showed a cystic mass with numerous septa. Partial thickening of the septa was suspected, and the lesion was classified as Bosniak IIF or III. As the patient had renal dysfunction, regular imaging study of the tumor lesion was performed to determine the timing of surgery. In the following year, plain CT revealed a new renal tumor 20 mm in diameter located lateral to the known tumor, with the mass having a tendency to increase. The patient underwent a laparoscopic radical left nephrectomy after the introduction of hemodialysis. Histopathological examination revealed that the tumor located in the medial upper pole of the left kidney was a multilocular cystic renal neoplasm of low malignant potential and that the new tumor located lateral to the known tumor was fumarate hydratase-deficient renal cell carcinoma. Simultaneous occurrence of fumarate hydratase-deficient renal cell carcinoma and multilocular cystic renal neoplasm of low malignant potential in the ipsilateral kidney is extremely rare. We report our case with a review of the literature.

Of the patients who have had artificial urinary sphincter (AUS) implantation, 30%-50% require reoperation because of recurrent stress urinary incontinence (SUI) or infection. The most common cause of recurrent postoperative SUI is the mechanical failure of the AUS. This case report describes AUS replacement without urethral manipulation after the mechanical failure of the AUS. A 63-year-old man underwent AUS implantation to treat severe SUI that developed after robot-assisted laparoscopic total prostatectomy. Intraoperatively during AUS implantation, the cuff was inflated under direct vision and the AUS was confirmed to work properly; however, SUI did not improve when the AUS was activated 7 weeks after surgery. Urethroscopy confirmed that the urethra was not contracted, and computed tomography indicated that the tube was not continuous with partially deflated pressure-regulating balloon (PRB). On reoperation, the tube was found to be disconnected at the intended point of connection. By refilling PRB and performing urethroscopy, we confirmed the PRB without leakage and good urethral cuff coaptation, respectively.The AUS replacement procedure was then completed with only the replacement of the control pump and reconnection of the tubing. After the surgery, AUS was immediately activated to confirm the improvement of SUI. After 3 months post-surgery, the patient have enjoyed urinary continence. If the defective part of the AUS system can be identified during replacement, the procedure can be completed with only partial replacement and without manipulation of the urethra, thus avoiding the risk of urethral injury.