(Purpose) The prostate specific antigen (PSA) level usually is lowered in response to initial endocrine therapy even in advanced cases of prostate cancer, but in some cases, it is not. We examined the cases in which the PSA level was not sufficiently lowered by initial endocrine therapy with maximal androgen blockade (MAB) or estrogenic drugs. (Materials and methods) The subjects were 20 patients with prostate cancer diagnosed between January 1992 and December 2005 whose PSA level was not lowered below 10ng/ml after initial endocrine therapy with MAB or estrogenic drugs. We investigated the frequency of cases, pretreatment PSA levels, PSA nadir levels after initial endocrine therapy and throughout the therapy, PSA response to second line therapy, and the prognosis. (Results) The PSA level was not lowered below 10ng/ml after initial endocrine therapy with MAB or estrogenic drugs in 4.9% of the cases. Cancer-specific survival rates in all cases were extremely poor, 75.0% at 1 year and 14.7% at 3 years. Prognosis tended to be worse in patients with a higher PSA nadir level throughout the therapy and on whom second therapy was not effective, although the difference was not statistically significant. (Conclusion) The patients whose PSA levels were not lowered sufficiently by MAB or estrogenic drugs had an extremely poor prognosis. These results are useful in planning the therapy, and in explaining the status or future prospective of the disease to patients and their families.
(Purpose) The objective of this study was to optimize least invasive techniques, like microwave tissue coagulation (MCT), radiofrequency ablation (RFA) or ultrasonically-activated scalpel (USS) for the electric and thermal conduction in kidney. (Materials and methods) Needle electrode of MCT, RFA or USS were inserted into pig's kidney, under general anesthesia. We examined if the interruption of renal artery or cooling of renal parenchyma by irrigation in the renal pelvis had an effect on the tissue temperature distribution and area of tissue degeneration. The tissue parenchyma temperatures were measured at regular intervals of area (each 2.5-5.0mm) from needle electrode or hook probe and of time (each 10 sec) using by needle temperature sensor, and pathological investigations on the tissue degeneration of the renal parenchyma were done. (Results) By MCT, interruption of renal artery had no effect on the distribution of tissue temperature and the area of tissue degeneration. Cooling of renal parenchyma by irrigation in the renal pelvis did not affect the area of tissue degeneration but the tissue temperature was elevated significantly. By RFA, particular interest, interruption of renal artery and cooling of renal parenchyma enhanced to increase both the tissue temperature and the area of tissue degeneration. By USS, interruption of renal artery enhanced to increase both the tissue temperature and the area of tissue degeneration. Cooling of renal parenchyma by irrigation in the renal pelvis had no effect on the distribution of temperature and the area of tissue degeneration. We also examined weather cooling of renal parenchyma by several irrigation solutions which have different electric conductivity (EC) such as normal saline solution (EC: 15, 800μS/cm), tap water (EC: 133μS/cm) and glucose solution (EC: 8.6μS/cm) in the renal pelvis using ureteral catheter would effect on the distribution of temperature and the area of tissue degeneration. In MCT and USS, these solutions did not have any effect, but in RFA the degree of tissue temperature elevation by normal saline, tap water and glucose solution were high, intermediate and low, respectively. (Conclusion) As RFA and USS tend to be affected by the surrounding environment, electric and thermal conductivity should be applied with caution, while using these techniques.
(Purpose) To analyze the characteristics and prognostic factor of penile cancer, we retrospectively reviewed the clinicopathological data of patients with a diagnosis of penile cancer treated. (Patients and methods) The records of 59 patients (median age 66, ranged from 47 to 91) with squamous cell carcinoma of the penis reffered between April 1988 and January 2006 were reviewed. The importance of tumor size and stage, differentiation, type of infiltration, vascular invasion, patient age, lymph node metastasis, distant metastasis and type of therapy were assessed using univariate and multivariate analyses. (Results) After a mean follow up of 37.7 months, 13 cases (22.0%) died of cancer and 5-year survival was 67.4%. Multivariate analysis demonstrated that, type of operation (p=0.0471, Hazard ratio 3.364), vascular invasion (p=0.0014, Hazard ratio 5.921) were associated with survival. (Conclusion) Vascular invasion and type of operation were related to survival. Our findings indicate that correct pathological diagnosis and appropriate treatment may lead to prolonged survival.
(Background) In Japan, patients suffering vesicosigmoidal fistula caused by diverculitis is increasing. Our aim is to report our seven cases and the literature review related with this disease. (Methods) A retrospective record review of seven patients in our hospital who were diagnosed and treated for vesicosigmoidal fistulas over a 12-year period from 1994 was performed. Data collection focused on symptoms, diagnostic studies, and methods of management. (Results) All of the patients were male whose ages ranged from 41 to 82 years, with a mean age of 60.7 years. All of the patients presented with some of the common presenting symptoms of pneumaturia, fecaluria, irritation, abdominal pain, recurrent urinary tract infection, macroscopic hematuria. In all cases, abnormal cystoscopic findings were observed. Onestage colectomy with partial cystectomy was underwent in all cases. (Conclusion) Many of the patients suffering from vesicosigmoidal fistula caused by diverticulitis have urological symptoms. So the above mentioned examinations are required when the outpatients complained of pneumaturia, fecaluria, irritative voiding symptoms, reccurent urinary tract infection. After diagnosed, surgical treatment is the most standard therapy and when the appropriate operative method is selected, postoperative prognosis is favorable.
A 54-year-old male presented with massive hematuria with bladder tamponade. Computed tomography and magnetic resonance imaging showed a 7.5×6.5×4.5cm. mass centered in the left renal pelvis, which is composed of macroscopic fat and soft-tissue component. Differential diagnosis included liposarcoma, lipoma and angiomyolipoma. Urothelial carcinoma was also undeniable because urine cytology was equivocal. Subsequently, a left nephroureterectomy was performed. Pathological examinations revealed a renal angiomyolipoma protruding into the renal pelvis. We present a rare case of angiomyolipoma in the renal pelvis and review the literature concerning these unusual findings of this common neoplasm.
Migration of surgical materials into the urinary tract is very rare. We present a case of spontaneous migration of a metal clip into renal pelvis after laparoscopic pyeloplasty. A 44-year-old woman who had a long history of multiple sclerosis presented with symptomatic left hydronephrosis due to ureteropelvic junction (UPJ) obstruction. Since antegrade endopyelotomy was unsuccessful, the patient underwent laparoscopic Anderson-Hynes pyeloplasty. The UPJ was wrapped with thick inflammatory tissue and a crossing vessel that firmly adhered to the UPJ was found and dissected. Metal clips were used for hemostasis. Although the hydronephrosis was improved and flank pain was completely dissolved, a stone was identified in the pelvis 22 months after the surgery. The stone was formed around a metal clip that had been possibly migrated into the renal pelvis. Transureteral lithotripsy was performed using an 8F ureterofiberscope and a clip was removed.
Malacoplakia is a relatively rare form of chronic granulomatous inflammation. Which occurs most frequently in the genito-urinary system, but renal parenchymal involvement is rare. We present a case of malacoplakia of the renal parenchyma. A 69-year-old woman with left renal mass was referred to our department. Abdominal enhanced CT scan revealed heterogeneous mass in the left kidney (50×45mm). CT-guided percutaneous left renal needle biopsy confirmed the diagnosis of renal malakoplakia. We successfully treated her with oral levofloxacin. The lesion resolved after the 4 months-therapy, and there has been no recurrence for 22 months since the treatment.
A case of bilateral pheochromocytomas with von Hippel Lindau disease (VHL) is reported. A 32-year-old man visited Kumamoto Red Cross Hospital for further examination of hypertension. Computed tomography revealed bilateral adrenal tumors and noradrenalin levels in serum and urine were elevated. Suspecting bilateral pheochromocytoma, he was reffered to our hospital for further examination and treatment. 131I-MIBG scnitigraphy showed accumulation in bilateral adrenal glands. Moreover, he had cerebellar and spinal hemangioblastomas. Bilateral adrenalectomies and left nephrectomy were performed because tumor thrombus extended into the left renal vein, and pathological diagnosis was pheochromocytoma. His sister had been diagnosed as VHL disease. We diagnosed the patient as VHL disease because of the existence of cerebellar and spinal hemangioblastomas, bilateral pheochromocytomas, missense mutation and his family history. This is the eleventh case of bilateral pheochromocytomas with VHL disease reported in Japanese literatures.