Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31
Filtrar
1.
Int J Urol ; 31(7): 795-801, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38622823

RESUMO

OBJECTIVES: This study aimed to investigate perioperative complications and the details of postoperative ureteral stricture after ureteroscopy with laser lithotripsy (URS-L) for upper urinary tract stones in Japan. METHODS: Patient data on intra- and postoperative complications after ureteroscopy using URS-L were retrospectively collected from multiple centers in Japan between April 2017 and March 2020 with the cooperation of the Japanese Society of Endourology and Robotics. Data included the number of patients undergoing URS-L, number and type of intra- and postoperative complications, and detailed characteristics of postoperative ureteral stricture. RESULTS: In total, 14 125 patients underwent URS-L over 3 years at 82 institutions. Annual URS-L numbers gradually increased from 4419 in 2017, to 4760 in 2018, and 4946 in 2019. The total complication rate was 10.5%, which was divided into intra-operative complications in 1.40% and postoperative complications in 9.18%. The annual incidences of intra- and postoperative complications were not significantly different from year to year (p = 0.314 and p = 0.112). Ureteral perforation, ureteral avulsion, and the intra-operative conversion rate were 1.35%, 0.03%, and 0.02%, respectively. Fever >38°C, septic shock, blood transfusion, and postoperative mortality were 7.44%, 0.81%, 0.07%, and 0.04%, respectively. Ureteral stricture occurred in 0.8% of cases. The median length of stricture site was 10.0 mm and the success rate of stricture treatment was 54.6%. CONCLUSION: Although URS-L utilization has increased in Japan, the annual complication rate has remained steady. Although URS-L is a useful and less invasive procedure, devastating complications can still occur.


Assuntos
Litotripsia a Laser , Complicações Pós-Operatórias , Ureteroscopia , Humanos , Ureteroscopia/efeitos adversos , Japão/epidemiologia , Masculino , Feminino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Litotripsia a Laser/efeitos adversos , Litotripsia a Laser/métodos , Estudos Retrospectivos , Idoso , Adulto , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Cálculos Ureterais/cirurgia , Cálculos Ureterais/terapia , Obstrução Ureteral/etiologia , Obstrução Ureteral/epidemiologia , Constrição Patológica/etiologia , Constrição Patológica/epidemiologia , Incidência , Cálculos Renais/cirurgia , População do Leste Asiático
2.
IJU Case Rep ; 6(5): 302-305, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37667763

RESUMO

Introduction: Testicular germ cell tumors with somatic-type malignancy, wherein teratomas transform into sarcomas, is drug resistant and has a poor prognosis. Case presentation: A 43-year-old man presented with a left testicular tumor, multiple pulmonary metastases, and mediastinal and para-aortic lymph node metastases. The testicular tumors were diagnosed as germ cell tumors. After bleomycin, etoposide, and cisplatin chemotherapy; right upper lobectomy for the pulmonary metastasis; and paclitaxel, ifosfamide, and cisplatin chemotherapy, rapidly progressing mediastinal lymph node metastasis was observed. It was resected at another specialized center owing to the challenging surgical approach. The histopathological diagnosis of the resected tumor was a teratoma with somatic-type malignancy (rhabdomyosarcoma). Subsequently, left hilar lymph node metastasectomy and left upper lobectomy were performed for the pulmonary metastases. The patient survived for more than 8 years after initial treatment. Conclusion: Surgery, although challenging, may yield long-term survival for patients with testicular germ cell tumors with sarcomatous transformation.

3.
BMC Urol ; 22(1): 177, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352389

RESUMO

BACKGROUND: While gemcitabine/cisplatin (GC) is the gold standard regimen for patients with advanced urothelial carcinoma (aUC), either dose-reduced GC or gemcitabine/carboplatin (GCa) is an alternative option for "cisplatin-unfit" patients. However, few studies have compared outcomes with these commonly used regimens in the real-world setting. METHODS: We retrospectively reviewed patients with aUC who received full-dose GC, dose-reduced GC, or GCa as first-line salvage chemotherapy at two university hospitals between 2016 and 2020. Progression-free survival, cancer-specific survival, and overall survival, as well as best overall response and adverse event profiles, were compared among these three regimens. RESULTS: Of 105 patients, 41, 27, and 37 patients received full-dose GC, dose-reduced GC, and GCa, respectively. Significant differences were noted in the patients' baseline age, primary site, and renal function among the three regimens. Sixty-nine (65.7%) patients died during a median follow-up period of 14 months. There was no significant difference among the three regimens for all survival outcomes and best overall response. However, the complete response rate of dose-reduced GC (2/27, 7.4%) appeared inferior to that of full-dose GC (9/41, 22.0%) or GCa (6/37, 16.2%). Regarding adverse event profiles, no significant difference was observed among the three regimens, except for significantly fewer cases with elevated alanine aminotransferase in the GCa group compared with the other groups. CONCLUSIONS: This study compared the oncological and toxicological outcomes of full-dose GC, dose-reduced GC, and GCa in real-world patients with aUC. Unlike in the clinical trial setting, there were almost no significant differences among the three regimens.


Assuntos
Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Humanos , Cisplatino , Carcinoma de Células de Transição/tratamento farmacológico , Carboplatina/efeitos adversos , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gencitabina
4.
Eur Radiol ; 32(11): 7513-7521, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35554648

RESUMO

OBJECTIVES: To develop a modified Vesical Imaging Reporting and Data System (VI-RADS) without dynamic contrast-enhanced imaging (DCEI), termed "non-contrast-enhanced VI-RADS (NCE-VI-RADS)", and to assess the additive impact of denoising deep learning reconstruction (dDLR) on NCE-VI-RADS. METHODS: From January 2019 through December 2020, 163 participants who underwent high-gradient 3-T MRI of the bladder were prospectively enrolled. In total, 108 participants with pathologically confirmed bladder cancer by transurethral resection were analyzed. Tumors were evaluated based on VI-RADS (scores 1-5) by two readers independently: an experienced radiologist (reader 1) and a senior radiology resident (reader 2). Conventional VI-RADS assessment included all three imaging types (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI], and dynamic contrast-enhanced imaging [DCEI]). Also evaluated were NCE-VI-RADS comprising only non-contrast-enhanced imaging types (T2WI and DWI), and "NCE-VI-RADS with dDLR" comprising T2WI processed with dDLR and DWI. All systems were assessed using receiver-operating characteristic curve analysis and simple and/or weighted κ statistics. RESULTS: Muscle invasion was identified in 23/108 participants (21%). Area under the curve (AUC) values for diagnosing muscle invasion were as follows: conventional VI-RADS, 0.94 and 0.91; NCE-VI-RADS, 0.93 and 0.91; and "NCE-VI-RADS with dDLR", 0.96 and 0.93, for readers 1 and 2, respectively. Simple κ statistics indicated substantial agreement for NCE-VI-RADS and almost perfect agreement for conventional VI-RADS and "NCE-VI-RADS with dDLR" between the two readers. CONCLUSION: NCE-VI-RADS achieved predictive accuracy for muscle invasion comparable to that of conventional VI-RADS. Additional use of dDLR improved the diagnostic accuracy of NCE-VI-RADS. KEY POINTS: • Non-contrast-enhanced Vesical Imaging Reporting and Data System (NCE-VI-RADS) was developed to avoid risk related to gadolinium-based contrast agent administration. • NCE-VI-RADS had predictive accuracy for muscle invasion comparable to that of conventional VI-RADS. • The additional use of denoising deep learning reconstruction (dDLR) might further improve the diagnostic accuracy of NCE-VI-RADS.


Assuntos
Sistemas de Dados , Neoplasias da Bexiga Urinária , Humanos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Estudos Prospectivos , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia , Campos Magnéticos
5.
Asian J Urol ; 9(2): 119-124, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35509484

RESUMO

Objective: This study was performed to evaluate the clinical and perioperative outcomes of laparoscopic retroperitoneal lymph node dissection (L-RPLND) and open retroperitoneal lymph node dissection (O-RPLND) performed by one surgeon at a single center. Methods: We evaluated 30 patients with stage IIA germ cell tumors who underwent retroperitoneal lymph node dissection (15 underwent L-RPLND and 15 underwent O-RPLND) at our institution between April 1, 2010 and March 31, 2018. The clinical parameters were compared between patients who underwent L-RPLND using the retroperitoneal approach and those who underwent O-RPLND using the transperitoneal approach. There were no significant differences in the background characteristics of the two groups except for the median follow-up duration (46 months for L-RPLND and 71 months for O-RPLND, p=0.02). Results: L-RPLND was associated with a shorter mean operative time (mean 222 min for L-RPLND vs. 453 min for O-RPLND, p<0.001). There was significantly less blood loss during surgery in the L-RPLND group compared to the O-RPLND group (mean 165 mL for L-RPLND vs. 403 mL for O-RPLND, p<0.001). Parameters related to postoperative recovery were significantly better for the L-RPLND group than for the O-RPLND group. There were no differences in the histopathological characteristics between the two groups. No patients in either group exhibited disease recurrence. Conclusion: Patients who underwent L-RPLND had more rapid recovery, and shorter hospital stay compared to those who underwent O-RPLND; complications were comparable between the two groups. L-RPLND is an efficient procedure with the benefits of minimally invasive surgery.

6.
Clin Genitourin Cancer ; 20(4): e291-e295, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35346591

RESUMO

Transurethral resection of bladder tumor (TURBT) is the essential first step in the current algorithm for the management of bladder cancer (BC). However, despite its necessity and significance, TURBT has several limitations, including cost, hospitalization, anesthesia, potential complications such as bladder perforation, and delay to radical cystectomy. The Vesical Imaging Reporting and Data System (VI-RADS) was developed to standardize the reporting of multiparametric magnetic resonance imaging for BC, and its diagnostic accuracy to predict muscle invasion has been validated. Given the high sensitivity of VI-RADS ≥ 3 and high specificity of VI-RADS ≥ 4 as clinically relevant cutoff values, we herein propose a new VI-RADS-based algorithm for the management of BC. Using this algorithm, patients with VI-RADS ≤ 2 may not need to undergo sampling of the detrusor muscle nor second TURBT even if there is no muscle in the initial TURBT specimen, whereas patients with VI-RADS ≥ 4 may skip conventional TURBT aimed at pathologic confirmation of muscle invasion and immediately undergo radical cystectomy. Our newly proposed algorithm enables the avoidance of unnecessary deep resection or second TURBT as well as delay to radical cystectomy. The VI-RADS-based algorithm enables a paradigm shift from the current TURBT-dependent practice in the management of BC.


Assuntos
Cistectomia , Neoplasias da Bexiga Urinária , Algoritmos , Sistemas de Dados , Humanos , Estudos Retrospectivos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia
8.
BMC Med Genomics ; 14(1): 217, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479548

RESUMO

BACKGROUND: Adenosquamous carcinoma of the prostate (ASCP) is an extremely rare and aggressive prostate cancer variant, whose genomic characteristics have not been elucidated. Although liquid biopsy of circulating tumor cells (CTCs) is an emerging topic in oncology, no study has assessed CTCs in patients with ASCP. CASE PRESENTATION: A 76-year-old man presented with discomfort in his urethra. His prostate-specific antigen (PSA) level was 13.37 ng/mL. A computed tomography (CT) scan indicated a prostate mass with multiple lymph node and lung metastases. The patient underwent transurethral resection of the prostate and prostatic needle biopsy; both specimens demonstrated Gleason grade group 5 acinar adenocarcinoma of the prostate. Bone scintigraphy indicated bone metastasis in the ischium. Combined androgen blockade was implemented, and his serum PSA level rapidly decreased to 0.01 ng/mL. However, a CT scan 6 months after the initial diagnosis revealed worsening of the disease. The patient therefore underwent repeated prostatic needle biopsy; its specimen demonstrated prostatic adenocarcinoma together with squamous carcinoma components. As immunohistochemical analyses showed the tumor cells to be negative for CD56, chromogranin A, synaptophysin, and PSA, the definitive diagnosis was ASCP. Although the patient underwent chemotherapy (docetaxel and cabazitaxel), he died of the disease 3 months after the diagnosis of ASCP, or 13 months after the initial diagnosis of prostatic adenocarcinoma. His PSA values remained ≤ 0.2 ng/mL. CTCs from the patient's blood (collected before starting docetaxel) were analyzed and genomically assessed. It showed 5 cytokeratin (CK)+ CTCs, 14 CK- CTCs, and 8 CTC clusters, per 10 mL. Next-generation sequencing identified a total of 14 mutations in 8 oncogenes or tumor suppressor genes: PIK3CB, APC, CDKN2A, PTEN, BRCA2, RB1, TP53, and CDK12. Of 14 mutations, 9 (64%) were detected on CK- CTCs and 5 (36%) were detected on CK+ CTCs. CONCLUSIONS: This is the first report of CTC analysis and genomic assessment in ASCP. Although the prognosis of ASCP is dismal due to lack of effective treatment, genomic analysis of CTCs might lead to effective treatment options and improved survival.


Assuntos
Células Neoplásicas Circulantes
9.
Radiol Case Rep ; 16(8): 2065-2071, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34158896

RESUMO

Pheochromocytoma/paraganglioma (PPGL)-related hypercatecholaminemic crisis is a rare lethal condition caused by uncontrolled catecholamine secretion, occasionally leading to critical fluctuation in blood pressure (BP). Emergent transcatheter arterial embolization (TAE) has been employed for spontaneous PPGL rupture, but never, to our knowledge, for critical fluctuation in BP associated with PPGL-related hypercatecholaminemic crisis. We describe here our experience utilizing this method to control critical fluctuation in BP associated with this crisis in a 44-year-old man with an unruptured retroperitoneal paraganglioma. The patient experienced sudden severe left abdominal pain and came to our emergency department, where he exhibited severe fluctuation in BP and underwent laboratory testing that showed hypercatecholaminuria and computed tomography (CT) that revealed a left retroperitoneal tumor with no apparent intra- or retroperitoneal hematoma. We performed emergent TAE from the left inferior phrenic artery using gelatin sponge, which stabilized his BP and relieved his abdominal pain. Histologic examination following elective surgical resection of the tumor confirmed our diagnosis of unruptured retroperitoneal paraganglioma. We believe that TAE represents an important option for the emergent treatment of the critical BP fluctuation associated with PPGL-related hypercatecholaminemic crisis.

10.
J Stroke Cerebrovasc Dis ; 30(9): 105943, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34175641

RESUMO

OBJECTIVES: the prevalence of intracranial aneurysms and arachnoid cysts is higher in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. A genotype correlation was reported for intracranial aneurysms, but it is unclear for arachnoid cysts. Therefore, the genotype correlation with intracranial aneurysms and arachnoid cysts was investigated in ADPKD. MATERIALS AND METHODS: intracranial aneurysms and arachnoid cysts were screened by magnetic resonance imaging (MRI), and PKD genotypes were examined using next-generation sequencing for 169 patients with ADPKD. RESULTS: PKD1-, PKD2- and no-mutation were identified in 137, 24 and 8 patients, respectively. Intracranial aneurysms and arachnoid cysts were found in 34 and 25 patients, respectively, with no significant difference in frequency. Genotype, sex, estimated glomerular filtration rate and age at ADPKD diagnosis significantly affected the age at brain MRI. The proportional hazard risk analyzed using the age at brain MRI adjusted by these four variables was 5.0-times higher in the PKD1 group than in the PKD2 group for arachnoid cysts (P = 0.0357), but it was not different for intracranial aneurysms (P = 0.1605). Arachnoid cysts were diagnosed earlier in the PKD1 group than in the PKD2 group (54.8 vs 67.7 years, P = 0.0231), but no difference was found for intracranial aneurysms (P = 0.4738) by Kaplan-Meier analysis. CONCLUSIONS: this study demonstrated the correlation between arachnoid cysts and PKD1 mutation. The reported association of arachnoid cysts with advanced renal disease may be due to the common correlation of these factors with PKD1 mutation.


Assuntos
Cistos Aracnóideos/genética , Aneurisma Intracraniano/genética , Mutação , Rim Policístico Autossômico Dominante/genética , Canais de Cátion TRPP/genética , Adulto , Idoso , Cistos Aracnóideos/diagnóstico por imagem , Angiografia Cerebral , Análise Mutacional de DNA , Feminino , Predisposição Genética para Doença , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fenótipo , Rim Policístico Autossômico Dominante/complicações , Rim Policístico Autossômico Dominante/diagnóstico , Medição de Risco , Fatores de Risco
11.
IJU Case Rep ; 4(3): 172-175, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33977252

RESUMO

INTRODUCTION: Median raphe cysts are rare benign lesions of the male genitalia that can develop anywhere along the midline from meatus to anus. They are believed to be caused by a defect in closure of median raphe during embryonic development. These cysts commonly appear in childhood or adolescence, although some are diagnosed after middle age, typically triggered by infection or trauma. Pigmented median raphe cysts, or those containing melanin pigment and/or melanocytes, are extremely rare. CASE PRESENTATION: A 78-year-old man visited our hospital with a complaint of a penile mass that he first noticed in his 50s which slowly grew, eventually causing voiding difficulty. He had no history of infection or trauma. The lesion was excised, and the pathological diagnosis was pigmented median raphe cyst. CONCLUSION: We successfully treated a rare case of pigmented median raphe cyst of the penis that developed after middle age without infection or trauma history.

12.
J Urol ; 205(3): 686-692, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33021428

RESUMO

PURPOSE: The Vesical Imaging Reporting and Data System (VI-RADS) was launched in 2018 to standardize reporting of magnetic resonance imaging for bladder cancer. This study aimed to prospectively validate VI-RADS using a next-generation magnetic resonance imaging scanner and to investigate the usefulness of denoising deep learning reconstruction. MATERIALS AND METHODS: We prospectively enrolled 98 patients who underwent bladder multiparametric magnetic resonance imaging using a next-generation magnetic resonance imaging scanner before transurethral resection of bladder tumor. Tumors were categorized according to VI-RADS, and we ultimately analyzed 68 patients with pathologically confirmed urothelial bladder cancer. We used receiving operating characteristic curve analyses to assess the predictive accuracy of VI-RADS for muscle invasion. Sensitivity, specificity, positive/negative predictive value, accuracy and area under the curve were calculated for different VI-RADS score cutoffs. RESULTS: Muscle invasion was detected in the transurethral resection of bladder tumor specimens of 18 patients (26%). The optimal cutoff value of the VI-RADS score was determined as ≥4 based on the receiver operating curve analyses. The accuracy of diagnosing muscle invasion using a cutoff of VI-RADS ≥4 was 94% (AUC 0.92). Additionally, we assessed the utility of denoising deep learning reconstruction. Combination with denoising deep learning reconstruction significantly improved the AUC of category by T2-weighted imaging, and of the 4 patients who were misdiagnosed by the final VI-RADS score 3 were correctly diagnosed by T2-weighted imaging+denoising deep learning reconstruction. CONCLUSIONS: In this prospective validation study with a next-generation magnetic resonance imaging scanner, VI-RADS showed high predictive accuracy for muscle invasion in patients with bladder cancer before transurethral resection of bladder tumor. Combining T2-weighted imaging with denoising deep learning reconstruction might further improve the diagnostic accuracy of VI-RADS.


Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Aprendizado Profundo , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Imageamento por Ressonância Magnética Multiparamétrica/instrumentação , Ruído , Valor Preditivo dos Testes , Estudos Prospectivos , Projetos de Pesquisa
13.
Res Rep Urol ; 12: 495-501, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33117749

RESUMO

PURPOSE: Urinary incontinence (UI) is a common health-related problem in the female population and has a negative impact on many aspects of patients' quality of life including mental problems. This study evaluated the mental effects of mid-urethral sling (MUS) surgery in female patients with stress UI or stress UI-dominant mixed UI. PATIENTS AND METHODS: Women with stress UI or stress UI-dominant mixed UI who underwent MUS surgery and were enrolled in this study and followed up for 12 months. The International Consultation of Incontinence Questionnaire-Short Form (ICIQ-SF) and the Hospital Anxiety and Depression Scale (HADS) at baseline and 12 months after the MUS to evaluate the efficacy of the surgery. RESULTS: At baseline, proportions of the patients with anxiety (HADS-Anxiety score of ≥8) and depression (HADS-Depression score of ≥8) were 21.6% (22/102) and 24.5% (25/102), respectively. At 12 months postoperatively, the median ICIQ-SF score, HADS-Anxiety score, and HADS-Depression score were significantly improved compared with their baseline values (p<0.001 for ICIQ-SF and HADS-Depression, p=0.011 for HADS-Anxiety). At 12 months postoperatively, changes in the ICIQ-SF and HADS-A scores showed a moderate correlation (r = 0.578, p < 0.001), and changes in the ICIQ-SF and HADS-D scores had a strong correlation (r = 0.838, p <0.001). CONCLUSION: This study demonstrated that MUS surgery significantly improved UI, anxiety, and depression with significant correlations in their symptoms. This suggests that improvement of the patients' UI helped to relieve their symptoms of anxiety and depression.

14.
BMC Urol ; 20(1): 133, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32859201

RESUMO

BACKGROUND: Although the albumin-to-globulin ratio (AGR) is a promising biomarker for various malignancies, few studies have investigated its prognostic significance for upper tract urothelial carcinoma (UTUC). METHODS: This retrospective study conformed to the REporting recommendations for tumour MARKer prognostic studies (REMARK) guideline. We reviewed 179 patients with UTUC who underwent radical nephroureterectomy at our institution between 2008 and 2018. Associations of preoperative clinicopathological factors, including the AGR, with cancer-specific survival (CSS) and overall survival (OS) were assessed. The Cox proportional hazards model was used for univariate and multivariable analyses. AGR was dichotomized as < 1.25 and ≥ 1.25, according to the most discriminatory cutoff determined from the receiver operating characteristic curve analysis. RESULTS: During a median follow-up of 34 months after surgery, 37 patients died from UTUC and 13 died of other causes. The preoperative AGR significantly correlated with pathological T stage, pathological N stage, and adjuvant chemotherapy. Multivariate analyses demonstrated that a decreased (< 1.25) preoperative AGR was an independent poor prognostic factor for both CSS (hazard ratio [HR] = 2.81, P <  0.01) and OS (HR = 2.09, P <  0.05). CONCLUSIONS: Preoperative AGR < 1.25 might serve as a useful prognostic marker for patients with UTUC undergoing radical nephroureterectomy.


Assuntos
Carcinoma de Células de Transição/sangue , Neoplasias Renais/sangue , Albumina Sérica/análise , Soroglobulinas/análise , Neoplasias Ureterais/sangue , Idoso , Carcinoma de Células de Transição/mortalidade , Feminino , Humanos , Neoplasias Renais/mortalidade , Masculino , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias Ureterais/mortalidade
15.
Prostate Int ; 8(1): 16-21, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32257973

RESUMO

PURPOSE: The aim of the present study was to evaluate the pathological and oncological outcomes of laparoscopic radical prostatectomy (LRP) and robot-assisted radical prostatectomy (RARP) performed by one surgeon at a single center. SUBJECTS: We evaluated 700 patients with localized prostate cancer (i.e., 250 received LRP and 450 received RARP) in the study. The clinicopathological outcomes, positive surgical margin (PSM) frequency, and biochemical recurrence (BCR)-free survival were compared between LRP and RARP. RESULTS: At diagnosis, the median patient age and level of prostate-specific antigsen in the serum for LRP were 68 years and 8.1 ng/ml, respectively, while those for RARP were 66 years and 7.7 ng/ml, respectively. In the LRP group, the overall PSM rate was 31.2% (11.1% for pT2a, 19.0% for pT2b, 25.0% for pT2c, 60.0% for pT3a, 64.3% for pT3b, and 50% for pT4). In the RARP group, the overall PSM rate was 20.7% (4.8% for pT2a, 15.9% for pT2b, 12.9% for pT2c, 36.9% for pT3a, 46.2% for pT3b, and 100% for pT4). The PSM rate was significantly lower for RARP in men with pT2c, pT3a, or pT3b disease (p = 0.006, p = 0.009, and p = 0.027, respectively). Based on the multivariate analysis, RARP reduced the risk of BCR (hazard ratio = 0.8, p = 0.014). CONCLUSIONS: We compared the pathological findings and rates of BCR-free survival between patients who received LRP and those who received RARP at a single center. The rate of BCR-free survival was significantly higher in men classified as D'Amico high-risk patients who received RARP versus that reported in D'Amico high-risk patients who received LRP.

16.
BMC Urol ; 20(1): 23, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32160878

RESUMO

BACKGROUND: Acute pyelonephritis (APN) with obstructive uropathy often causes sepsis. Recently, sepsis was redefined using the sequential organ failure assessment (SOFA) score, based on the new Sepsis-3 criteria. We investigated predictors for sepsis using this new definition in patients with obstructive APN associated with upper urinary tract calculi. METHODS: We retrospectively evaluated patients who were admitted to our hospital for treatment of obstructive APN associated with upper urinary tract calculi. Blood and urine samples were collected before treatment of obstructive APN. Treatment included adequate antimicrobial therapy and emergency drainage to decompress the renal collecting system. We diagnosed sepsis using the new Sepsis-3 definition. We assessed predictors for sepsis by multivariate logistic regression analysis. RESULTS: Sixty-one patients were included in this study. Overall, all patients underwent emergency drainage, and 11 (18.0%) patients showed sepsis. There were no significant differences in performance status or comorbidities between sepsis and non-sepsis groups. Platelet count and serum albumin level were significantly lower in the sepsis group than in the non-sepsis group (p = 0.001 and p = 0.016, respectively). Procalcitonin (PCT) and presepsin (PSEP) levels were significantly higher in the sepsis group than in the non-sepsis group (p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that PCT elevation (OR = 13.12, p = 0.024) and PSEP elevation (OR = 13.13, p = 0.044) were independent predictors for sepsis. CONCLUSIONS: Elevation of PCT and PSEP levels before treatment might predict the development of sepsis in patients with obstructive APN.


Assuntos
Receptores de Lipopolissacarídeos/sangue , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Pielonefrite/sangue , Sepse/sangue , Doença Aguda , Idoso , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pielonefrite/complicações , Pielonefrite/diagnóstico , Estudos Retrospectivos , Sepse/diagnóstico , Sepse/etiologia
17.
J Endourol ; 34(6): 676-681, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31984760

RESUMO

Purpose: The conventional flexible ureteroscope has limited access into the lower calix and often causes biomechanical stress to surgeons. Recently, a novel flexible ureteroscope with an omnidirectional bending tip with a joystick-type control unit (URF-Y0016; Olympus, Japan) was developed. We verified the operability and ergonomics of the URF-Y0016 compared with that of the conventional flexible ureteroscope (URF-P6) in bench models. Materials and Methods: Twenty-five medical students with no experience in performing ureteroscopic manipulation were randomly assigned to URF-Y0016 and URF-P6 leading groups in a crossover study. The task was performed using a simple model as an exploratory experiment and an artificial kidney model as an evaluation experiment. We compared the task completion times of both groups, while the factors influencing task completion time were entered into a multivariate model. The ergonomics of endourology were compared using a validated questionnaire. Results: The task completion time in the URF-Y0016 group was significantly shorter than in the URF-P6 group (p < 0.001). The URF-Y0016 group showed no difference in task completion time between each renal calix, whereas in the URF-P6 group the task completion time in the lower calix was significantly longer than that in other calices (p < 0.001). In multivariate analysis, the model of flexible ureteroscope used significantly influenced the task completion time (p < 0.001). The ergonomics of the URF-Y0016 group were significantly better than those of the URF-P6 group (p = 0.001). Conclusions: URF-Y0016 may offer benefits in ureteroscopy performance over the conventional flexible ureteroscope.


Assuntos
Ureteroscópios , Ureteroscopia , Estudos Cross-Over , Desenho de Equipamento , Humanos , Japão
18.
IJU Case Rep ; 2(4): 218-220, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32743418

RESUMO

INTRODUCTION: Since pheochromocytomas present with various complications due to catecholamine hypersecretion, their perioperative management needs special attention. CASE PRESENTATION: A 45-year-old man visited our hospital with a complaint of abdominal swelling. Radiological and endocrinological assessments determined the tumor as a giant (>20 cm) cystic pheochromocytoma. After administration of doxazosin, the patient underwent radical surgery. Since the tumor was extremely large and fixed to surrounding structures, we punctured it and aspirated cystic fluid to improve the tumor's mobility. However, during the aspiration, the patient developed acute hypotension, which could be reversed by suction withdrawal and vasopressor administration. A similar event occurred during a second aspiration. Eventually, the tumor was successfully excised with negative surgical margin. The cystic fluid proved to contain extremely high concentrations of catecholamines, which might result in the hypotension. CONCLUSION: We report the first case who developed acute hypotension due to aspiration of cystic fluid from giant pheochromocytoma.

19.
Case Rep Oncol ; 11(1): 6-10, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29515402

RESUMO

We report a case of a vesicoenteric fistula arising from an adenocarcinoma of ectopic pancreatic tissue in a Meckel diverticulum in a 58-year-old man. The patient suffered from refractory micturition pain and increased urinary frequency. Computerized tomography with a contrast agent showed a ring-shaped enhanced mass near the dome of the urinary bladder. Magnetic resonance imaging showed a cystic mass close to the urinary bladder with partly irregular wall and fistula formation to the urinary bladder. Surgical findings showed a Meckel diverticulum in the ileum, which formed a fistula with the urinary bladder, and Meckel diverticulectomy and partial cystectomy were performed. Histological findings revealed a vesicoenteric fistula arising from a papillary adenocarcinoma of ectopic pancreatic tissue in a Meckel diverticulum. The patient has survived without recurrence for more than 4 years since surgery.

20.
Prostate ; 78(8): 576-582, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29508425

RESUMO

OBJECTIVE: We examined whether androgen receptor splice variant 7 (AR-V7) in circulating tumor cell(CTC)clusters can be used to predict survival in patients with bone metastatic castration resistant-prostate cancer (mCRPC) treated with abiraterone or enzalutamide. METHODS: We retrospectively enrolled 98 patients with CRPC on abiraterone or enzalutamide, and investigated the prognostic value of CTC cluster detection (+ v -) and AR-V7 detection (+ v -) using a CTC cluster detection - based AR-V7 mRNA assay. We examined ≤50% prostate-specific antigen (PSA) responses, PSA progression-free survival (PSA-PFS), clinical and radiological progression-free survival (radiologic PSF), and overall survival (OS). We then assessed whether AR-V7 expression in CTC clusters identified after On-chip multi-imaging flow cytometry was related to disease progression and survival after first-line systemic therapy. RESULTS: All abiraterone-treated or enzalutamide-treated patients received prior docetaxel. The median follow-up was 20.7 (range: 3.0-37.0) months in the abiraterone and enzalutamide cohorts, respectively. Forty-nine of the 98 men (50.0%) were CTC cluster (-), 23 of the 98 men (23.5%) were CTC cluster(+)/AR-V7(-), and 26 of the 98 men (26.5%) were CTC cluster(+)/AR-V7(+). CTC cluster(+)/AR-V7(+) patients were more likely to have EOD ≥3 at diagnosis (P = 0.003), pain (P = 0.023), higher alkaline phosphatase levels (P < 0.001), and visceral metastases (P < 0.001). On multivariable analysis, pretherapy CTC cluster(+), CTC cluster(+)/AR-V7(-), and ALP >UNL were independently associated with a poor PSA-PFS, radiographic PFS, and OS in abiraterone-treated patients and enzalutamide-treated patients. CONCLUSION: The CTC clusters and AR-V7-positive CTC clusters detected were important for assessing the response to abiraterone or enzalutamide therapy and for predicting disease outcome.


Assuntos
Acetato de Abiraterona/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/química , Feniltioidantoína/análogos & derivados , Neoplasias de Próstata Resistentes à Castração/química , Receptores Androgênicos/análise , Idoso , Benzamidas , Biomarcadores Tumorais/análise , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Resistencia a Medicamentos Antineoplásicos , Humanos , Masculino , Células Neoplásicas Circulantes/química , Nitrilas , Feniltioidantoína/uso terapêutico , Valor Preditivo dos Testes , Prognóstico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/mortalidade , Neoplasias de Próstata Resistentes à Castração/patologia , Receptores Androgênicos/genética
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA