(Objective) The study aimed to retrospectively evaluate the therapeutic effects of adjuvant chemotherapy (AC) in patients following radical cystectomy (RC) in locally advanced bladder cancer.

(Methods) A single-center-derived database registered 227 patients diagnosed with muscle-invasive bladder cancer and treated with RC and pelvic lymphadenectomy between March 2003 and December 2021. Of these, patients diagnosed with non-organ-confined diseases were classified as either pT3-T4 or pN-positive without distant metastasis. Platinum-based AC was administered for the following categories: two courses for patients with pT3-T4 and pN-negative and three courses for those with pTany and pN-positive. The primary endpoint was the disease-free survival (DFS) and overall survival (OS) between the patients receiving and not receiving AC.

(Results) Among all patients, 90 were diagnosed with non-organ-confined disease: 43 (47.8%) were treated with AC and the remaining 47 (52.2%) were left untreated. The methotrexate, vinblastine, doxorubicin, and cisplatin regimen; the gemcitabine and cisplatin regimen; and the gemcitabine and carboplatin regimen were administered to 14 (32.6%), 25 (58.1%), and 4 (9.3%) patients, respectively. With a median follow-up period of 26 months, the groups that received and did not receive AC had 2-year DFS rates of 36.3% and 25.9% (median DFS time: 15 vs. 8 months, p=0.026) and 2-year OS rates of 64.3% and 41.4% (median OS time: 38 vs. 18 months, p=0.064), respectively. In patients with pT3-T4 and pN-negative, no significant difference in the median DFS and OS between the AC and non-AC groups was observed. However, in patients with pTany and pN-positive, the DFS (median: 14 vs. 4.5 months, p=0.002) and OS (38 vs. 11.5 months, p=0.009) were longer in the AC than those in the non-AC group, respectively. The multivariate Cox regression analysis revealed that AC administration was an independent predictor for DFS (hazard ratio: 0.44, 95% confidence interval: 0.24-0.79, p=0.006).

(Conclusion) Platinum-based AC following RC significantly improved DFS in pN-positive patients with locally advanced bladder cancer.

(Background) Prostate biopsy is the most important examination for the diagnosis of prostate cancer and the most common test in urology. We evaluated the results of transrectal prostate biopsy performed at Kanazawa Medical University Hospital.

(Materials and Methods) Prospectively collected cases of 1,935 patients was undergone transrectal prostate biopsy between January 2002 and December 2021. We looked at patients age, serum Prostate-specific antigen (PSA) level, PSA density (PSAD), total prostate volume, number of biopsy times, and number of biopsy core. We examined the positive cancer rate.

(Results) The median age of patients was 70 years (range: 36-96 years), the median serum PSA level was 7.6 ng/mL (range: 0.19-15,823 ng/mL), the mean number of biopsy times was 1.3 (range: 1-6), and the mean number of total biopsy core was 8.6 (range: 2-14). There were 880 (45.5%) positive cases and 1,055 (54.5%) negative cases. Comparing the cancer-positive and cancer-negative groups, the median age was 72 years (range: 50-96 years), 68 years (range: 36-93 years), the median PSA level was 11.0 ng/mL (range: 0.19-15,823 ng/mL), 6.6 ng/mL (range: 0.24-86.0 ng/mL), median prostate volume was 29.5 mL (range: 7.4-206 mL), 39.1 mL (range: 9.6-178 mL), median PSAD 0.376 (range: 0.003-1,582), 0.177 (range: 0.016-7.513), mean number of biopsy times 1.2 (range: 1-6), 1.4 (range: 1-6), mean number of total biopsy core 8.9 (range: 2-14), 8.5 (range: 4-14), and there was a significant difference in all comparison.

(Purpose) Surgical positioning injury (SPI) is a cutaneous, musculoskeletal, neurological, or vascular injury resulting from the position of the patient during surgery. We performed a retrospective study using incident reporting system to examine the incidence of SPI at our hospital.

(Materials and methods) Among anesthesiology managed surgical cases, SPI cases reported in the incident reporting system between 2012 and 2017 were examined. The primary endpoint was the incidence of SPI.

(Results) Of 35,400 anesthesiology managed cases, 59 (0.2%) had SPI reported in the incident reporting system. Forty-four (75%) were male patients. Median age and BMI were 60 and 23.6 years, respectively. Forty-four (75%) were not supine position. Median operative time and blood loss were 419 minutes and 220 ml, respectively. Nurses reported incident reports in 52 (88%) cases, and only 7 (12%) by physicians. Skin injuries were reported in 42 cases (71%) and neurovascular injuries in 17 cases (29%). Of the neurovascular injuries, 4 (7%) were lower extremity compartment syndrome. Three cases of the 4 received the fasciotomy.

(Conclusions) The incidence of SPI reported in the incident report system was 0.2%. Four cases had compartment syndrome. This result suggested the importance of intraoperative and postoperative observation in addition to proper correct positioning.

(Introduction) In this study, we investigated the surgical outcomes and cancer control achieved with cytoreductive radical prostatectomy (cRP) in patients with castration-resistant prostate cancer (CRPC).

(Patients and Methods) The study included 12 patients who underwent cRP at Kure Medical Center between August 2010 and April 2022 for diagnosis of CRPC. Perioperative outcomes, decline in serum prostate-specific antigen (PSA) levels from baseline, PSA progression-free survival, and postoperative treatment-free survival were recorded.

(Results) We observed that 5 of 12 patients showed no metastases at the time of initial diagnosis, 2 had only regional lymph node metastases, and 5 had distant metastases. No patient showed identifiable metastases on imaging studies at the time of surgery. The median PSA value at the time of surgery was 0.47 ng/mL, and 5 patients had PSA values ≥1 ng/mL. All patients underwent laparoscopic cRP. Postoperative adverse events included Clavien-Dindo grade I complications in 4 and grade III complications in 1 patient; however, no patient developed rectal injury. Postoperative serum PSA levels were < 0.2 ng/mL in 8 of 12 patients (66.7%) and undetectable in 5 patients (41.7%). The median postoperative PSA progression-free survival and postoperative treatment-free survival were 12.4 and 14.5 months, respectively.

(Conclusion) cRP was associated with a good anti-cancer effect in selected cases of CRPC and may serve as a potentially useful treatment option in this patient population.

Mucinous cystic tumor of low malignant potential (MCTLMP) is a very rare disease.

The patient was a 50-year-old man. Contrast-enhanced computed tomography and magnetic resonance imaging showed a multiocular cystic lesion on the top of the bladder. We performed surgery to remove the tumor for definitive diagnosis. Intraoperative rapid pathological diagnosis of the cyst wall showed no malignant findings, so we performed combined resection of the peritoneum and part of the bladder wall.

Based on imaging findings, tumor location, and pathological and immunostaining findings (CK20 and CDX2 positivity; β-catenin negativity), the patient was diagnosed with MCTLMP thought to be of urachal origin. After the operation, recurrence was not observed.

A 57-years-old woman was referred to our urological department due to a 7.2-cm tumor in the left kidney, detected on computed tomography (CT). Dynamic CT of the kidney confirmed the diagnosis of left renal cancer, with lung metastasis (cT2aN0M1). The patient had a poor prognosis (IMDC classification), given the following risk factors: Time from initial diagnosis to initiation of systemic therapy < 1year, hemoglobin of 8.4 g/dL, calcium of 10.7 mg/dL, and platelet of 74.2×10⁴/mm³. Laparoscopic left radical nephrectomy was performed before systemic drug treatment because the solitary lung metastasis was relatively small (10 mm) and the patient had symptoms of hematuria and fever. The pathological diagnosis was a clear cell carcinoma with renal sinus invasion (pT3a). Four days postoperatively, the patient developed lymphatic leakage, and was unresponsive to diet and conservative treatment. Lymphatic embolization with iodized poppy oil fatty acid ethyl ester was performed 22 days postoperatively. Contrast material leakage from the left renal hilar lymph node was observed before embolization. Post-embolization CT confirmed no contrast leakage. The patient resumed oral feeding on the 28^th postoperative day, and the drain was successfully removed the next day. She was discharged on the 35^th postoperative day. On follow-up, increased lung metastases were observed on CT. She was treated with the combination of ipilimumab and nivolumab. After one course of treatment, a CT scan showed a further increased in lung metastases (RECIST: PD). Thus, she was initiated on cabozantinib monotherapy. Lymphatic embolization may be a safe and effective treatment for lymphatic leakage that does not improve with conservative treatment.