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OBJECTIVE: Real-world evidence regarding enfortumab vedotin for unresectable or metastatic urothelial carcinoma is scarce, particularly in Japan. We investigated real-world data focusing on patient background, previous treatments, response, survival and adverse events in patients receiving enfortumab vedotin. METHODS: A multicentre database was used to register 556 patients diagnosed with metastatic urothelial carcinoma from 2008 to 2023; 34 patients (6.1%) treated with enfortumab vedotin were included. Best radiographic objective responses were evaluated using the Response Evaluation Criteria in Solid Tumors (v1.1) during treatments. Overall survival and progression-free survival were estimated (Kaplan-Meier method). Toxicities were reported according to the Common Terminology Criteria for Adverse Events, version 5.0. The relative dose intensity, which could impact oncological outcomes, was calculated. RESULTS: The median number of enfortumab vedotin therapy cycles was 5. The best objective response to enfortumab vedotin was partial response, stable disease and progressive disease in 19 (56%), 5 (15%) and 10 (29%) patients, respectively. The median overall survival and progression-free survival after the first enfortumab vedotin dose were 16 and 9 months, respectively. No significant relationship was observed between survival outcomes after enfortumab vedotin initiation and the enfortumab vedotin relative dose intensity. The median overall survival from first-line platinum-based chemotherapy initiation was 42 months. Twenty-six (76%) patients experienced any grade of enfortumab vedotin-related toxicities; eight (24%) experienced Grades 3-4 toxicities, the most common being skin toxicity (any grade, 47%; Grades 3-4, 12%). CONCLUSIONS: Here, we report real-world evidence for enfortumab vedotin therapy in Japan. Tumour responses and safety profiles were comparable with those of clinical trials on this novel treatment.
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Anticuerpos Monoclonales , Carcinoma de Células Transicionales , Neoplasias de la Vejiga Urinaria , Humanos , Carcinoma de Células Transicionales/tratamiento farmacológico , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Japón , Neoplasias de la Vejiga Urinaria/patología , Platino (Metal)/uso terapéuticoRESUMEN
OBJECTIVE: To develop the first Japanese real-world evidence of switch-maintenance avelumab in advanced, unresectable or metastatic urothelial carcinoma (aUC). METHODS: A multicenter-derived database registered 505 patients diagnosed with aUC between 2008 and 2021. Of these, 204 patients (40%) were selected and stratified according to the type of therapy used: maintenance avelumab group (27 [5.3%]), second-line (2 L) pembrolizumab group (103 [20%]) and 2 L cytotoxic chemotherapy group (74 [15%]). The progression-free survival and overall survival from the initiation of following therapy were compared. Tumor response was evaluated based on the Response Evaluation Criteria in Solid Tumors guideline v1.1 during the treatment period. A detailed analysis was performed in the maintenance avelumab group to investigate possible factors associated with response to avelumab therapy. RESULTS: The maintenance avelumab group had a longer overall survival, not progression-free survival, compared with the other two treatment groups. The median treatment-free interval between the last dose of first-line (1 L) chemotherapy and the initiation of avelumab therapy was 6 weeks (range, 3-22). Disease control rate of maintenance avelumab therapy in patients with a treatment-free interval of ≤6 weeks was higher than that in patients with a treatment-free interval of >6 weeks (77 vs 40%, P = 0.029). The patients showing objective response to 1 L chemotherapy were less likely to experience tumor relapse (4 of 19) after the initiation of avelumab therapy compared with those showing stable disease (7 of 8). CONCLUSIONS: Objective response to 1 L chemotherapy and early induction of maintenance avelumab therapy may be associated with increased benefit from maintenance avelumab therapy.
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Carcinoma de Células Transicionales , Neoplasias de la Vejiga Urinaria , Humanos , Carcinoma de Células Transicionales/tratamiento farmacológico , Pueblos del Este de Asia , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , InmunoterapiaRESUMEN
The purpose of this study is to provide certain data on clinical outcome of primary androgen deprivation therapy in men over 80 years of age with localized high-risk prostate cancer. This study included 54 Japanese super-elderly men with high-risk prostate cancer treated with primary androgen deprivation therapy between 2005 and 2015. The median overall survival was 9.1 years (95% confidence interval, 8.1-10.1) and no patient died from prostate cancer. Overall, 51.9% of patients experienced any grade of adverse events following androgen deprivation therapy. Associations between clinicopathological factors including comorbidity count at initial diagnosis and overall survival were investigated. On multivariate analysis, only comorbidity count at initial diagnosis [≥2 vs. ≤1; hazard ratio, 5.34 (95% confidence interval, 1.55-18.49); P = 0.003] was an independent risk factor for overall survival. Our findings suggest that comorbidity count at initial diagnosis is robustly prognostic for overall survival. For super-elderly men with localized high-risk prostate cancer, comorbidity count at initial diagnosis should be emphasized when deciding whether primary androgen deprivation therapy is necessary or not.
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Antagonistas de Andrógenos , Neoplasias de la Próstata , Anciano , Anciano de 80 o más Años , Antagonistas de Andrógenos/efectos adversos , Andrógenos/uso terapéutico , Humanos , Masculino , Pronóstico , Modelos de Riesgos Proporcionales , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/patologíaRESUMEN
BACKGROUND: First-line pembrolizumab is available for recurrent disease within 12 months after the receipt of platinum-based perioperative chemotherapy. However, the benefit of first-line pembrolizumab is unclear. This study evaluated the oncological outcome of patients treated with pembrolizumab compared with chemotherapy as first-line therapy for early relapsing disease after the receipt of platinum-based perioperative chemotherapy. METHODS: Data from a multicenter study included 454 patients diagnosed with unresectable or metastatic UC from November 2006 to July 2021. We identified patients with early and non-early relapsing disease. Oncological outcomes were evaluated using progression-free survival, overall survival, and survival with disease control. RESULTS: Fifty-three patients with early relapsing disease and 15 patients with non-early relapsing disease were identified. Of 53 patients with early relapsing disease, 26 (49.1%) were treated with pembrolizumab and 27 (50.9%) were treated with chemotherapy as first-line therapy. Fifteen patients with non-early relapsing disease were treated with chemotherapy. Early relapsing disease was associated with shorter progression-free survival and overall survival than non-early relapsing disease. Pembrolizumab was associated with longer progression-free survival and survival with disease control than chemotherapy in patients with early relapsing disease. There was no significant difference in overall survival between pembrolizumab and chemotherapy, but overall survival plateau with a long tail was observed in pembrolizumab. CONCLUSIONS: First-line pembrolizumab in earlier clinical settings for highly malignant tumors might improve the prognosis of patients with early relapsing disease after the receipt of platinum-based perioperative chemotherapy.
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Carcinoma de Células Transicionales , Neoplasias de la Vejiga Urinaria , Neoplasias Urológicas , Humanos , Carcinoma de Células Transicionales/patología , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/etiología , Estudios Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/etiología , Neoplasias Urológicas/tratamiento farmacológico , Neoplasias Urológicas/cirugíaRESUMEN
AIMS: There is accumulating evidence that excessive salt intake contributes to nocturnal polyuria. We aimed to investigate the relationship between salt intake, leg edema, and nocturnal urine volume (NUV) to assess the etiology of nocturnal polyuria. METHODS: A total of 56 men aged ≥60 years who were hospitalized for benign prostatic hyperplasia or with suspected prostatic cancer were enrolled. Urine frequency-volume charts of the patients were maintained, and they underwent bioelectrical impedance analysis twice daily (at 5:00 pm and 6:00 am) and examination of blood (brain natriuretic peptide levels) and urine (sodium and creatinine levels and osmotic pressure) samples once daily (at 6:00 am). Free-water clearance, solute clearance, and sodium clearance at night were measured, and daily salt intake was estimated. RESULTS: The data of 52 patients were analyzed. Daily salt intake positively correlated with leg edema at 5:00 pm, differences in leg extracellular fluid levels between 5:00 pm and 6:00 am, and NUV, but not with diurnal urine volume. Partial correlation coefficients showed that salt intake was a factor of the correlation between NUV and change in extracellular volume in the legs between 5:00 pm and 6:00 am. A multivariate logistic model showed that sleep duration and sodium clearance were independent predictive factors for nocturnal polyuria. CONCLUSIONS: Sodium intake correlates with diurnal leg edema and NUV in elderly men. These results provide evidence supporting sodium restriction as an effective treatment for nocturnal polyuria.
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Edema/etiología , Nocturia/etiología , Poliuria/etiología , Cloruro de Sodio Dietético/efectos adversos , Anciano , Humanos , Pierna , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
PURPOSE: We objectively investigated the relationship between sleep quality/efficiency and factors associated with micturition using at-home electroencephalogram assessment. MATERIALS AND METHODS: Participants were recruited from among those enrolled in the Fujiwara-kyo Study, a community based longitudinal evaluation that began in Nara Prefecture, Japan, in 2007. Included participants were men at least 65 years old who woke up in the middle of the night/early morning at least 3 times per week with the urge to void. We evaluated lower urinary tract symptoms using the I-PSS and subjective sleep quality using the Pittsburgh Sleep Quality Index. Uroflowmetry and 3-day frequency volume charting measurements were also obtained. Electroencephalogram recordings were obtained during sleep to evaluate objective sleep quality. RESULTS: Final analysis included data from 47 participants. I-PSS-quality of life score and slow wave sleep time were independent predictors of good subjective sleep quality as determined by Pittsburgh Sleep Quality Index scores. Nocturnal urinary volume was an independent predictor of greater sleep efficiency. Maximum flow rate was an independent predictor of longer slow wave sleep time. CONCLUSIONS: In elderly men with nocturia, sleep quality is associated with lower urinary tract function. Higher subjective sleep quality is associated with longer slow wave sleep time and less severe lower urinary tract symptoms. Higher objective sleep quality is further associated with a higher urinary flow rate and lower nocturnal urinary volume.
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Nocturia/complicaciones , Hiperplasia Prostática/complicaciones , Calidad de Vida , Trastornos del Sueño-Vigilia/diagnóstico por imagen , Trastornos del Sueño-Vigilia/etiología , Anciano , Anciano de 80 o más Años , Electroencefalografía/métodos , Estudios de Seguimiento , Evaluación Geriátrica/métodos , Humanos , Vida Independiente , Japón , Estudios Longitudinales , Síntomas del Sistema Urinario Inferior/complicaciones , Síntomas del Sistema Urinario Inferior/diagnóstico , Masculino , Análisis Multivariante , Nocturia/diagnóstico , Valor Predictivo de las Pruebas , Hiperplasia Prostática/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Trastornos del Sueño-Vigilia/fisiopatología , Factores de Tiempo , UrodinámicaRESUMEN
A total of 29 men 60 years and older (mean age 74 years) who complained at least once about nocturnal voiding and were diagnosed with nocturnal polyuria in the frequency volume chart (FVC) were enrolled in this study. Body water was measured by bioelectric impedance analysis just after lying down at 4 pm and after raising legs 30 minutes later. Nocturnal urine production was measured by FVC, and urine production per unit of time at first nocturnal voiding (urine volume at first nocturnal voiding/hours of undisturbed sleep (HUS) : UFN/HUS), urine production per unit of time during sleep (total nocturnal urine volume/hours of sleep : TNV/HS), etc was evaluated. Extra cellular water (ECW) of 0.19 l (4.0%) in legs was reduced caused by body position changing. There was a significant positive correlation between the amount of ECW in legs and UFN/HUS, TNV/HS (rï¼0. 57, pï¼0.001 ; rï¼0. 38, pï¼0.042, respectively). Moreover, UFN/HUS had a significant correlation with soft lean mass in legs, ECW in legs and daytime water intake. This study suggested that a change in leg fluids caused by a change in position results in increased urine production and decreased HUS.
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Agua Corporal/fisiología , Postura/fisiología , Anciano , Impedancia Eléctrica , Líquido Extracelular/fisiología , Humanos , Pierna , Masculino , Nocturia , Poliuria , Sueño/fisiologíaRESUMEN
A 66-year-old man was referred to our hospital because of right leg pain. Computed tomography (CT) revealed multiple osteolytic changes. His serum prostate-specific antigen (PSA) level was increased to 77.83 ng/ml at the time of hospitalization. A prostate biopsy was performed, and histological examination results indicated poorly differentiated adenocarcinoma. Under the diagnosis of multiple bone metastasis of prostate cancer, androgen deprivation therapy was started. However, 1 month later, the patient was confused and lost appetite. Brain CT image demonstrated brain metastasis, and magnetic resonance image showed hydrocephalus. Although the patient underwent ventricular drainage because of a depressed level of consciousness, he died of primary disease complicated by pneumonia 3 months after the first visit. Perioperative cerebrospinal fluid cytological examination revealed adenocarcinoma cells. Therefore, a diagnosis of carcinomatous meningitis caused by prostate cancer metastasis was made.
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Adenocarcinoma/patología , Neoplasias Óseas/secundario , Carcinomatosis Meníngea/diagnóstico , Carcinomatosis Meníngea/etiología , Neoplasias de la Próstata/patología , Anciano , Neoplasias Encefálicas/secundario , Humanos , Masculino , Tomografía Computarizada por Rayos XRESUMEN
A 37-year-old man visited our hospital with a chief complaint of sudden onset of right scrotal pain. Because spermatic cord torsion was suspected, an exploratory incision was made. There was no spermatic cord torsion, but an induration was palpated in a part of the right testis. Because a testicular tumor was strongly suspected, right high orchiectomy was performed. The histopathological diagnosis was a pT1 seminoma. Our experience with this case suggests that testicular tumor should be considered in the differential diagnoses of acute scrotum.
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Escroto/patología , Neoplasias Testiculares/complicaciones , Enfermedad Aguda , Adulto , Humanos , Masculino , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/patología , Neoplasias Testiculares/cirugía , UltrasonografíaRESUMEN
A 71-year-old man had been under treatment for nocturia with an anti-cholinergic agent at a urologic clinic for the last 2 years. Because the symptoms did not improve, he was referred to our hospital for treatment of urinary retention. Based on the findings of a neurological examination, we suspected the presence of a neurogenic bladder due to sacral lesions. Moreover, magnetic resonance imaging indicated tethered cord syndrome (TCS) due to spinal cord lipoma. He underwent surgical treatment for TCS, which improved storage function, but not voiding function. Generally speaking, we believe that early diagnosis of TCS facilitates early surgery that can prevent the development of neurogenic disorders. In the present case, if the neurological findings had been appropriately assessed and cystometry/urodynamic studies had been performed at an earlier stage, a prompt diagnosis could have been made and surgery could have been performed earlier as well. Although adult cases with TCS are rarely observed, TCS should be considered as one of the causes of intractable lower urinary tract symptoms.
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Defectos del Tubo Neural/diagnóstico , Anciano , Humanos , Masculino , Defectos del Tubo Neural/complicaciones , Defectos del Tubo Neural/cirugía , Vejiga Urinaria Neurogénica/etiologíaRESUMEN
BACKGROUND/AIM: The therapeutic landscape for metastatic castration-resistant prostate cancer (mCRPC) has changed dramatically with the introduction of several novel agents. However, limited data are available to determine whether the introduction of novel agents affected patient characteristics, treatment patterns, and outcomes compared with the period when these agents were not available. The objective of this study was to evaluate the impact of the introduction of novel mCRPC agents on patient characteristics, treatment patterns, and outcomes. PATIENTS AND METHODS: Two cohorts of Japanese patients diagnosed with mCRPC between 2009 and 2014 (Epoch 1) and 2015 and 2019 (Epoch 2) were retrospectively analyzed. RESULTS: A total of 125 treatment-naïve mCRPC patients, consisting of 42 patients in Epoch 1 and 83 patients in Epoch 2, were evaluated. We obtained the following results: (i) a dramatic shift in the first-line treatment from docetaxel to androgen receptor axis-targeted agents (ARATs), (ii) an age range expansion for first-line treatment, and (iii) an overall survival (OS) advantage in Eopch 2 compared to Epoch 1. Multivariate analysis in the overall population showed that Epoch 2 and low prostate-specific antigen (PSA) levels at the start of first-line treatment were independent prognostic factors for OS. CONCLUSION: In real-world mCRPC practice, the introduction of novel agents has improved the prognosis of mCRPC while allowing more patients to receive mCRPC treatment across a broad age range. In addition, low PSA levels at the start of first-line treatment were associated with improved OS, indicating the importance of starting mCRPC treatment while PSA levels are low.
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Neoplasias de la Próstata Resistentes a la Castración , Humanos , Masculino , Neoplasias de la Próstata Resistentes a la Castración/tratamiento farmacológico , Neoplasias de la Próstata Resistentes a la Castración/patología , Neoplasias de la Próstata Resistentes a la Castración/mortalidad , Anciano , Anciano de 80 o más Años , Estudios Retrospectivos , Persona de Mediana Edad , Resultado del Tratamiento , Docetaxel/uso terapéutico , Antígeno Prostático Específico/sangre , Metástasis de la Neoplasia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Antineoplásicos/uso terapéuticoRESUMEN
INTRODUCTION: Immune checkpoint inhibitor (ICI) therapy has significantly improved the prognosis of some patients with advanced urothelial carcinoma (UC), but it does not provide high therapeutic efficacy in all patients. Therefore, identifying predictive biomarkers is crucial in determining which patients are candidates for ICI treatment. This study aimed to identify the predictors of ICI treatment response in patients with platinum-refractory advanced UC treated with pembrolizumab. METHODS: Patients with platinum-refractory advanced UC who had received pembrolizumab at two hospitals in Japan were included. Univariate and multivariate analyses were performed to identify biomarkers for progression-free survival (PFS) and overall survival (OS). RESULTS: Forty-one patients were evaluable for this analysis. Their median age was 75 years, and the vast majority of the patients were male (85.4%). The objective response rate was 29.3%, with a median overall survival (OS) of 17.8 months. On multivariate analysis, an Eastern Cooperative Oncology Group performance status (ECOG-PS) ≥ 2 (HR = 6.33, p = 0.03) and a baseline neutrophil-to-lymphocyte ratio (NLR) > 3 (HR = 2.79, p = 0.04) were significantly associated with poor OS. Antibiotic exposure did not have a significant impact on either PFS or OS. CONCLUSIONS: ECOG-PS ≥ 2 and baseline NLR > 3 were independent risk factors for OS in patients with platinum-refractory advanced UC treated with pembrolizumab. Antibiotic exposure was not a predictor of ICI treatment response.
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OBJECTIVES: To investigate the clinical features of detrusor underactivity (DU) in elderly men without neurological disorders. METHODS: A total of 336 men aged ≥50 years without neurogenic disorders who underwent pressure flow studies and who had DU or bladder outlet obstruction (BOO) were reviewed retrospectively. According to the bladder contractility index (BCI) and the BOO index (BOOI), the subjects were classified into the following three groups: (a) pure DU group, BCI < 100 and BOOI < 40; (b) DU + BOO group, BCI < 100 and BOOI ≥ 40; and (c) pure BOO group, BCI ≥ 100 and BOOI ≥ 40. Subjective and objective parameters were compared among the three groups, and the predictors for pure DU were evaluated by multivariate analysis. RESULTS: Of the 336 patients, 205 who met the study criteria were included in the analysis: 63 (30.7%) with pure DU, 48 (23.4%) with DU + BOO, and 94 (45.9%) with pure BOO. The proportion of the pure DU group increased with increasing age. Prostate volume was the lowest in the pure DU group. Frequency, urgency on the International Prostate Symptom Score (IPSS), and the IPSS storage subscore were the lowest in the pure DU group. Multivariate analysis showed that age (odds ratio [OR] 1.114 [95% CI, 1.032-1.203], P = .005), prostate volume (OR 0.968 [95% CI, 0.949-0.987], P = .001), and urgency (OR 0.623 [95% CI, 0.431-0.900], P = .012) were predictors of pure DU. CONCLUSION: Older age, smaller prostate volume, and less urgency may be clinical features of pure DU.
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Síntomas del Sistema Urinario Inferior , Enfermedades del Sistema Nervioso , Obstrucción del Cuello de la Vejiga Urinaria , Vejiga Urinaria de Baja Actividad , Anciano , Femenino , Humanos , Síntomas del Sistema Urinario Inferior/diagnóstico , Masculino , Enfermedades del Sistema Nervioso/complicaciones , Estudios Retrospectivos , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico , Vejiga Urinaria de Baja Actividad/complicaciones , Vejiga Urinaria de Baja Actividad/diagnóstico , UrodinámicaRESUMEN
INTRODUCTION: Response to pembrolizumab after first-line chemotherapy is vital to prolonged survival in advanced, unresectable, and/or metastatic urothelial carcinoma (aUC). However, there are sparse clinical data on host-tumor immune modification by first-line platinum-based chemotherapy. This study investigated the association between response to first-line gemcitabine plus cisplatin (GC) or carboplatin (GCarbo) chemotherapy and response to subsequent pembrolizumab treatment. PATIENTS AND METHODS: A multicenter-derived database registered 454 patients diagnosed with aUC between 2008 and 2020. Of these, 108 patients who received first-line GC or GCarbo followed by second-line or later pembrolizumab were eligible for investigation and were classified into 3 groups: 48 receiving full-dose GC, 21 receiving dose-reduced GC, and 39 receiving GCarbo. Overall survival (OS) was calculated using the Kaplan-Meier method and compared using the log-rank test. Possible factors associated with the response to pembrolizumab were evaluated using binary logistic regression methods. RESULTS: The rate of patients undergoing surgical removal of the primary organ was higher and creatinine clearance was lower in the dose-reduced GC and GCarbo groups than in the full-dose GC groups. Pembrolizumab responders had significantly better survival benefits than nonresponders. The rate of pembrolizumab responders was much higher in first-line chemotherapy responders than in first-line chemotherapy nonresponders. In contrast to the full-dose GC and GCarbo groups, the pembrolizumab responder rate was lower, and no association was observed between response to first-line chemotherapy and response to pembrolizumab in the dose-reduced GC group. CONCLUSION: Cisplatin and carboplatin may play an important role in the antitumor immune response, which could impact the outcome of subsequent pembrolizumab treatment. Given that the rate of response to pembrolizumab after dose-reduced GC chemotherapy was relatively low, this regimen is not recommended for cis-unfit patients with aUC. Further studies are required to understand the mechanisms responsible for the cross-reactivity of platinum and immune checkpoint inhibitors.
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Carcinoma de Células Transicionales , Neoplasias de la Vejiga Urinaria , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica , Carboplatino , Carcinoma de Células Transicionales/tratamiento farmacológico , Carcinoma de Células Transicionales/patología , Cisplatino , Desoxicitidina/análogos & derivados , Humanos , Neoplasias de la Vejiga Urinaria/patología , GemcitabinaRESUMEN
To investigate the organ-specific response and clinical outcomes of mixed responses (MRs) to immune checkpoint inhibitors (ICIs) for unresectable or metastatic urothelial carcinoma (ur/mUC), we retrospectively analyzed 136 patients who received pembrolizumab. The total objective response rate (ORR) and organ-specific ORR were determined for each lesion according to the Response Evaluation Criteria in Solid Tumors version 1.1 as follows: (i) complete response (CR), (ii) partial response (PR), (iii) stable disease (SD), and (iv) progressive disease (PD). Most of the organ-specific ORR was 30−40%, but bone metastasis was only 5%. There was a significant difference in overall survival (OS) between responders and non-responders with locally advanced lesions and lymph node, lung, or liver metastases (HR 9.02 (3.63−22.4) p < 0.0001; HR 3.63 (1.97−6.69), p < 0.0001; HR 2.75 (1.35−5.59), p = 0.0053; and HR 3.17 (1.00−10.0), p = 0.049, respectively). MR was defined as occurring when PD happened in one lesion plus either CR or PR occurred in another lesion simultaneously, and 12 cases were applicable. MR was significantly associated with a poorer prognosis than that of the responder group (CR or PR; HR 0.09 (0.02−0.35), p = 0.004). Patients with bone metastases benefitted less. Care may be needed to treat patients with MR as well as patients with pure PD. Further studies should be conducted in the future.
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We developed a rapid multiplex PCR assay available in bedside for the simultaneous detection of Neisseria gonorrhoeae and Chlamydia trachomatis, which enables diagnosis in less than 30 minutes. In this study, we validated the clinical utility of this assay including its sensitivity and specificity for NG and CT detection.
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Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , Chlamydia trachomatis/aislamiento & purificación , Gonorrea/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/aislamiento & purificación , Adulto , Infecciones por Chlamydia/microbiología , Infecciones por Chlamydia/orina , ADN Bacteriano/análisis , Femenino , Gonorrea/microbiología , Gonorrea/orina , Humanos , Masculino , Sensibilidad y Especificidad , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiologíaRESUMEN
A 50-year-old woman visited our department for further examination of incidental bladder tumor detected by ultrasound at her health check. Cystoscopy demonstrated a submucosal tumor in the anterior wall of the urinary bladder. Magnetic resonance imaging revealed that the tumor had high intensity in T2- weighted images. The slightly-elevated serum level of dopamine and uptake image in the meta iodobenzyl granidine-scintigraphy test suggested that she might have ectopic pheochromocytoma in the urinary bladder. Partial cystectomy with extirpation of the tumor was performed. The histological diagnosis was schwannoma, which is rarely found in the urinary bladder.
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Neurilemoma/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Cistoscopía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana EdadRESUMEN
PURPOSE: The aim of this study was to compare the safety and efficacy of photoselective vaporization of the prostate (PVP) and transurethral enucleation with a bipolar system (TUEB). PATIENTS AND METHODS: Patients who underwent PVP or TUEB surgery for lower urinary tract symptoms due to bladder outlet obstruction at our institution from September 2015 to May 2019 were retrospectively reviewed. A total of 83 patients (PVP: n=45, TUEB: n=38) who were available for follow-up at least 12 months after surgery were included. Preoperative characteristics, perioperative parameters, and postoperative outcomes-such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and complications-at 3, 6, and 12 months after surgery were compared between the two groups. RESULTS: Although differences in age, IPSS, and QoL were not significant, a significantly greater prostate volume, lower Qmax, and greater PVR were noted in the TUEB group. In perioperative parameters, a significantly shorter operation time, less change in serum hemoglobin, fewer days of catheterization, and shorter length of stay were observed in the PVP group. As for postoperative outcomes, the IPSS storage subscore and PVR were significantly improved in the TUEB group. As complications, stress urinary incontinence was more frequently observed in the TUEB group, and urethral stricture was more common in the PVP group. CONCLUSION: The present data suggest that PVP and TUEB are efficient and safe surgical treatment options. Management of patients undergoing PVP in the perioperative period appears easy. Improvements of subjective and objective parameters were superior after TUEB than after PVP.
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INTRODUCTION: The treatment strategy for castration-resistant prostate cancer (CRPC) has changed with the approval of several new agents. In 2011, abiraterone acetate was approved for the treatment of metastatic CRPC; however abiraterone is known to cause mineralocorticoid excess syndrome characterized by hypokalemia, fluid retention, and hypertension. We experienced two cases of grade 4 hypokalemia associated with abiraterone treatment. CASE PRESENTATION: Case 1: a 71-year-old male with metastatic CRPC presented with convulsive seizures two weeks after receiving abiraterone plus prednisone. The serum potassium level was 2.1mEq/l. We determined that convulsive seizure was caused by hypokalemia associated with abiraterone. Case 2: a 68-year-old male with metastatic CRPC presented with severe lethargy one month after receiving abiraterone plus prednisone. The serum potassium level was 1.7mEq/l and we concluded that severe lethargy was caused by hypokalemia associated with abiraterone. They were treated with potassium supplementation and increased prednisone following withdrawal of abiraterone. DISCUSSION: The two patients had been on glucocorticoid therapy before abiraterone therapy. Prolonged administration of exogenous glucocorticoid can lead adrenocortical insufficiency and consequently reduce endogenous glucocorticoid production. This situation may increase the risk of abiraterone-induced mineralocorticoid excess. To reduce the risk of abiraterone-induced hypokalemia, evaluation of adrenocortical insufficiency is required.