[A Case of Reactive Arthritis after BCG Intravesical Infusion Therapy Successfully Treated with Salazosulfapyridine].

The patient was a 70-year-old woman who underwent transurethral resection of bladder tumor in May 2020. She was diagnosed with urothelial carcinoma (high grade, pT1 by pathology). We started bacillus Calmette-Guerin (BCG) intravesical infusion (80 mg Tokyo strain) in August of the same year after a second transurethral resection. Pain during urination persisted during the administration of BCG, and it worsened after the completion of six doses. The patient was hospitalized with back and neck pain and difficulty in physical movement. At the time of admission, bilateral conjunctivitis was observed. The patient was diagnosed with reactive arthritis associated with BCG intravesical injection therapy, as three typical symptoms were observed (bilateral conjunctivitis, urethritis, polyarthritis). The patient was treated with prednisolone and non-steroidal anti-inflammatory drugs for arthritis, but the symptoms did not improve. We administered salazosulfapyridine and her reactive arthritis improved.

Creation, effects on embryo quality, and clinical outcomes of a new embryo culture medium with 31 optimized components derived from human oviduct fluid: A prospective multicenter randomized trial.

Purpose: Our aim is to make an ideal embryo culture medium close to human oviduct fluid (HOF) components, and to evaluate the quality of this medium with embryo quality and clinical outcomes in assisted reproductive technology (ART) by a prospective randomized controlled trial (RCT). Methods: Study I: HOF was collected laparoscopically from patients (n = 28) with normal pelvic findings. According to HOF analysis results, the new medium "HiGROW OVIT®" (OVIT) was designed. Study II: Embryos (2 pronuclei (2PN) = 9633) were assigned from 1435 patients. The blastulation rate (BR), good BR (gBR), utilized (transferred/cryo-preserved) BR (uBR), pregnancy rate (PR), and miscarriage rate (MR) were compared between the OVIT and control groups by RCT. Results: The novel medium 'OVIT' was produced according to 31 HOF components. The concentrations of essential amino acids (e-AAs) were lower in OVIT than in current media, yet the opposite was true for ne-AA concentrations. gBR and uBR were higher in the OVIT group than in the control group. In the older female group, gBT and uBR were significantly higher in the OVIT group. Conclusions: The novel medium 'OVIT' was produced according to HOF data. The OVIT had significantly better embryo quality and clinical outcomes than the current media.

Overproduction of PGR5 enhances the electron sink downstream of photosystem I in a C4 plant, Flaveria bidentis.

C4 plants can fix CO2 efficiently using CO2 -concentrating mechanisms (CCMs), but they require additional ATP. To supply the additional ATP, C4 plants operate at higher rates of cyclic electron transport around photosystem I (PSI), in which electrons are transferred from ferredoxin to plastoquinone. Recently, it has been reported that the NAD(P)H dehydrogenase-like complex (NDH) accumulated in the thylakoid membrane in leaves of C4 plants, making it a candidate for the additional synthesis of ATP used in the CCM. In addition, C4 plants have higher levels of PROTON GRADIENT REGULATION 5 (PGR5) expression, but it has been unknown how PGR5 functions in C4 photosynthesis. In this study, PGR5 was overexpressed in a C4 dicot, Flaveria bidentis. In PGR5-overproducing (OP) lines, PGR5 levels were 2.3- to 3.0-fold greater compared with wild-type plants. PGR5-like PHOTOSYNTHETIC PHENOTYPE 1 (PGRL1), which cooperates with PGR5, increased with PGR5. A spectroscopic analysis indicated that in the PGR5-OP lines, the acceptor side limitation of PSI was reduced in response to a rapid increase in photon flux density. Although it did not affect CO2 assimilation, the overproduction of PGR5 contributed to an enhanced electron sink downstream of PSI.

Machine learning methods can more efficiently predict prostate cancer compared with prostate-specific antigen density and prostate-specific antigen velocity.

BACKGROUND: Prostate-specific antigen (PSA)-based screening for prostate cancer has been widely performed, but its accuracy is unsatisfactory. To improve accuracy, building an effective statistical model using machine learning methods (MLMs) is a promising approach. METHODS: Data on continuous changes in the PSA level over the past 2 years were accumulated from 512 patients who underwent prostate biopsy after PSA screening. The age of the patients, PSA level, prostate volumes, and white blood cell count in urinalysis were used as input data for the MLMs. As MLMs, we evaluated the efficacy of three different techniques: artificial neural networks (ANNs), random forest, and support vector machine. Model performance was evaluated using area under the receiver operating characteristic curve (AUC) and compared with the PSA level and the conventional PSA-based parameters: PSA density and PSA velocity. RESULTS: When using two annual PSA testing, all receiver operating characteristic curves of the three MLMs were above the curve for the PSA level, PSA density, and PSA velocity. The AUCs of ANNs, random forest, and support vector machine were 0.69, 0.64, and 0.63, respectively. Those values were higher than the AUCs of the PSA level, PSA density, and PSA velocity, 0.53, 0.41, and 0.55, respectively. The accuracies of the MLMs (71.6% to 72.1%) were also superior to those of the PSA level (39.1%), PSA density (49.7%), and PSA velocity (54.9%). Among the MLMs, ANNs showed the most favorable AUC. The MLMs showed higher sensitivity and specificity than conventional PSA-based parameters. The model performance did not improve when using three annual PSA testing. CONCLUSION: The present retrospective study results indicate that machine learning techniques can predict prostate cancer with significantly better AUCs than those of PSA density and PSA velocity.

[Metastases of Urothelial Carcinoma with Trophoblastic Differentiation that Responded to Combination Chemotherapy with Gemcitabine and Oxaliplatin : A Case Report].

A 70-year-old man was admitted with complaint of gross hematuria. Cystoscopy and computed tomography (CT) revealed a 2.5 cm nodular tumor in the urinary bladder. Pathological diagnosis after the transurethral resection of bladder tumor (TURBT) was invasive urothelial cancer with trophoblastic differentiation of pT1. The tumor was positively stained with human chorionic gonadotropin (HCG). The serum HCG level was 12.8 IU/l in the fourth week after TURBT, and it increased to 35.7 IU/l in the 20th week after TURBT. However, radiological examination at this point did not reveal tumor recurrence or metastases. Three months later, the patient coughed up bloody sputum. Lung metastases (up to 2.4 cm) were identified, and they were surgically removed. The pathological specimen consisted of syncytiotrophoblastic giant cells with hemorrhage and necrosis, but no urothelial cancer element. Because the lung and lymph node metastases developed soon after surgery, chemotherapy was planned. Because the patient had impaired renal function with a creatinine clearance of 33.7 ml/min, we selected combination chemotherapy with gemcitabine and oxaliplatin (GEMOX) rather than cisplatin -based chemotherapy. CT after two courses of GEMOX showed stable disease, but HCG levels markedly decreased from 1,240 IU/l to 7.9 IU/l. This marker of response continued through six courses of GEMOX. Then, the chemotherapy was discontinued due to grade 2 neuropathy. He died of cancer 12 months after development of metastases. Autopsy revealed only tumor cells with trophoblastic differentiation, but no urothelial carcinoma in multiple metastatic sites.

[Fever, Hepatic Dysfunction and Interstitial Pneumonia Caused by Intravesical Bacillus Calmette-Guerin (BCG) Instillation after Urethral Bougie : A Case Report].

A 60-year-old man had a past history of urothelial carcinoma of the left renal pelvis treated with laparoscopic left total nephroureterectomy in October 2004. He underwent transurethral resection of the bladder tumor (TUR-Bt) twice for recurrence of urothelial carcinoma in the bladder in April 2014 and February 2015, and subsequently received intravesical Bacillus Calmette-Guerin (BCG) instillation at weekly intervalsfor prevention of recurrence. In November 2016, a year and a half after BCG induction, he received BCG therapy after urethral bougie to dilate the urethral stricture. After BCG therapy, he exhibited a continuously high fever. Immediate antituberculosis drug therapy in consideration of BCG sepsis failed to improve the symptoms, and all cultures from urine and blood were negative for mycobacterium tuberculosis. Serum liver enzyme was markedly elevated and chest CT showed diffuse interstitial shadows in both lower lungs. Thus, we considered that these symptoms were caused by a hypersensitivity reaction to BCG and started pulse steroid therapy. After pulse steroid therapy, body temperature, and hepatic function became normal and interstitial pneumonia subsided.

[Metachronous Bilateral Testicular Tumors with Frequently Recurrent Hydrocele : A Case Report].

We report a case of metachronous bilateral testicular tumors combined with hydrocele. A 46-year-old male presented with frequently recurrent left hydrocele. His medical history included a stage IIA right testicular tumor,which had been treated with right high orchiectomy and retroperitoneal lymph node dissection 22 years ago. Magnetic resonance imaging (MRI) showed hydrocele and a low intensity area in the left testis,and the patient underwent left high orchiectomy. After cytological examination of the hydrocele it was categorized as class V,and after a pathological study it was diagnosed as seminoma and embryonal carcinoma. Since postoperative computed tomography showed lung metastasis,treatment with bleomycin,etoposide,and cisplatin (BEP) was indicated. Three courses of BEP produced a complete response. No recurrent testicular tumor was seen at 3 months after the BEP therapy. A metachronous testicular tumor should be considered in patients with a history of testicular tumors who frequently develop recurrent hydrocele.

NDH-Mediated Cyclic Electron Flow Around Photosystem I is Crucial for C4 Photosynthesis.

C4 photosynthesis exhibits efficient CO2 assimilation in ambient air by concentrating CO2 around ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco) through a metabolic pathway called the C4 cycle. It has been suggested that cyclic electron flow (CEF) around PSI mediated by chloroplast NADH dehydrogenase-like complex (NDH), an alternative pathway of photosynthetic electron transport (PET), plays a crucial role in C4 photosynthesis, although the contribution of NDH-mediated CEF is small in C3 photosynthesis. Here, we generated NDH-suppressed transformants of a C4 plant, Flaveria bidentis, and showed that the NDH-suppressed plants grow poorly, especially under low-light conditions. CO2 assimilation rates were consistently decreased in the NDH-suppressed plants under low and medium light intensities. Measurements of non-photochemical quenching (NPQ) of Chl fluorescence, the oxidation state of the reaction center of PSI (P700) and the electrochromic shift (ECS) of pigment absorbance indicated that proton translocation across the thylakoid membrane is impaired in the NDH-suppressed plants. Since proton translocation across the thylakoid membrane induces ATP production, these results suggest that NDH-mediated CEF plays a role in the supply of ATP which is required for C4 photosynthesis. Such a role is more crucial when the light that is available for photosynthesis is limited and the energy production by PET becomes rate-determining for C4 photosynthesis. Our results demonstrate that the physiological contribution of NDH-mediated CEF is greater in C4 photosynthesis than in C3 photosynthesis, suggesting that the mechanism of PET in C4 photosynthesis has changed from that in C3 photosynthesis accompanying the changes in the mechanism of CO2 assimilation.

Allocation of Absorbed Light Energy in Photosystem II in NPQ Mutants of Arabidopsis.

To analyze changes of energy allocation in PSII at non-steady state photosynthesis, the induction and relaxation of non-photochemical quenching of Chl fluorescence was re-evaluated with the use of Arabidopsis thaliana mutants in which the ability to induce non-photochemical quenching was either enhanced (npq2) or suppressed (npq1 and npq4). When dark-treated leaves of the wild type (WT) were illuminated, very high Φf,D, which represents the loss of excitation energy via non-regulated dissipation, at the beginning of light illumination was gradually decreased to the steady-state level. In contrast, ΦNPQ, representing regulated energy dissipation in PSII, was relatively constant after a significant change in the first 10 min. In npq1 and npq4 mutants, lower ΦNPQ resulted in much higher Φf,D than in the WT. Comparison of npq1 and npq4 mutants showed a kinetic difference of two types of non-photochemical quenching. Because non-photochemical quenching calculated as NPQ = Fm - Fm')/Fm' was determined by the interplay between ΦNPQ and Φf,D, NPQ and ΦNPQ, both of which represent regulatory heat dissipation, were not linearly correlated. We showed that the kinetics of NPQ formation in the light and relaxation in the dark were affected by drastic changes in Φf,D We discuss the nature of a high level of Φf,D at the dark-light transition. We also point out an unavoidable problem of applying the energy allocation model when the Fv/Fm value changes during a photoinhibiotry illumination.

Accumulation of the components of cyclic electron flow around photosystem I in C4 plants, with respect to the requirements for ATP.

By concentrating CO2, C4 photosynthesis can suppress photorespiration and achieve high photosynthetic efficiency, especially under conditions of high light, high temperature, and drought. To concentrate CO2, extra ATP is required, which would also require a change in photosynthetic electron transport in C4 photosynthesis from that in C3 photosynthesis. Several analyses have shown that the accumulation of the components of cyclic electron flow (CEF) around photosystem I, which generates the proton gradient across thylakoid membranes (ΔpH) and functions in ATP production without producing NADPH, is increased in various NAD-malic enzyme and NADP-malic enzyme C4 plants, suggesting that CEF may be enhanced to satisfy the increased need for ATP in C4 photosynthesis. However, in C4 plants, the accumulation patterns of the components of two partially redundant pathways of CEF, NAD(P)H dehydrogenase-like complex and PROTON GRADIENT REGULATION5-PGR5-like1 complex, are not identical, suggesting that these pathways may play different roles in C4 photosynthesis. Accompanying the increase in the amount of NDH, the expression of some genes which encode proteins involved in the assembly of NDH is also increased at the mRNA level in various C4 plants, suggesting that this increase is needed to increase the accumulation of NDH. To better understand the relation between CEF and C4 photosynthesis, a reverse genetic approach to generate C4 transformants with respect to CEF will be necessary.

Growth Properties and Biomass Production in the Hybrid C4 Crop Sorghum bicolor.

Hybrid vigor (heterosis) has been used as a breeding technique for crop improvement to achieve enhanced biomass production, but the physiological mechanisms underlying heterosis remain poorly understood. In this study, to find a clue to the enhancement of biomass production by heterosis, we systemically evaluated the effect of heterosis on the growth rate and photosynthetic efficiency in sorghum hybrid [Sorghum bicolor (L.) Moench cv. Tentaka] and its parental lines (restorer line and maintainer line). The final biomass of Tentaka was 10-14 times greater than that of the parental lines grown in an experimental field, but the relative growth rate during the vegetative growth stage did not differ. Tentaka exhibited a relatively enlarged leaf area with lower leaf nitrogen content per leaf area (Narea). When the plants were grown hydroponically at different N levels, daily CO2 assimilation per leaf area (A) increased with Narea, and the ratio of A to Narea (N-use efficiency) was higher in the plants grown at low N levels but not different between Tentaka and the parental lines. The relationships between the CO2 assimilation rate, the amounts of photosynthetic enzymes, including ribulose-1,5-bisphosphate carboxylase/oxygenase, phosphoenolpyruvate carboxylase and pyruvate phosphate dikinase, Chl and Narea did not differ between Tentaka and the parental lines. Thus, Tentaka tended to exhibit enlargement of leaf area with lower N content, leading to a higher N-use efficiency for CO2 assimilation, but the photosynthetic properties did not differ. The greater biomass in Tentaka was mainly due to the prolonged vegetative growth period.

Physiological functions of PsbS-dependent and PsbS-independent NPQ under naturally fluctuating light conditions.

The PsbS protein plays an important role in dissipating excess light energy as heat in photosystem II (PSII). However, the physiological importance of PsbS under naturally fluctuating light has not been quantitatively estimated. Here we investigated energy allocation in PSII in PsbS-suppressed rice transformants (ΔpsbS) under both naturally fluctuating and constant light conditions. Under constant light, PsbS was essential for inducing the rapid formation of light-inducible thermal dissipation (Φ(NPQ)), which consequently suppressed the rapid formation of basal intrinsic decay (Φ(f,D)), while the quantum yield of electron transport (Φ(II)) did not change. In the steady state phase, the difference between the wild type (WT) and ΔpsbS was minimized. Under regularly fluctuating light, the reduced PsbS resulted in higher Φ(II) upon the transition from high light to low light and in lower Φ(II) upon the transition from low light to high light, indicating that Φ(II) was, to some extent, controlled by PsbS. Under naturally fluctuating light in a greenhouse, rapid changes in Φ(II) were compensated by Φ(NPQ) in the WT, but by Φ(f,D) in ΔpsbS. As a consequence, a significantly lower ΣNPQ integrated Φ(NPQ) over a whole day) and higher Σf,D were found in ΔpsbS. Furthermore, thermal dissipation associated with photoinhibtion was enhanced in ΔpsbS. These results suggest that PsbS plays an important role in photoprotective process at the induction phase of photosynthesis as well as under field conditions. The physiological relevance of PsbS as a photoprotection mechanism and the identities of Φ(NPQ) and Φ(f,D) are discussed.

Light energy allocation at PSII under field light conditions: how much energy is lost in NPQ-associated dissipation?

In the field, plants are exposed to fluctuating light, where photosynthesis occurs under conditions far from a steady state. Excess energy dissipation associated with energy quenching of chlorophyll fluorescence (qE) functions as an efficient photo-protection mechanism in photosystem II. PsbS is an important regulator of qE, especially for the induction phase of qE. Beside the regulatory energy dissipation, some part of energy is lost through relaxation of excited chlorophyll molecules. To date, several models to quantify energy loss through these dissipative pathways in PSII have been proposed. In this short review, we compare and evaluate these models for PSII energy allocation when they are applied to non-steady state photosynthesis. As a case study, an investigation on energy allocation to qE-associated dissipation at PSII under non-steady state photosynthesis using PsbS-deficient rice transformants is introduced. Diurnal and seasonal changes in PSII energy allocation in rice under natural light are also presented. Future perspective of studies on PSII energy allocation is discussed.

PGR5 and NDH pathways in photosynthetic cyclic electron transfer respond differently to sublethal treatment with photosystem-interfering herbicides.

Effects of sublethal levels of the photosystem-interfering herbicides atrazine (Atr) and methyl viologen (MV) on photosynthetic electron transport were investigated in Arabidopsis thaliana mutants with defects in cyclic electron transfer (CET) activity. Analysis based on chlorophyll fluorescence parameters showed that pgr5 mutant (a defect in the PGR5 pathway) was more sensitive to both Atr and MV than wild type (Wt) and pnsB3 mutant (a defect in the NDH pathway). Real-time PCR (polymerase chain reaction) analysis of transcripts indicated that Wt plants showed marked increases in transcripts in the PRG5 and NDH pathways under treatment with either Atr or MV. In contrast, Atr increased the gene transcripts in CET, but MV decreased them in pnsB3 mutant plants. Atr did not increase the transcripts, while MV down-regulated them in pgr5 mutant. Immunoblot analysis partially supported the changes in the transcripts; that is, the protein levels of PGRL1 and PGR5 were increased in pnsB3 mutant, while no protein level was increased in pgr5 mutant after the herbicide treatment. The present results suggest that cyclic electron transport is very sensitive to photosystem-interference induced by chemicals and that the PGR5 pathway is very critical for regulation. Thus, pgr5 mutants may be useful plants for monitoring photosystem-interfering herbicides.

Risk factors for loss to follow-up during active surveillance of patients with Stage I seminoma.

OBJECTIVE: To elucidate the patterns and risk factors for loss to follow-up during active surveillance for Stage I seminoma. METHODS: A total of 425 cases with Stage I seminoma underwent radical orchiectomy from 1985 to 2006 at 25 Japanese institutions, including 22 community hospitals and 3 university hospitals. The post-orchiectomy management selected was active surveillance for 186 patients, adjuvant radiotherapy for 182 patients and chemotherapy for 57 patients. The Kaplan-Meier method was used to estimate the recurrence-free survival and loss to follow-up rate. The risk factors for loss to follow-up were examined using Cox's proportional hazards model with multiple variables. RESULTS: The 2-, 5- and 10-year loss to follow-up rates in the active surveillance group were 14.2, 37.8 and 71.3%, respectively, which were not significantly different in comparison with those in the active surveillance and adjuvant radiotherapy or chemotherapy groups. With regard to the active surveillance group, the multivariate analysis demonstrated that patients younger than 36 years at diagnosis, patients diagnosed since 2000 and patients treated at hospitals that enrolled more than 10 cases had a significant risk for loss to follow-up. No significant correlation between the loss to follow-up rate and pathological risk factors such as tumor size (≤4 versus >4 cm) and rete testis invasion (presence versus absence) was shown. CONCLUSIONS: The loss to follow-up rates beyond 5 years were unsatisfactorily high during active surveillance. Further approaches to improve the quality of active surveillance are needed, especially for high-risk patients such as those of younger age.

Diurnal and developmental changes in energy allocation of absorbed light at PSII in field-grown rice.

The allocation of absorbed light energy in PSII to electron transport and heat dissipation processes in rice grown under waterlogged conditions was estimated with the lake model of energy transfer. With regard to diurnal changes in energy allocation, the peak of the energy flux to electron transport, J(PSII), occurred in the morning and the peak of the energy flux to heat dissipation associated with non-photochemical quenching of Chl fluorescence, J(NPQ), occurred in the afternoon. With regard to seasonal changes in energy allocation, J(PSII) in the rapidly growing phase was greater than that in the ripening phase, even though the leaves of rice receive less light in the growing phase than in the ripening period in Japan. This seasonal decrease in J(PSII) was accompanied by an increase in J(NPQ). One of the reasons for the lower J(PSII) in the ripening phase might be a more sever afternoon suppression of J(PSII). To estimate energy dissipation due to photoinhibition of PSII, J(NPQ) was divided into J(fast), which is associated with fast-recovering NPQ mainly due to qE, and J(slow), which is mainly due to photoinhibition. The integrated daily energy loss by photoinhibiton was calculated to be about 3-8% of light energy absorption in PSII. Strategies for the utilization of light energy adopted by rice are discussed. For example, very efficient photosynthesis under non-saturating light in the rapidly growing phase is proposed.

Oncological outcomes of metastatic testicular cancers under centralized management through regional medical network.

OBJECTIVE: To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network. MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin. RESULTS: Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was >0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate- and poor-prognosis groups were 97, 93 and 84%, respectively. CONCLUSIONS: Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.

Cyclic electron transport around photosystem I and its relationship to non-photochemical quenching in the unicellular green alga Dunaliella salina under nitrogen deficiency.

Electron transport in photosystem II (PSII) and photosystem I (PSI) was estimated in terms of chlorophyll fluorescence and changes in P700 redox, respectively, in the unicellular green alga Dunaliella salina in the presence or absence of a nitrogen source in the culture medium. In a nitrogen-containing medium, the quantum yield of PSII (Φ(II)) and that in PSI (Φ(I)) were at the same level in low light, but cyclic electron transport around photosystem I (CET-PSI) was induced under high light as estimated from an increase in Φ(I)/Φ(II). High light might further enhance the rate of electron transport in PSI by inducing the state 2 transition, in which the distribution of light energy is shifted to PSI at the expense of PSII. Nitrogen deficiency resulted in a decrease in Φ(II) and an increase in Φ(I). As a consequence, the rate of CET-PSI was expected to increase. The high CET-PSI under N deficiency was probably associated with a high level of energy quenching (qE) formation in PSII.

[Renal tuberculosis in an isthmus of a horseshoe kidney after bacillus Calmette-Guerin therapy for bladder cancer].

A 63-year-old man with a horse shoe kidney was evaluated after an episode of asymptomatic gross hematuria. Cystoscopy revealed bladder tumor near the right ureteral orifice, and transurethral resection demonstrated high grade pT1 urothelial carcinoma. The patient was started on intravesical BCG instillation therapy at a dose of 81 mg weekly for 8 weeks without fever. 6 months later after the final BCG treatment, CT examination demonstrated a renal hypovascular tumor in an isthmus of a horseshoe kidney. We couldn't deny malignant tumor and tumorectomy was performed. Histological examination revealed epithelioid cell granulomas and no organisms were identified by Ziehl-Neelsen or Grocott-Gomori stains for acid-fast bacilli and fungi. We reported a rare case of renal tuberculosis in an isthmus of a horseshoe kidney after BCG therapy for bladder cancer that was considered due to vesicoureteral reflux.