Comparison of single- and multiple-dose cefazolin as prophylaxis for transurethral enucleation of prostate: A multicenter, prospective, randomized controlled trial by the Japanese Research Group for Urinary Tract Infection.

OBJECTIVES: To compare the optimal administration period of antimicrobial prophylaxis in patients undergoing transurethral enucleation of the prostate for benign prostatic hyperplasia. METHODS: We carried out a randomized controlled trial to compare the differences in incidence of perioperative genitourinary tract infection between single and multiple (3 days) administrations of cefazolin for transurethral enucleation of the prostate in benign prostatic hyperplasia patients without pyuria or bacteriuria between January 2015 and December 2018. RESULTS: This multicenter randomized controlled trial included 203 patients who underwent a transurethral enucleation of the prostate procedure. All received antimicrobial prophylaxis, and were randomized into those who received single-dose (n = 101) or multiple-dose (n = 102) therapy. The rate of genitourinary tract infection after transurethral enucleation of the prostate for all patients was 1.5%, whereas that in the single-dose group was 1.0% and in the multiple-dose group was 2.0%, which were not significantly different (P = 1.00). CONCLUSIONS: A single dose of antimicrobial prophylaxis as a prophylactic antibacterial drug is sufficient for patients undergoing transurethral enucleation of the prostate who do not have presurgical pyuria or bacteriuria.

Fertility preservation and pregnancy outcomes in adolescent and young adult male patients with cancer.

PURPOSE: Sperm cryopreservation is the gold standard for maintaining fertility in male survivors of cancer. In order to help increase the future success of fertility preservation in these patients, the present state of sperm cryopreservation was examined at the current institution and its challenges were discussed. METHODS: Between January, 2004 and February, 2017, 31 male patients with cancer were introduced to the center for fertility preservation. The ages and semen characteristics of these patients were examined and compared between those whose sperm were cryopreserved before (the pretreatment group) and after (the post-treatment group) cancer treatment. RESULTS: The mean sperm concentration of the pretreatment group was significantly higher than that of the post-treatment group. Normozoospermia was found in eight and three patients in the pretreatment and the post-treatment groups, respectively, albeit this difference was not significant. In contrast, the prevalence of azoospermia was higher in the post-treatment group (five patients) than in the pretreatment group (one patient). CONCLUSION: As many patients possibly suffer from infertility following chemotherapy, it is necessary to provide fertility preservation opportunities to young male patients with cancer prior to the commencement of cancer treatment.

[Small cell carcinoma in a vesical diverticulum: a case report].

We report a case of small cell carcinoma located within the vesical diverticulum. A 73-year-old woman referred to our hospital with a chief complaint of gross hematuria. Cystoscopy confirmed a non-papillary tumor within the vesical diverticulum. Histopathologic diagnosis with transurethral resection of the tumor (TURBT) specimen was small cell carcinoma. Later, tumor recurrence occurred within the same diverticulum. TURBT and biopsy of the vesical mucosa were performed. After confirming that no tumor was detected outside of the diverticulum, partial cystectomy was done including an adequate margin around the diverticulum in September, 2010. Since the histopathologic finding of the specimen revealed urothelial carcinoma (UC) this time and microinvasion and venous invasion were detected, we performed an adjuvant chemotherapy according to the protocol of gemcitabine and cisplatin therapy. To our knowledge, this is the 4th case report of small cell carcinoma located in a vesical diverticulum in Japan.

A large seminoma occurring 20 years after diagnosis of complete androgen insensitivity syndrome: A case report.

•A seminoma developed in a patient with androgen insensitivity syndrome.•The patient had a de novo androgen receptor mutation.•Proper management of AIS, including appropriate genetic counseling, is necessary.

Antimicrobial prophylaxis to prevent perioperative infection in urological surgery: a multicenter study.

We prospectively investigated the rates of incidence of surgical site infection (SSI), urinary tract infection (UTI), and remote infection (RI) in 4,677 patients who underwent urological surgery from January to December 2010, including 2,507 endourological cases, 1,276 clean cases, 807 clean-contaminated cases, and 87 contaminated cases involving bowel segments. A single dose of antimicrobial prophylaxis (AMP) was administered in the endourological, clean, and clean-contaminated surgery cases, except for patients who underwent transurethral resection of the prostate (TURP) or percutaneous nephrolithotripsy (PNL). AMP was administered within 72 h in TURP and PNL, and AMP was administered within 48 h in contaminated surgery cases. In cases of endourological surgery, UTI was observed in 4% and RI in 0%, and SSI, UTI, and RI were seen in 1%, 1%, and 1%, respectively, of clean surgery cases, in 3%, 3%, and 2%, respectively, of clean-contaminated surgery cases, and in 17%, 30%, and 10%, respectively, of contaminated surgery cases. In multivariate analysis of the risk factors for infection, operative time was a significant risk factor for UTI in endourological surgery, and American Society of Anesthesiologists score and operative time were significant risk factors for RI in clean surgery. No significant risk factor was found in analyses of clean-contaminated and contaminated surgery cases. A single-dose AMP regimen was shown to be effective and feasible for prevention of perioperative infection in urological surgery.

21-hydroxylase deficiency associated with male infertility: report of 2 cases with gene analyses.

We treated two patients with male infertility due to 21-hydroxylase deficiency. Endocrinologic examinations disclosed low levels of LH and FSH, with elevated ACTH and 17-OH-progesterone in both. In addition, a small testicular tumor was found in Case 1, which disappeared after adrenal replacement. Suppressed gonadotropin levels caused by increased androgen seemed to underlie the sperm dysfunction in these patients. Dexamethasone and then clomiphene were administered in Case 1, and dexamethasone in Case 2. Spermatogenesis was somewhat improved in both patients and pregnancy achieved in Case 2, though spontaneous abortion later occurred.

A single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urological clean and clean-contaminated surgery.

A single dose of antimicrobial prophylaxis (AMP) was administered parenterally for the prevention of perioperative infection in a total of 788 patients undergoing urological surgery, including 380 endoscopic-instrumental, 328 clean, and 80 clean-contaminated operations performed at our institute between January 2007 and December 2009. Surgical site infections (SSIs), urinary tract infections (UTIs), and remote infections (RIs) were prospectively surveyed. The definition for a single dose of AMP allowed for the administration of an additional dose of an antimicrobial during surgery if the procedure was longer than 3 h, but not for the parenteral or oral administration at the end of the procedure in the recovery room, or at a later time over a period of more than 24 h. UTI was observed in 12 (3.2%) patients after endoscopic-instrumental operation, 1 (0.3%) after clean operation, and 1 (0.9%) after clean-contaminated operation. SSI was observed in 2 (0.6%) patients after clean operation but in none after clean-contaminated operations. RI was observed in 1 (0.3%) patient after endoscopic-instrumental operation, 3 (0.9%) after clean operation, and none after clean-contaminated operations. A single-dose regimen of AMP was effective and feasible for the prevention of perioperative infections, including SSIs, UTIs, and RIs, in endoscopic-instrumental, clean, and clean-contaminated urological surgical procedures.

[A case of lymphangioma of the intrascrotum in an adult].

We reported a rare case of intrascrotal lymphangioma in an adult. A 31-year-old man visited a urological clinic with a chief complaint of left scrotal swelling since a few days ago, and was pointed out to have a left intrascrotal cystic mass. The patient was sent to our hospital for further examination in 23 April 2008. The left scrotal mass was palpated elastic hard below the left testis and its surface was irregular. Light transillumination test showed positive. Ultrasonography revealed a cystic mass 7.0 x 4.4 x 4.5 cm with multiseptate accumulation at the lower pole of the left testis. Magnetic resonance imaging showed low intensity by T1WI and high intensity by T2WI, suggesting a protein-rich component. We suspected left intrascrotal lymphangioma and extirpated the scrotal mass under lumbar anesthesia. Pathological examination demonstrated lymphangioma. The patient had no evidence of recurrence after 1 year.

[An adenocarcinoma arising from the urinary bladder 37 years after bladder augmentation using the ileum].

A 57-year-old man had undergone right nephrectomy at 10 years of age and bladder augmentation using the ileum at 20 years for treatment of urinary tract tuberculosis. He also had undergone intermittent catheterization after a traffic accident at 49 years of age. He presented at another hospital with a complaint of asymptomatic macroscopic hematuria. Cystoscopy revealed a lobulated tumor in the bladder. Transurethral resection of bladder tumor was performed, but complete resection was difficult. Histopathological examination of the specimen revealed a well differentiated adenocarcinoma. He was referred to our hospital for total cystectomy and percutaneous left nephrostomy. The tumor arose from the bladder wall near the anastomotic site between the bladder and the ileal segment. Histopathological examination revealed a well differentiated adenocarcinoma infiltrating into the muscle layer (pT2a). Postoperatively, he has been free of recurrence for one year. This is the 19th case of adenocarcinoma following bladder augmentation using the ileum reported in the Japanese literature.

[Influence of blood cells in urine samples on results of screening for urothelial carcinoma with NMP22 bladder chek].

We compared the sensitivity of Bladder Chek NMP22 with that of urine cytology in bladder cancer patients. Further, we evaluated the usefulness of Bladder Chek NMP22 in patients with benign diseases such as cystitis, urolithiasis, and benign prostate hyperplasia (BPH) and examined how blood cells in urine samples affect the results of Bladder Chek NMP22. Patients with macroscopic hematuria were excluded from this study. Of 77 bladder cancer patients, Bladder Chek NMP22 showed positive in 46.8%, while urine cytology in 33.8% (p = 0.16). Bladder Chek NMP22 and urine cytology showed positive in 31.8 and 0.0% in G1 (p = 0.004), 51.2 and 46.3% in G2 (p = 0.66) and 57.1 and 50% in G3 (p = 0.71); 44.4 and 88.9% in Tis (p = 0.052), 25.6 and 15.4% in Ta (p = 0.27), 72.2 and 33.3% in T1 (p = 0.02) and 81.8 and 54.5% in T2 or higher (p = 0.18), respectively. In bladder cancer patients with microscopic hematuria or pyuria, the positive rates of Bladder Chek NMP22 were 82.1 and 73.1%, respectively, whereas they were 26.5% (p < 0.001) and 33.3% (p = 0.002), respectively, in those without hematuria or pyuria. In 36 cystitis, 20 urolithiasis, and 19 BPH patients, the positive rates of Bladder Chek NMP22 were 58.3, 25.0 and 5.5%, respectively. Bladder Chek NMP22 showed higher sensitivity for detection of bladder cancer, especially in low-grade and low-stage cancers than urine cytology, but the result was likely affected by blood cells in urine samples. Thus, although Bladder Chek NMP22 may be less useful as the first device for screening of urothelial cancer in patients with hematuria or pyuria, it may show results of high quality when used in patients with negative urine cytology after excluding benign diseases.

[Testicular tumor detected in a male infertility patient with prior orchiopexy].

A 37-year-old man was referred to our hospital with the chief complaint of infertility. Semen analysis at another clinic had demonstrated severe oligozoospermia and he had a history of bilateral orchiopexy for undescended testes. Scrotal ultrasonography revealed a hypoechoic heterogeneous mass (1.5 cm in diameter) within the left testis. With a provisional diagnosis of testicular tumor, left high orchiectomy was performed. Pathological examination of the tumor revealed seminoma. At 12 months after surgery, there has been no evidence of recurrence. Clinicians should be aware of the link between male infertility and testicular cancer, particularly following orchiopexy.

[Case with renal pelvic carcinoma with giant hydronephrosis].

A 62-year-old man consulted us for further examination of left giant hydronephrosis which was accidentally found by abdominal ultrasonography. The patient chose observation instead of left nephrectomy. One year later, he re-visited us with a complaint of sudden abdominal pain. Computed tomography (CT) revealed left giant hydronephrosis containing high-density fluid which was suspected of hemorrhage in the renal pelvis. Percutaneous nephrostomy yielded discharge of 7000 ml of hemorrhagic fluid and urine cytology revealed class V. Systemic examination by CT and magnetic resonance imaging (MRI) showed renal pelvic tumors in the left kidney as well as multiple metastatic lesions in the lung, liver and bone. Pathological examination of the left renal pelvic tumors obtained by biopsy showed high-grade urothelial carcinoma. Although systemic and intra-arterial chemotherapy showed partial response in the metastatic lesions, he died of cancer 1 year and 3 months after the first diagnosis.

[Idiopathic retroperitoneal fibrosis diagnosed by CT-guided needle biopsy: a case report].

A 72-year-old man was admitted to another hospital because of general fatigue and dyspnea secondary to renal insufficiency. Abdominal computed tomography (CT) and magnetic resonance imaging showed left atrophic kidney, right hydronephrosis, and an intra-pelvic mass of soft-tissue density located anterior to the sacrum, involving the right ureter at the level between the 5th lumber vertebra and the sacrum. He was referred to our hospital after percutaneous nephrostomy was constructed into right kidney. CT-guided needle biopsy revealed the idiopathic retroperitoneal fibrosis, leading us to give him steroid therapy. Three weeks later, radiographic findings showed a remarkable reduction of the mass and the improvement of the right ureteral stricture.

[Myolipoma arising from the renal capsule: a case report].

A 53-year-old female visited us with an asymptomatic renal mass, which was incidentally found on abdominal ultrasonography (US). US showed a heterogeneous renal mass measuring 5 cm in diameter. Computed tomorraphy and magnetic resonance imaging showed that the tumor was mixed with muscle and fat tissue, faintly enhanced, and located at the lower portion of the left kidney. Although renal angiomyolipoma (AML) was suspected from these findings, we could not rule out a malignant tumor. Therefore, she underwent a laparoscopic partial nephrectomy. Histopathological examination revealed the tumor composed of smooth muscle and mature adipose tissue without cytological atypia arising from the renal capsule. The tumor contained no AML-like blood vessels, and was negative for HMB-45 staining. The final diagnosis was myolipoma arising from the renal capsule. Myolipoma is a rare benign neoplasm in the soft tissue of retroperitoneum and abdominal cavity. Since it is difficult to distinguish myolipoma from other benign and malignant tumors with fat tissue only by imaging studies, a surgical approach should be considered.

[A case of adenomatoid tumor of the testis treated by testis-sparing surgery: a case report].

A 44-year-old man was referred to our hospital with a chief complaint of a painless left intrascrotal mass, palpable at the lower portion of the left testis. Serum levels of tumor markers, human choriogenic gonadotropin (hCG), hCG-beta, and alpha fetoprotein were within the normal limits. Ultrasonography revealed a hyperechoic mass 13 mm in diameter, which was demonstrated as a hypovascular tumor by Gadrinium-enhanced magnetic resonance imaging. Since the tumor was diagnosed as a benign tumor by frozen section examination intraoperatively, testis-sparing surgery was performed. Histological examination revealed adenomatoid tumor originating from the tunica alubuginea of testis. Adenomatoid tumor of the testis is a rare benign tumor, and the present case is the 36th one in the Japanese literature.

Diagnostic efficacy of free to total ratio of prostate-specific antigen and prostate-specific antigen velocity, singly and in combination, in detecting prostate cancer in patients with total serum prostate-specific antigen between 4 and 10 ng/ml.

To assess the diagnostic efficacy of prostate-specific antigen (PSA)-related parameters, using a total of 226 patients with gray zone PSA who underwent prostate biopsy, various cutoff points of free to total ratio of PSA (f/t PSA) and PSA velocity (PSAV) were evaluated. Higher cutoff points of f/t PSA resulted in high sensitivity and negative predictive value (NPV): at f/t PSA <15%, sensitivity was 82.0% (41/50) and NPV 84.7% (50/59), and at f/t PSA <20%, 96.0% (48/50) and 92.3% (24/26). Lowering cutoff points also resulted in higher sensitivity and NPV: at PSAV >or=0.75 ng/ml per year, sensitivity was 71.4% (15/21) and NPV 82.4% (28/34), and at PSAV >or=0.40 ng/ml per year, 95.2% (20/21) and 95.2% (20/21). Further, among the patients with both of these parameters available, both sensitivity and NPV achieved 100% (10/10 and 7/7) when the indication for biopsy was determined as f/t PSA <15% or PSAV >or=0.40 ng/ml per year. Our results showed that unnecessary prostate biopsies could be more effectively avoided among patients with "gray zone PSA" by combination of f/t PSA and PSAV than single usage of these indexes.

[Huge retroperitoneal leiomyosarcoma: a case report].

This is a case report of retroperitoneal leiomyosarcoma in a 61-year-old woman. She presented with a chief complaint of back pain. Computed tomography showed a left huge retroperitoneal tumor. The tumor was removed with left nephrectomy and left hemi-colectomy. Histological examination demonstrated leiomyosarcoma 26 x 20 x 16 cm in diameter and, 3.84 kg in weight. She died of local recurrence causing ileus 2 months after the surgery. Fifty-four cases of retroperitoneal leiomyosarcoma including the present case in the Japanese literature are reviewed.

[Spontaneous rupture of renal cell carcinoma: a case report].

A 45-year-old man felt sudden pain in the left abdomen while taking a bath. Computed tomography (CT) showed a huge hematoma above the left kidney, which was diagnosed as spontaneous rupture of the kidney. Two months later, several low-density areas were observed in the liver on CT. Suspecting renal cell carcinoma (RCC) with multiple liver metastasis, we performed left radical nephrectomy and partial hepatectomy. A pathological study revealed a small RCC of 2 cm in diameter in the middle of the left kidney. In spontaneous renal rupture secondary to renal tumors, imaging studies such as CT or MRI sometimes fail to demonstrate primary lesions.

[A case of retention cyst in the prostate complicated of dysuria: a case report].

A 42-year-old man presented with the chief complaint of dysuria which occurred suddenly. He showed a large quantity of post-voiding residue. Abdominal ultrasonography and cystoscope revealed a hypo-echoic mass with a diameter of 15 mm at the bladder neck. Transurethral resection of the cyst was performed, and dysuria was markedly improved. Pathological examination showed a retention cyst of the prostate.

[Orthotopic bladder substitution].

Orthotopic bladder substitution is the most desired form of urinary diversion because the patient can restore normal voiding after cystectomy. However, urethral recurrence must be seriously considered and the patients with a risk of urethral recurrence are not indicated. Each method of bladder substitution has merits and demerits. We compared the Mainz method and the Studer method of orthotopic bladder substitution we performed on 8 and 11 patients, respectively since 1992. The Studer orthotopic ileal bladder substitution has given better results with better voiding pattern and less complication rates. We consider the Studer ileal bladder substitution as a good technique to restore normal voiding after cystectomy.