Effectiveness of soft coagulation in robot-assisted partial nephrectomy in preventing pseudoaneurysms and its influence on renal function based on propensity score-matched analysis.

Background: Renal artery pseudoaneurysm (RAP) is one of the most stressful and life-threatening complications of partial nephrectomy, the standard treatment for small renal cell carcinoma. The use of a monopolar soft coagulation system for hemostasis during robot-assisted partial nephrectomy (RAPN) is expected to prevent post-surgical RAP development. In this study, we aimed to investigate how the use of a soft coagulation system in RAPN reduces postoperative pseudoaneurysms and changes renal function over time. Methods: The incidence of pseudoaneurysms and postoperative renal function were compared in 208 partial nephrectomies performed between May 2016 and March 2023 at a single institution, with propensity score matching to balance patient backgrounds. Outcomes were analyzed using multivariate logistic or linear regression analyses. Results: In total, 80 matched pairs were analyzed. One (1.2%) and eighteen (22.5%) pseudoaneurysms were found in the soft coagulation users and non-users, respectively (P<0.001). Compared to the non-user group, postoperative estimated glomerular filtration rates (eGFRs) in the user group were 89% vs. 96% (P<0.001), 87% vs. 93% (P=0.009), and 88% vs. 92% (P=0.15) at 1, 3, and 12 months, respectively. Subsequent multivariate analyses showed a lower incidence of pseudoaneurysms in the user group with an odds ratio of 0.05 [95% confidence interval (CI): 0.01 to 0.44; P=0.007], and no significant difference in the rate of change in renal function at 12 months postoperatively (-1.1%, 95% CI: -5.5% to 3.3%; P=0.61). Conclusions: The use of a soft coagulation system reduces pseudoaneurysm occurrence after partial nephrectomy. Although renal function decreased in the short-term for the use group, no long-term differences were observed.

Early recovery of urinary continence after robot-assisted radical prostatectomy is associated with membranous urethra and neurovascular bundle preservation.

OBJECTIVES: We investigated the correlation between surgical outcomes and postoperative urinary continence recovery in robot-assisted radical prostatectomy (RARP). METHODS: Patients who underwent RARP in our institution (n = 195) were included in this study. Preserved urethral length (PUL) was assessed during the procedure. Other outcomes of the surgical procedure were collected from operative records. Kaplan-Meier analysis with log-rank test was used to compare urinary continence recovery rate with the PUL, sparing of the neurovascular bundle (NVB), and other surgical procedures. Univariate and multivariate analyses were performed using Cox proportional hazards model, and p-values of <0.05 were considered significant. RESULTS: Patients with a PUL ≥26 mm had 10.0%, 24.7%, 36.6%, and 89.0% continence recovery rates at 30, 60, 90, and 365 days after surgery, respectively, while patients with a PUL <26 mm had 0%, 17.8%, 26.1%, and 80.9% recovery rates, respectively. Kaplan-Meier curves showed significantly better postoperative urinary continence recovery at 30 days after RARP in patients with a PUL ≥26 mm than those with a PUL <26 mm (p = 0.0028) and in patients with NVB preservation than those with no NVB preservation (p = 0.014). Urinary continence recovery within 30, 60, and 90 days after surgery was 90.6% for patients with a PUL of ≥26 mm and NVB preservation, while only 82.3% for patients with a PUL of <26 mm or no NVB preservation. CONCLUSION: Our results suggest that a PUL ≥26 mm and NVB preservation after RARP correlate with a significantly higher postoperative rate of recovery of urinary continence.

Surgical resection of retinoblastoma-associated bladder leiomyosarcoma during pregnancy: a case report.

BACKGROUND: Management of a bladder tumor during pregnancy is an uncommon clinical situation. Leiomyosarcoma of the urinary bladder is a rare histological type of bladder tumor and a rare secondary cancer in survivors of retinoblastoma (RB). However, there has been no report of RB-associated bladder leiomyosarcoma during pregnancy. CASE PRESENTATION: A 37-year-old pregnant woman with a medical history of RB in infancy presented with gross hematuria at the 17th week of gestation. Cystoscopy revealed a 40-mm papillary tumor on the left lateral wall of the urinary bladder. At the 25th week of gestation, she underwent transurethral resection of the bladder tumor, and the pathological diagnosis was bladder leiomyosarcoma with loss of RB1 expression. At the 31st week of gestation, she gave birth by caesarean section. One month after the delivery (to allow for involution of the uterus), she underwent partial cystectomy, and the specimen contained no residual leiomyosarcoma tissue. CONCLUSIONS: We have reported a case of RB-associated bladder leiomyosarcoma that was successfully treated during and after pregnancy.

Left-right reversal of the testes within the scrotum: An extremely rare variant of testicular ectopia.

Introduction: Testicular ectopia refers to abnormal positioning of testis, which includes a wide variety of variants. An ectopic testis is located off the normal path of male gonadal descent, unlike conventional undescended testis. Case presentation: A 37-year-old man presented with the complaint of a palpable lesion in the scrotum. Magnetic resonance imaging of the scrotum revealed bilateral testes on the respective opposite sides of the scrotum with bilateral spermatic cords crossing under the base of the penis. Accordingly, he was diagnosed as "left-right reversal of the testes within the scrotum." In retrospect, the "palpable" lesion was thought to be the spermatic cords crossing above the testes. Semen analysis identified deteriorated sperm motility, suggesting possible male infertility. Conclusion: This case of left-right reversal of the testes within the scrotum is probably a new variant of testicular ectopia that has never been reported.

[CASE OF LOW-RISK PROSTATE CANCER WITH LYMPH NODE METASTASIS IN THE ANTERIOR PROSTATIC FAT TISSUE].

A 78-year-old man with a prostate-specific antigen level of 10 ng/mL was referred to our hospital. Magnetic resonance imaging revealed a Prostate Imaging-Reporting and Data System category of 5 in the apex transition zone. Transrectal and transperineal prostate needle biopsies were performed at a total of 20 sites. A well-differentiated adenocarcinoma with a Gleason score of 3+3 was detected on the right peripheral zone of the biopsied specimen. There were no apparent metastases, and robot-assisted radical prostatectomy was performed (Lesion 1: 30 mm lesion with a Gleason score of 4+5, EPE1, RM1, ly0, v0, pn1, sv0 in the bilateral transitional zones; Lesion 2: 4 mm lesion with a Gleason score of 3+3, EPE0, RM0, ly0, v0, pn0, sv0 in the left peripheral zone). Lymph node metastasis was found in the separately submitted anterior prostatic fat tissue. Removal of the anterior prostatic fat tissue is a simple procedure and is considered useful for evaluating the stump, and in this hospital, the tissue is routinely submitted for pathological diagnosis. It is extremely unlikely that lymph nodes will be found in the anterior prostatic fat tissue, and it is even less likely that any lymph node in the tissue will contain lymph node metastases. We therefore report a case of incidental discovery of lymph node metastasis in the anterior prostatic fat tissue at our hospital.

[A CASE REPORT OF Xp11.2 TRANSLOCATION RENAL CELL CARTINOMA SUSPECTED RENAL PELVIC CARCINOMA].

The patient was a 33-year-old female who visited the Department of Gastroenterology of this hospital after experiencing lower abdominal pain and nausea. The patient was referred to this department after suspicions of right kidney hemorrhage revealed by non-contrast computed tomography (CT). We also identified hematuria macroscopically, and contrast-enhanced CT scans revealed uneven deep staining in the upper right kidney during the early phase. Furthermore, by the late phase, we identified a 29-mm solid tumor with no staining. There was no clear pseudomembrane and no clear boundary with the kidney parenchyma. Additionally, there was no metastasis to the lymph nodes and other organs. Based on the above findings, we suspected renal parenchymal infiltration of right renal cell carcinoma (RCC) or right renal pelvic carcinoma. Since the patient was young, we considered the risk of the residual tumor and performed total nephroureterectomy and lymph node dissection with an enlarged view. The inside of the resected tumor specimen showed significant necrosis and hematoma spread, which had infiltrated the renal pelvis. Based on the characteristic histological findings and genetic results obtained using the fluorescence in situ hybridization (FISH) approach, we diagnosed the patient with Xp11.2 translocation RCC. No additional treatments were provided after surgery, and even now the patient is being followed-up through outpatient visits, but there has been no recurrence or new metastasis. There have only been a few reported cases of Xp11.2 translocation RCC; therefore, in many cases, treatments and follow-up duration according to the disease stage and disease prognosis have not been determined. In this study, we report a case of Xp11.2 translocation RCC experienced at our hospital, with additional literature considerations.

[A CASE REPORT OF PRIMARY MUCOSA ASSOCIATED LYMPHOID TISSUE LYMPHOMA OF THE PROSTATE].

The patient was a 53-year-old man who was referred to the department of urology of our hospital after screening results indicated elevated prostate-specific antigen (PSA) levels. The PSA level was 5.33 ng/ml, and rectal examination revealed that the prostate was elastic and hard with mild prostatic hyperplasia. Because magnetic resonance imaging revealed abnormal signals in the prostatic transition area, prostate cancer was suspected and the patient underwent transrectal prostate needle biopsy. The pathological diagnosis was adenocarcinoma (Gleason score 5+5 = 10). After using thoracic, abdominal, and pelvic computed tomography (CT) and bone scintigraphy to confirm that metastasis had not occurred, robot-assisted radical prostatectomy (RARP) was performed. Prostate cancer was not detected during pathologic diagnosis of the surgical specimen, and on the basis of the results of re-examination with immunostaining, a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma was made. In addition, an upper and lower endoscopy examination, positron emission tomography (PET) -CT, and bone marrow biopsy confirmed that generalized tumor lesions and lymph node swelling were not present, and the patient was diagnosed with primary MALT lymphoma of the prostate. Currently, 12 months since surgery, the patient continues to undergo follow-up as an outpatient and no recurrence has been observed. There have been only a few reports of primary MALT lymphoma of the prostate, in English or Japanese, and herein, we present our experience with a patient for whom a definitive diagnosis was difficult, along with a review of the literature.