(Objective) We examined if the degree of preoperative hydronephrosis influences the occurrence of postoperative intravesical recurrence (IVR) in patients with upper tract urothelial cancer (UTUC).

(Material and method) From January 2010 to March 2022, a total of 237 patients underwent total nephroureterectomy and partial cystectomy for UTUC at our hospital. For this study, 169 patients were selected after excluding 57 patients with a history of bladder cancer, 10 patients who received postoperative intravesical anticancer drug injection and 1 patient with inadequate data. Cases with Society for Fetal Urology (SFU) Grade 2 or higher (renal pelvis and several calyces observed) on preoperative computed tomography were considered to have hydronephrosis. Multivariate analysis was performed by selecting four known risk factors: tumor localization (ureter tumor), positive preoperative urine cytology, multiple upper tract ureteral carcinomas, and carcinoma in situ of UTUC.

(Result) There were 120 male patients (71.0%) and 49 female patients (29.0%), with a median age of 71 years. The median observation period was 43 months. IVR was observed in 46 patients (27.2%) after surgery; 82 patients (49.1%) had SFU Grade 2 or higher (preoperative hydronephrosis) and 25 had SFU Grade 4 (dilatation of the renal pelvis and calyces and thinning of the renal parenchyma). There was a correlation between SFU Grade progression and an increase in IVR rate. Compared with patients without hydronephrosis, the presence of SFU Grade 4 hydronephrosis was found to be an independent associate factor after adjusting for known risk factors in multivariate analysis (p=0.02, hazard ratio 3.02, 95% confidence interval 1.18-7.75).

(Conclusion) Patients with preoperative SFU Grade 4 hydronephrosis are more likely to have IVR. Postoperative intravesical anticancer drug injections and more frequent cystoscopies may be beneficial for these patients.

(Introduction and objective) Water vapor energy therapy (WAVE) received insurance approval in Japan in September 2022 for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Here we report a prospective trial of WAVE.

(Patients and methods) This study included 16 patients who underwent WAVE between November 2022 and December 2023. International Prostate Symptom Score (IPSS), IPSS Quality of Life (QOL) score, overactive bladder symptom score, post-void residual urine volume (PVR), prostate volume (PV) measured using transrectal ultrasonography, postoperative catheter removal rate, surgical duration, and adverse events were recorded preoperatively and at 1, 3, 6, and 12 months postoperative.

(Results) The median age was 76.5 years, and 11 of 16 patients (69%) received antiplatelets and/or anticoagulants. The median preoperative PV was 43.5 ml, while the median postoperative follow-up period was 6.9 months. Comparison of the baseline and 6-month postoperative follow-up values showed that the median IPSS and IPSS-QOL scores decreased significantly (by 48% and 55%, respectively), while the median PV was significantly reduced by 36%. The median PVR was reduced by 51%; however, the difference was not significant. Catheter removal was successful in 80% of patients. The median surgical duration was 8.5 min (range, 4.0-26.0 min). Complications (grade ≤ II) according to the Common Terminology Criteria for Adverse Events v5.0 occurred in 12 patients.

(Conclusion) WAVE is a useful minimally invasive surgical approach in elderly patients and patients receiving antiplatelets and/or anticoagulants, featuring a short surgical duration, improved micturition, and no serious adverse events.

Dysuria is caused by bladder outlet obstruction (BOO) and detrusor underactivity. Female BOO is often overlooked because it is difficult to diagnose a condition from history and symptoms alone. Fowler's syndrome is seen in young women and causes urinary retention due to a primary disorder of urethral sphincter relaxation. Although the level of evidence is still low, sacral neuromodulation or intra-sphincteric Botulinum toxin injection has been applied to Fowler's syndrome. A 44-year-old woman with a chief complaint of dysuria started clean intermittent catheterization because of urinary retention. Videourodynamics showed BOO, open bladder neck, and narrowing of the middle urethra during voiding, and MRI showed thickening of the urethral sphincter. A neurological examination was performed with no neurologic features, so the diagnosis of Fowler's syndrome was suggested. The possibility of a diagnosis of female BOO should always be kept in mind when a woman has dysuria, and urodynamic study or Videourodynamics should be considered.

A 80-year-old woman presented with a swelling and pain in the left thigh visited our hospital. CT showed an impacted stone in the left ureter, left hydronephrosis and abscess formation extending from the perirenal area to the left thigh. Immediately, the patient was admitted and left nephrostomy was placed. On day 3 of admission, drainage of abscess in the left thigh was performed with the cooperation of an orthopedic surgeon. On day 17, a contrast-enhanced CT showed shrinkage of the thigh abscess, however, showed the left non-functioning kidney and poor drainage of the left iliopsoas abscess. On day 24, open left nephrectomy and unroofing of the iliopsoas abscess were performed, and all the abscess showed shrinkage thereafter. To sum up, multiple drainage should be considered for widely extending abscess originated in the retroperitoneal space.

A 72-year-old man was referred to our hospital because of right renal tumors. Ultrasound examination revealed two masses in the right renal hilum. Contrast-enhanced computed tomography (CT) scan showed 25 mm and 10 mm soft tissue density nodules with poor contrast effect in the right renal hilum. Positron emission tomography-CT scan showed an accumulation of SUVmax of 6.65 in the same area. A CT-guided biopsy was performed, and immunostaining revealed the presence of IgG4-positive plasma cell clusters and a high serum IgG4 level of 658 mg/dL. A definitive diagnosis of IgG4-related disease was made, and the patient was placed under observation.

A CT-guided biopsy is helpful for the diagnosis of IgG4-related disease and should be considered when masses are found in the unilateral renal hilum.