Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus.

The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16-40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n = 220, 67.9%), S. saprophyticus (n = 36, 11.1%), and K. pneumoniae (n = 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant and extended-spectrum ß-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan.

A pretreatment nomogram predicting recurrence- and progression-free survival for nonmuscle invasive bladder cancer in Japanese patients.

PURPOSE: Our aim was to provide nomograms that allow urologists to easily calculate a nonmuscle invasive bladder cancer patient's risk of recurrence and progression. MATERIALS AND METHODS: We retrospectively analyzed 800 nonmuscle invasive bladder cancer patients newly diagnosed between 1991 and 2001 from the Gifu urothelial cancer registry program. We developed the nomogram using the original 500 patients and validated it using the remaining 300 patients. The prognostic factors of recurrence and progression were identified by multivariate analysis in 500 patients. RESULTS: In the multivariate analysis, tumor number, shape, grade, and intravesical instillation were associated with recurrence-free survival. Tumor shape and grade were associated with progression-free survival. Six factors for recurrence and three factors for progression were used to make the nomogram. Using the original 500 patients who were modeled for the nomogram, the areas under the receiver operating characteristic curves (AUCs) were calculated to be 0.61 for recurrence and 0.71 for progression. To validate nomogram performance, we applied an additional 300 patients to the nomograms. The AUCs were 0.57 for recurrence and 0.67 for progression. CONCLUSIONS: The nomograms that have been developed can be used to predict the probability of recurrence and progression of nonmuscle invasive bladder cancer.

[Clinical evaluation of our first 50 laparoscopic adrenalectomies].

We performed 50 laparoscopic adrenalectomies during the period from 1998 through 2003. We report our experience and the outcomes of this procedure, which has become a standard surgery for adrenal tumors. In most cases, the transperitoneal approach was used. In 48 cases, laparoscopic adrenalectomy was performed successfully. However, in two cases, the operation was converted to an open procedure because of bleeding. As our experience with laparoscopic adrenalectomy increased, operation time decreased. Laparoscopic adrenalectomy should be used more widely in the future.

[Renal cell carcinoma metastatic to the ovary].

A 45-year-old woman underwent left radical nephrectomy in April 2002. Pathological diagnosis was a renal cell carcinoma, clear cell subtype, pT3a, v(-), NO. One year later, abdominal ultrasound revealed a left ovarian tumor which had an enlargement tendency. A laparoscopic bilateral salpingooophorectomy was performed. Immunohistochemical analysis confirmed the diagnosis of metastatic ovarian renal cell carcinoma. This is the 20th case in the literature.

[Analysis of factors affecting reccurence and prognosis of superficial bladder cancer--study of 800 patients--].

PURPOSE: The purpose of the present paper was to evaluate clinical factors responsible for recurrence and prognosis of superficial bladder cancer. SUBJECTS AND METHOD: We reviewed date from 800 patients who were initially treated between 1991 and 2000. Recurrent and prognostic factors were examined with univariate and multivariate analysis. Kaplan-Meier Method and log rank test were used for comparing the significance of recurrence free curve and survival curve. Cox's proportional hazard model was used for univariate and multivariate analysis. A 5% level of significance was used for all statistical testing. RESULTS: Of 800 cases 282 patients (35.2%) had recurrence and 27 patients (3.4%) were died in during follow up. Progression was defined as the development of muscle invasion or metastasis, progression were noted on 10 metastasis cases and 16 muscle invasion cases. Univariate analysis revealed that tumor numbers, shape, size, stage and grade were significant recurrent and prognostic factors. Multivariate analysis revealed that tumor numbers (P<0.0001), shape (P = 0.066) and size (P = 0.0178) were significant recurrent factors, and tumor shape (P = 0.0422), size (P = 0.0140) and stage (P = 0.0330) were significant prognostic factors. Of 272 recurrent cases, univariate analysis revealed that tumor shape, stage and grade were significant prognostic factors, and multivariate analysis revealed that tumor shape (P = 0.0164) and stage (P = 0.0017) were significant prognostic factors. CONCLUSION: We conclude that tumor numbers, shape and size are predictive value in recurrence and tumor shape, size and stage are predictive value in prognosis, and when recurrent case, tumor shape and stage are predictive value.

[A case report of sarcomatoid carcinoma of the bladder with metastasis to small intestine].

A 67-year-old male presented to our clinic with gross hematuria. Cystoscopic examination revealed a broad-based tumor of 2.5 cm in diameter on the lateral side of the right ureteral orifice. Under the clinical diagnosis of TCC G2 > G3, T3bNOM0, radical cystectomy with orthotopic bladder substitution was performed. Pathological diagnosis was TCC G3 with sarcomatoid carcinoma, pT2pR0pL1 pVlpN0. Adjuvant chemotherapy was not performed because of his transient poor conditions. Lung metastasis was observed 6 months postoperatively. Despite of M-VAC therapy and radiation therapy, additional metastases to brain and liver were observed. One month later, partial ileectomy specimen for occlusive ileum revealed the same histologic findings, TCC G3 with sarcomatoid carcinoma. He died 9 months postoperatively. To our knowledge, this is the first case of sarcomatoid carcinoma of the bladder with metastasis to small intestine, although 6 cases of transitional cell carcinoma of the bladder with metastasis to small intestine has been reported in Japan.

[Comparison of laparoscopic versus open surgery for adrenal tumor].

We performed 25 laparoscopic adrenalectomies for adrenal tumor between January 1998 and December 2000. In 23 cases, adrenal tumors were successfully removed laparoscopically, but in 2, the laparoscopic procedure was converted to open surgery because of liver injury and endoscopically uncontrolled bleeding at the renal hilum. Postoperative complications, involving retroperitoneal hematoma, hypercapnia, and wound infections, could be managed without surgical treatment. We compared laparoscopic adrenalectomy with conventional open surgery, which had been performed for 24 adrenal tumors in our clinic. The mean operative time for the laparoscopic adrenalectomy (228.8 +/- 65.5 minutes) was significantly longer than those for the open surgery (156.0 +/- 43.8 minutes). The estimated blood loss (82.3 +/- 125.4 g) was significantly less than those for the open surgery (210.8 +/- 167.7 g), and the laparoscopic adrenalectomy had significant advantages in lessening postoperative analgesic requirements, shortening postoperative recovery period, and preserving good physical appearance. Therefore, we conclude that the laparoscopic adrenalectomy is a less invasive surgery, and is acceptable as a standard operation for adrenal tumors.

[Voiding function and sexual activity in patients following Hautmann neobladder construction].

PURPOSE: We retrospectively evaluated the outcome of Hautmann neobladder reconstruction in terms of complications, lower urinary tract symptoms, and sexual function in a large group of patients who underwent radical cystectomy. METHODS: We reviewed the medical records of 118 patients (105 men and 13 women) who underwent radical cystectomy and Hautmann neobladder construction at the Gifu University Hospital or one of its affiliate hospitals between Jan 1993 and Dec 1999. The 118 patients were asked to complete a questionnaire regarding lower urinary tract symptoms and sexual activity, and the data was compiled. RESULTS: The mean follow-up period was 50.4 months (range, 6.8-88.2). Early complications comprised wound infection (in 17.8% of patients) and ileus (in 10.1% of patients). Late complications comprised ileus, pyelonephritis, stone, and stricture of the pouch-urethral anastomosis, each of which occurred in 3.4% of patients. Eighty-one (73 men and 8 women, 72.9%) of 90 surviving patients replied to the questionnaire. Seventy-seven (95.1%) of these patients reported spontaneous micturition, whereas 4 (4.9%) patients required intermittent self-catheterization. The mean total I-PSS was 11.6 points. Twenty-five percent of patients experienced interrupted voiding almost always; 38% of patients did not experience this at all. Approximately 26% of patients experienced weak urinary streams; 36% did not. Daytime continence was achieved in 97.3% of patients; nighttime incontinence was present in 61.3%. Preoperatively, 79.7% of the men were capable of sexual intercourse. Postoperatively, 63.6% of men who underwent radical cystectomy with the nerve-sparing procedure were capable of sexual intercourse, whereas only 14.8% of men who underwent radical cystectomy without the nerve-sparing procedure were. CONCLUSIONS: Morbidity rates were acceptable and functional outcome was excellent in this rather large group of patients who underwent Hautmann neobladder construction. Some problems have not been fully overcome, however, i.e., nocturnal incontinence and sexual dysfunction.

Primitive neuroectodermal tumor of the kidney confirmed by fluorescence in situ hybridization.

We report a rare case of primitive neuroectodermal tumor of the kidney. The diagnosis was confirmed by the immunohistochemical profile and fluorescence in situ hybridization in formalin-fixed, paraffin-embedded tissues. The patient received intensive chemoradiotherapy after radical surgery and remains alive without recurrence 1 year after initial presentation.

Endourological re-establishment of a disrupted infundibulum after renal laceration.

We report a case of severe urinary extravasation after renal contusion and its successful management by endoscopic creation of a neoinfundibulum. When the stenotic infundibulum cannot be traversed with a guide wire, creation of a new infundibulum will offer a secure alternative for accessing the collecting system.

Successful management of lower pole moiety ureteropelvic junction obstruction in a partially duplicated collecting system using retrograde endoureteropyelotomy with the Holmium:YAG laser.

A patient with lower pole moiety ureteropelvic junction obstruction in a partially duplicated collecting system was managed successfully by retrograde endoureteropyelotomy using a Holmium:YAG laser. To our knowledge, we report the first case of this entity managed successfully by retrograde endoureteropyelotomy without a percutaneous approach.