Predictors of renal function deterioration at one year after off-clamp non-renorrhaphy partial nephrectomy.

BACKGROUND: Preservation of renal function is an important goal in renal cell carcinoma-related surgery. Although several case-dependent techniques for renal pedicle clamping and hemostasis have been used, their effects on long-term renal function are controversial. METHODS: The clinical records of 114 patients who underwent off-clamp non-renorrhaphy open partial nephrectomy at our hospital were retrospectively reviewed. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors of eGFR decline 12 months post-surgery and overtime deterioration of renal function were identified using a multivariate regression analysis. RESULTS: The median patient age was 65 years, and the median tumor size was 27 mm. The mean eGFR preservation at 1, 3, and 12 months post-surgery were 90.1%, 89.0%, and 86.9%, respectively. eGFR decline at 1 and 3 months were associated with poor eGFR preservation at 12 months with the odds ratio (95% confidence interval (CI)) of 1.97 and 3.157, respectively. Multivariate regression analyses revealed that tumor size was an independent predictor of eGFR decline at 12 months. Among 65 patients with eGFR preservation over 90% at 1 month post-surgery, eGFR value of 28 patients deteriorated below 90% at 12 months post-surgery compared with preoperative eGFR. Tumor size and eGFR preservation at 1 month were independent predictors of long-term renal function deterioration. CONCLUSION: Tumor size predicted eGFR decline 12 months post-surgery. Only a mild decline in eGFR was observed between 3 and 12 months after open partial nephrectomy. Tumor size and eGFR preservation at 1 month predicted the deterioration of renal function over time.

Advantages of enhanced recovery after surgery program in robot-assisted radical cystectomy.

Radical cystectomy is a gold-standard treatment for muscle-invasive bladder cancer. We recently introduced robot-assisted radical cystectomy (RARC) with perioperative enhanced recovery after surgery (ERAS). The medical records of patients with bladder cancer who underwent open radical cystectomy (ORC) or RARC/ERAS at NTT Medical Center Tokyo were retrospectively reviewed to compare the surgical outcomes, hospital stay, and medical costs between groups. Multidisciplinary full ERAS items were provided for the RARC/ERAS group. The median estimated blood losses in the ORC and RARC/ERAS groups were 650 and 100 mL, and the median operative times were 312 and 445 min, respectively. In addition, the median times to liquid food intake in these groups were 6 and 0 days, the median times to first flatus and first defecation were 2 and 1 day, and 3 and 1.5 days, respectively. The rates of postoperative ileus in the ORC and RARC/ERAS groups were 27.5% and 4.5%, and the median postoperative hospital stays was 26.5 and 12 days, respectively. Medical costs excluding surgery were significantly lower in the RARC/ERAS group. In conclusion, RARC/ERAS represents a safe treatment option for muscle-invasive bladder cancer with decreased perioperative complications and lower medical costs.

Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy.

Background: There is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy. Therefore, this retrospective study aimed to identify predictive factors of perioperative decline in renal function after off-clamp, non-renorrhaphy open partial nephrectomy. Methods: Clinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy was performed using a soft coagulation system. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery. Results: The median operation time was 122 minutes, and the median volume of estimated blood loss was 155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Estimated blood loss was an independent predictor of perioperative decline in eGFR 5 days after surgery [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96, 0.98; P<0.001]. Preoperative eGFR and estimated blood loss were independent predictors of perioperative decline in eGFR 1 month after surgery (OR: 0.86; 95% CI: 0.77, 0.95; P=0.007 and OR: 0.98; 95% CI: 0.97, 0.99; P<0.001, respectively). Age, preoperative eGFR, and estimated blood loss were independent predictors of perioperative decline in eGFR 3 months after surgery (OR: 0.64; 95% CI: 0.54, 0.81; P<0.001, OR: 0.72; 95% CI: 0.61, 0.85; P<0.001; and OR: 0.98; 95% CI: 0.97, 0.99; P=0.004, respectively). Conclusions: Estimated blood loss during surgery was a predictor of perioperative decline in eGFR within 3 months after off-clamp, non-renorrhaphy open partial nephrectomy. Age was a predictor of perioperative decline in eGFR 3 months after surgery.

Granulomatous prostatitis with high suspicion of prostatic adenocarcinoma on radiological imaging.

INTRODUCTION: Granulomatous prostatitis is a benign inflammatory condition of the prostate that may mimic prostatic adenocarcinoma on magnetic resonance imaging findings. Even in the era of multiparametric magnetic resonance imaging, the differential diagnosis of granulomatous prostatitis from malignancy remains difficult. CASE PRESENTATION: A 69-year-old man with abnormal magnetic resonance imaging and positron emission tomography/magnetic resonance imaging findings, and a prostate-specific antigen value of 2.48 ng/mL underwent prostate needle biopsy. He had a history of urinary tract infection 3 months prior to presentation. Multiparametric magnetic resonance imaging showed low-intensity signals on T2-weighted images, slightly high-intensity signals on diffusion-weighted images, and low values on apparent diffusion coefficients. The prostate imaging-reporting and data system version 2 score was 3. Histological examination revealed granulomatous prostatitis. CONCLUSION: For patients with preceding urinary tract infections, granulomatous prostatitis should be considered as a differential diagnosis, even when magnetic resonance imaging and positron emission tomography suggest prostatic adenocarcinoma.

Assessment of surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy for ≥T1b renal tumours.

PURPOSE: To assess the surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy. In the era of robot-assisted surgeries, open partial nephrectomy remains a surgical option for ≥ T1b renal tumours. Although the necessity of renal pedicle clamping and renorrhaphy in open partial nephrectomy for larger tumours remains to be discussed, reports on this issue are rare. METHODS: Twenty-seven open partial nephrectomies for ≥ T1b renal tumours were performed without renal pedicle clamping or renorrhaphy. A soft coagulation system was used to control bleeding from the resection bed. Surgical results, complications, and predictors of perioperative estimated glomerular filtration rate (eGFR) preservation at 1 month and 3 months after surgery were analysed. RESULTS: The median estimated volume of blood loss was 420 mL. The rates of perioperative eGFR preservation were 88.9 and 87.3% at 1 and 3 months after surgery, respectively. Tumour size was an independent predictor of perioperative eGFR preservation at 1 month after surgery, whereas age and exophytic/endophytic properties of the tumour were independent predictors of perioperative eGFR preservation at 3 months after surgery. CONCLUSION: Open partial nephrectomy without renal pedicle clamping or renorrhaphy could be safely performed for ≥ T1b renal tumours, even when tumours were entirely endophytic and located close to the renal pedicle. Mild perioperative eGFR reduction was observed. Although surgical indications should be carefully considered in these cases, off-clamp open partial nephrectomy without renorrhaphy is a feasible procedure for patients with ≥ T1b renal tumours.

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

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

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

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