(Introduction) Patients with severe pelvic organ prolapse (POP) are currently being treated with robot-assisted or laparoscopic sacrocolpopexy (LSC). LSC is recognized as being more secure and more effective than transvaginal mesh surgery (TVM). However, favorable postoperative outcomes occur even in patients treated with TVM using ORIHIME^® mesh. We compared the differences in postoperative outcomes and complication rates between patients who underwent either of these two methods using ORIHIME^® mesh.

(Material and methods) We retrospectively evaluated 95 patients with POP. In our hospital, 41 patients were treated by LSC, whereas 54 were treated by TVM. We measured the changes in symptoms before and after surgery using the IPSS, OABSS, and ICIQ-SF, and 1-h pad weight testing and complication rates.

(Result) Between 3 and 12 months following surgery, both groups' residual urine volume and IPSS plus QOL score significantly decreased. The pad test results revealed a significant decrease 3 months after surgery in the TVM group. From 3 to 12 months after surgery in the TVM group for all patients and patients with POP scored ≤ stage 3, and at 12 months after surgery in the LSC group for all patients, OABSS and ICIQ-SF scores declined significantly. There were no statistically significant differences in the rate of urinary incontinence, mesh exposure after surgery between the two groups. The rate of prolapse recurrence in the TVM group was as low as in the LSC group among patients with stage 2 or 3 POP.

(Conclusion) TVM using ORIHIME^® mesh has a favorable postoperative course compared to LSC at 1 year postoperatively. TVM surgery should be preferentially considered for patients scored ≤ stage 3 POP-Q.

(Purpose) To evaluate the safety and efficacy of outpatient procedures using botulinum toxin (BTX) for patients with intractable overactive bladder (OAB) in a Female Urology Clinic.

(Methods) Medical charts of female patients who underwent outpatient BTX procedures for intractable OAB were retrospectively reviewed between 2020 and 2022. In addition to uroflowmetry and residual urine measurement, OAB symptoms score (OABSS), international prostate symptom score (IPSS), and patient global impression of improvement (PGI-I) were evaluated preoperatively and postoperatively at 2, 6, 12, and 24 weeks.

(Results) Forty-one patients underwent a total of 50 BTX procedures during the above period (1 procedure: 34 patients, 2 procedures: 5 patients, 3 procedures: 2 patients). The average age was 72.4±7.6 (50-86), and 9 (22.0%) and 3 (12.2%) patients had a history of surgeries for pelvic organ prolapse and stress urinary incontinence, respectively. Two patients (4.9%) developed temporal urinary retention which was managed with clean self-intermittent catheterization. Symptomatic urinary tract infection occurred in 3 patients (7.3%). The average maximum flow rate showed a small but significant decrease, and the average residual urine significantly increased from preoperative 41.4 ml to 103.4 ml (week 2), 88.5 ml (week 6), 72.4 ml (week 12), and 60.3 ml (week 24). However, IPSS-voiding symptom score did not show significant differences at week 2-24. OABSS-Q1 (daytime frequency) did not show significant improvement at any point, and OABSS-Q2 (nocturnal frequency) showed significant improvement at week 2 and 6. OABSS-Q3 (urinary urgency), OABSS-Q4 (urgency urinary incontinence), OABSS total score, IPSS-Q4 (urinary urgency), IPSS-storage symptom score, and IPSS-QOL all showed significant improvement at week 2-24. PGI-I showed the highest improvement rates at week 2 (marked improvement 63.4%, improvement 92.7%), and this improvement was sustained at week 12 (marked improvement 43.6%, improvement 84.6%). Most patients did not choose to have additional therapy until 24 weeks to over one year had passed. Furthermore, 12 patients (29.3%) chose to have a second BTX procedure.

(Conclusion) In Female Urology Clinics, there are many patients suffering from refractory OAB including those after surgeries for pelvic organ prolapse and stress urinary incontinence. As urinary retention is less frequently caused by BTX and its efficacy is more evident among female patients, BTX procedures could be anticipated as an outpatient treatment option in Female Urology.

(Objectives) Trans-umbilical laparo-endoscopic single-site surgery for a urachal remnant (LESSU) enables an aesthetically outcome as the scar is concealed within the umbilical fold. We performed trans-umbilical LESSU using the glove port to minimize interference between surgical instruments and evaluated its efficacy.

(Materials and methods) LESSU was performed by a single surgeon in our institute in 13 patients between August 2020 and April 2023. GelPOINT Mini™ (Applied Medical Corporation) or Free access XS (TOP^® Corporation) were used in the first two cases, followed by the glove port method from the third case onward. We retrospectively collected clinical data by using medical records.

(Results) Five males and six females, with a median age of 33 years (23-74 years), underwent surgery with the glove method. The median operating time was 126 minutes (84-153 minutes), and minimal blood loss was observed in all cases. Perioperative complications occurred in one case (forcal peritonitis, Clavien-Dindo II). The median postoperative hospital stay was 3 days (2-5 days). Fixation using a rubber band attached to a camera port from the fifth case onwards, contributed to reduced average operating time. The surgical cost of surgery using the glove method was lower than using standard surgical platforms for single-port surgery.

(Conclusion) LESSU using the glove method has several benefits such as offering better flexibility of each surgical instrument, better surgical imaging near the umbilicus, and treatment at a lower surgical cost.

The patient in this case is a 67-year-old male. The previous physician examined the patient due to the primary complaint of ulcers on the penis, and the patient was diagnosed with squamous cell carcinoma (cT1N0M0). Our clinic performed a penectomy.

Since vascular invasion was negative, a lymphadenectomy was not performed, and the patient was subsequently observed. However, four months after the surgery, we confirmed that the cancer had metastasized to the left inguinal lymph node and the left external iliac lymph node.

The patient completed the fourth cycle of the TIP treatment before we performed an inguinal pelvic lymphadenectomy, and the patient succeeded in complete remission.

Presently, two years and five months after the lymphadenectomy, no recurrence was found.

Testicular torsion is a condition of ischemia due to blood flow disturbance, ischemia-reperfusion injury after the detorsion, and compartment syndrome with increased intratesticular pressure. If no improvement in testicular color and appearance is noted after the detorsion, the tunica albuginea incision can be performed to preserve the testis. Case 1: A 13-year-old male came to our hospital with left scrotal pain, and emergency surgery was performed six hours after the onset with the diagnosis of left testicular torsion. The left testis was externally rotated 180 degrees, and the testis remained poorly colored after the detorsion. The testicular color improved after the tunica albuginea incision. The defect of the albuginea was covered with a tunica vaginalis flap. One year after the operation, testicular size remained the same, and blood flow in the left testis was good. Case 2: A 16-year-old male came to our hospital with right scrotal pain, and emergency surgery was performed 10 hours after the onset with a diagnosis of right testicular torsion. The right testicle was internally rotated 180 degrees, and the testis remained poorly colored after the detorsion. The tunica albuginea incision was performed and covered with a tunica vaginalis flap after improvement of color. Six months after the operation, testicular size remained the same, and blood flow in the right testis was good. Testicular preservation was possible with tunica albuginea incision and tunica vaginalis flap for testicular torsion. However, the long-term effect of these techniques on testicular function is unclear, and long-term follow-up is likely to be necessary.

A 34-year-old man had undergone living donor kidney transplantation for hypoplastic and dysplastic kidney and gastrocystoplasty and umbilical-urinary tract reconstruction using the appendix for contracted bladder in his early childhood. At the age of 19 years, renal transplant function was lost, and hemodialysis was thus initiated. Since then, he had regularly visited our department while continuing to perform urethral self-catheterization and self-bladder irrigation to alleviate bladder irritation symptoms due to hematuria-dysuria syndrome. Subsequently, the patient experienced hemorrhage from the bladder augmented with the stomach, which led to the development of bladder tamponade and the progression of anemia. He was thus admitted to our department and received continuous bladder irrigation and other conservative therapies, as well as vascular embolization. Because hemostasis was not achieved despite these procedures, partial cystectomy (resection of the bladder augmented with the stomach) was performed. Here, we report our experience with a patient with refractory bladder hemorrhage due to hematuria-dysuria syndrome, for which we performed partial cystectomy and achieved hemostasis. Although gastrocystoplasty has been rarely performed in recent years because of specific postoperative complications such as hematuria-dysuria syndrome, caution should be exercised in patients with anuria due to renal failure or other causes.

We present a case of retroperitoneal carcinosarcoma. A 48-year-old woman with left-sided abdominal pain and a 15 cm tumor in the lower left renal retroperitoneal region on computed tomography (CT) was referred to our hospital. Contrast-enhanced CT showed a well-defined tumor with contrast effect on the retroperitoneum. Magnetic resonance imaging (MRI) demonstrated a heterogeneous cystic mass and well-enhanced mural nodules in the tumor on T2-weighted images. Her levels of serum CA-125 and CA-19-9 were high at 44.7 and 143.0 U/mL, respectively. Although she was diagnosed with primary retroperitoneal mucinous cystadenocarcinoma and underwent surgical resection, the pathological diagnosis was a carcinosarcoma on the retroperitoneum. No adjuvant therapy was given. CT findings at 2 months revealed local recurrence and multiple pulmonary metastases. She received paclitaxel (175 mg/m² on day 1) and carboplatin (area under the curve of 6 on day 1) (TC) every 3 weeks. After two courses of TC therapy, some pulmonary metastases disappeared and shrank, but the progression of local recurrence was observed. However, after seven total courses of TC therapy, local recurrence further progressed, with the infiltration of the abdominal wall and lumbar pain, which was determined to be progressive disease (PD). A comprehensive genomic profiling test revealed no actionable genetic mutations. She died of cancer five months after the disease recurred. Carcinosarcoma is a rare tumor with poor prognosis, for which no established treatment exists beyond surgical resection. In this case, the therapeutic agent could not be determined; however, genomic analysis should be performed to guide the treatment of carcinosarcoma in advanced cases.

A 70-year-old man was referred to our institution because of a left seminal vesicle tumor revealed by computed tomography (CT) for postoperative follow-up of malignant melanoma. The prostate-specific antigen level (1.03 ng/mL) was not elevated. We performed transrectal ultrasound-guided seminal biopsy, and the pathological diagnosis was schwannoma. We decided to do follow-up because it was a benign tumor. However, the maximum diameter of the tumor increased over time from 21 mm to 47 mm during 7 years of follow-up. Since malignant potential could not be denied by image diagnosis, we decided to resect the tumor radically. The patient received robot-assisted laparoscopic left seminal vesicle resection. The pathological diagnosis was schwannoma with no malignant features. In such cases, robot-assisted surgery has great advantages in terms of expansion of the operative field and understanding of the three-dimensional structure.

Denys-Drash syndrome (DDS) is characterized by rapidly progressing nephropathy, Disorders of Sex development, and Wilms tumor. Gonadal removal is recommended owing to the increased risk of developing gonadal tumors; however, the optimal timing remains uncertain. Herein, we report three cases with gonadoblastoma discovered in excised gonads. Case 1 involves a 13-year-old girl for whom peritoneal dialysis (PD) was initiated at 6 months of age. The left gonad removal at 9 months revealed hypoplastic testicular tissue. At 2 years and 8 months, kidney transplantation and bilateral nephrectomy were performed. A living kidney transplant was received at the age of 10 years. Subsequently, virilization signs and right gonadal swelling led to a diagnosis of gonadoblastoma during right gonadectomy at 13 years and 7 months. Case 2 involves a 6-year-old girl for whom PD was initiated 1 month after birth. Left nephrectomy was performed at 1 years and 11 months, followed by right nephrectomy at 5 years and 4 months. At the age of 6 years and 1 months, living kidney transplantation and simultaneous right gonadectomy revealed gonadoblastoma with a dysgerminoma component, without metastasis. Left gonadectomy 3 months post-transplantation revealed testis pathology. Case 3: involves a 4-year-old girl for whom PD was initiated 9 days after birth. Bilateral nephrectomy was performed at 1 year of age. Bilateral gonadectomy at 4 years and 5 months revealed bilateral ovotestis with a left gonadoblastoma component. While gonadoblastoma has limited malignant findings, it serves as the precursor of highly malignant gonadal tumors, highlighting the importance of timely excision. In DDS cases, determining the optimal timing for gonadectomy remains complex owing to variations in nephropathy progression. The priority given to PD initiation and Wilms' tumor prevention further complicates excision timing. Notably, the case of dysgerminoma in our 6-year-old patient appears to be one of the youngest cases in the literature.