[A Case of Partial Prostatectomy for Advanced Rectal Cancer Involving the Prostate in the Jack-Knife Position].

A 72-year-old man was diagnosed with advanced rectal cancer possibly involving the prostate on magnetic resonance imaging (MRI) findings. Following neoadjuvant chemoradiotherapy (CRT), he underwent curative surgery. Confirming negative surgical margin through intraoperative pathological evaluation, colorectectomy with partial prostatectomy was performed in the jack-knife position. No evidence of local recurrence of the tumor was observed one year after surgery without symptoms of the urinary tract. Partial prostatectomy is a choice to be taken into account in the treatment of advanced rectal cancer achieving both the good surgical outcome and the patient's quality of life (QOL).

[Adenocarcinoma of an augmented bladder 49 years after enterocystoplasty : a case report].

A 69-year-old man visited our hospital presenting with bladder tamponade. The patient had undergone bladder augmentation using the ileocecum and the ascending colon for an atrophy bladder due to tuberculosis 49 years previously. Cystoscopy revealed an invasive bladder tumor in the anastomotic region of the bladder and the intestine. He underwent cystourethrectomy and ileal conduit (utilizing the previous ureteroileal anastomosis). A deliberate procedure of urinary tract diversion was required because of the severe postoperative adhesion by the augmentation. The pathological diagnosis showed adenocarcinoma. The tumor spread over the intestinal tract side and the deepest part reached the adventitia of the intestinal tract. The patient is receiving additional therapy of combined modality including chemotherapy.

[Carboplatin plus irinotecan induced partial response in a patient with small cell carcinoma of the prostate; a case report].

An 80-year-old man with prostate cancer receiving hormone therapy presented with urinary retention. The computed tomographic scan showed metastases to the lung, liver, and lymph nodes, as well as increased prostate volume. Transurethral resection of the prostate (TURP) was performed, and the resected specimen was pathologically found to be a small cell carcinoma of the prostate. The patient was treated with a combination of carboplatin and irinotecan, and achieved a partial response : size reduction of the prostate and the metastatic lesions, and decreased neuron specific enolase (NSE) level. The chemotherapy with carboplatin and irinotecan is reported to have fewer serious adverse effects, and equivalent efficacy to the cisplatin/etoposide chemotherapy. Therefore, this regimen could also be a treatment option for the patients with small cell carcinoma of the prostate.

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.

[Acquired hemophilia presenting as gross hematuria and perineal subcutaneous hemorrhage after prostate biopsy: a case report].

Acquired hemophilia is a rare disease that can result in life threatening bleeding associated with coagulation factor VIII inhibitors. A 61-year-old man presented gross hematuria and urinary retention. A retrograde pyelography, cystoscopy, abdominal computed tomography and prostate biopsy showed no finding suggestive of malignancy. Extensive subcutaneous hemorrhage over the perineal region and severe hematuria were observed after the prostate biopsy. Further hematological evaluation showed the presence of coagulation factor VIII inhibitors, which led to the diagnosis of acquired hemophilia. All symptoms disappeared without complication after administration of predonisolone and recombinant activated factor VII.

[Two cases of congenital pelvic arteriovenous malformation in male].

Congenital pelvic arteriovenous malformation(AVM) is extremely rare, especially in males. Herein we report two males with pelvic AVM. Computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated markedly dilated, and tortuous vessels in the pelvis in both patients. The first patient, a 77- year-old male, presented with difficulty in voiding and weak urinary stream. He was scheduled to have a prostate biopsy for suspicion of prostate cancer with pelvic lymph node swelling. However, the mass was diagnosed as pelvic AVM with MRI, and the prostate biopsy was cancelled. He has been followed conservatively since then. The second patient, a 55-year-old male, presented with gross hematuria which caused severe hemorrhagic hypovolemic shock. He had pelvic AVM, and he was treated with transcatheter arterial embolization two times. When patients with this disease present with general urological symptoms, urological procedures, without attention to this disease, might cause severe complications such as serious hemorrhage. We discuss the clinical course and the treatment for AVM, and review the literature.

[Hormone refractory prostate carcinoma metastasizes to the penis: a case report].

A 76-year-old man presented with urinary retention and penile discomfort. At 67-years-old, he was diagnosed with stage D2 prostate cancer and then, was treated with hormone therapy. Several nodules were observed on the glans, and histological examination of the penile tumor biopsy showed metastatic adenocarcinoma of the prostate. For the purpose of maintaining quality of life, transurethral resection of the prostate and partial penectomy were done. Twelve months have passed after the surgery, he is free from discomfort and progressive disease has not been observed.

[Hormone refractory prostate carcinoma metastasizes to the penis: a case report.]

A 76-year-oldman presentedwith urinary retention andpenile discomfort. At 67 years old, he was diagnosedwith stage D2 prostate cancer andthen, was treatedwith hormone therapy. Several nodules were observedon the glans, andhistological examination of the penile tumor biopsy showedmetastatic adenocarcinoma of the prostate. For the purpose of maintaining quality of life, transurethral resection of the prostate andpartial penectomy were done. Twelve months have passedafter the surgery, he is free from discomfort and progressive disease has not been observed.

[A randomized study of prophylactic intravesical instillation of pirarubicin (THP) prior to transurethral resection of superficial bladder cancer].

A prospective randomized study was conducted to evaluate the efficacy of prophylactic intravesical instillation of pirarubicin (THP) prior to transurethral resection (TUR) of superficial bladder cancer. A total of 63 patients were randomized into two groups, the THP group and the control group. In the THP group, 30 mg of THP dissolved in 50 ml saline was administered 4 times intravesically for 4 consecutive days before TUR. In the control group, no instillation was performed before TUR. The patients were followed by cystoscopy and urinary cytology every 3 months. The non-recurrence rates in the THP group and control group were 54.1% versus 37.6% at 1 year and 40.4% versus 26.8% at 2 years, respectively (P = 0.086). Time to recurrence for tumors larger than 1 cm was significantly longer in the THP group (P = 0.0137). Time to recurrence for single and grade 1+2 tumors tended to be longer in the THP group (P = 0.09, P = 0.079). No significant adverse effects were observed in any patient. Our findings suggest that intravesical THP instillation prior to TUR would be effective for patients with single, low grade lesions larger than 1 cm of superficial bladder cancer.

Chronic expanding hematoma in the psoas muscle.

We report an unusual case of chronic expanding hematoma in the psoas muscle. A 53-year-old man was admitted for evaluation of a mass shadow in the left lower lung field on chest X-rays. He had also been suffering from dull left back pain. A computed tomography scan showed a cystic lesion with a rim enhancement in the left retroperitoneal space. Mixed signal intensity in a mosaic pattern was seen on a T2-weighted magnetic resonance image. We could not rule out a suspicion of a neoplastic intratumoral hemorrhage. Due to increased pain and the definite diagnosis, surgery was performed. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The expansion process is thought to be due to the irritant effects of blood and its breakdown products, which cause repeated exudation and bleeding from capillaries in the granulation tissues.

[Endovascular stent graft for management of ureteroarterial fistula: a case report].

We report a case of ureteral-iliac artery fistula and its minimally invasive management with endovascular stent grafting. A 76-year-old male was admitted with massive gross hematuria from an ilial conduit. He underwent a radical cystectomy with ileal loop urinary diversion for bladder cancer 7 months ago and had undergone placement of a 7 Fr single-J ureteral catheter for repair of a partial disruption of the left ureteroileal anastomosis. Although the fistula was not confirmed radiographically, a left ureteral-common iliac artery fistula was highly suspected. The patient was treated by percutaneous placement of an autoexpandable covered stent graft across the left common iliac and left external iliac artery. After successful endovascular management of the ureteroarterial fistula, the patient's hematuria resolved and he recovered fully. During 10 months of follow up, he has been free of hemorrhagic episodes. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide a safety treatment alternative.

Primary carcinoid tumor arising in a retroperitoneal mature teratoma in an adult.

An extremely rare case of a primary carcinoid tumor arising in a mature retroperitoneal teratoma is reported. A 53-year-old woman was admitted for further examination of an incidental retroperitoneal mass with calcification. Computed tomography scans demonstrated a tumor with fat, soft tissue and bone densities on the left renal hilum. Surgical excision of the tumor was performed with a preoperative diagnosis of retroperitoneal teratoma. The pathological diagnosis was mature teratoma, including all three germ layers. A carcinoid tumor was evident among teratoid tissues and it was thought to be a teratoma with malignant transformation. The patient did not have a carcinoid syndrome and had an uneventful recovery. She has been followed for 31 months with no recurrence. Carcinoid tumors rarely occur in teratomas of the ovary and the testis and, to our knowledge, this is the first case of carcinoid arising in a retroperitoneal mature teratoma.

[Mixed epithelial and stromal tumor growing with polypoid pattern in the renal pelvis].

A 68-year-old woman was found incidentally to have right hydronephrosis and a renal pelvic mass by abdominal ultrasonography. Radiographic examinations revealed a heterogeneous renal pelvic tumor, and right nephroureterectomy was performed. The tumor was well circumscribed yellow-whitish solid mass with scattered cysts. Histologically, the tumor was composed of both mesenchymal and epithelial components. The mesenchymal elements consisted of fibroblasts and smooth muscle cells, and the epithelial elements of cystic and tubular structures lined by cuboidal epithelium. Atypia and mitoses were not identified. The patient was free of recurrence 42 months postoperatively. Mixed epithelial and stromal tumor of the kidney is a recently recognized neoplasm that occurs almost exclusively in perimenopausal woman. Similar tumors have been reported previously under various names, including adult mesoblastic nephroma and cystic hamartoma of the renal pelvis. Histogenesis of the tumor is still controversial.

[Clinical effects of naftopidil on nocturia associated with benign prostatic hyperplasia].

We studied the efficacy of naftopidil (50 mg/day) on nocturia associated with benign prostatic hyperplasia in 35 patients (62-80 years old). The patients had BPH > 20 ml, nocturia, more than 3 times, international prostate symptom score (IPSS) > 7, quality of life score (QOL) < 1, and maximum flow rate (Qmax) < 15 ml/sec. They received naftopidil for more than 6 weeks. IPSS, QOL, Qmax, micturition volume, and side effects were analyzed. Naftopidil was effective for nocturia associated with benign prostatic hyperplasia, especially when taken at night.

Neoadjuvant flutamide monotherapy for locally confined prostate cancer.

BACKGROUND: We compared the clinical effects and impact on quality of life (QOL) of patients who received a 3-month course of flutamide monotherapy before radical prostatectomy with those who received a 3-month course of luteinizing hormone-releasing hormone (LHRH) agonist monotherapy. METHODS: Thirty-seven patients with non-metastatic prostate cancer were enrolled in this study (19, flutamide; 18, LHRH agonist). The rates of change of serum prostate-specific antigen (PSA) and testosterone levels, downsizing of prostate volume, the rate of organ confined disease, adverse effects and perioperative scores measured using the European Organization for Research and Treatment of Cancer Prostate Cancer Quality of Life Questionnaire (EORTC-P) and the Sapporo Medical University Sexual Function Questionnaire (SMUF) were analyzed. RESULTS: At radical prostatectomy, pathological variables were not significantly different in the two groups. Serum testosterone level was significantly higher (mean 359.2 compared to 10.5, P < 0.001), complete response rate of PSA (13% compared to 57%, P = 0.028) and rate of downsizing of prostate volume (mean, -17.7% compared to -35.4%, P = 0.038) were significantly lower in the flutamide group than in the LHRH group. After neoadjuvant hormone therapy, the scores on the sexual problem domain of EORTC-P (P = 0.033) and sexual desire score of SMUF (P = 0.021) were significantly higher in the flutamide group than in the LHRH group. At a median follow-up of 34 months after prostatectomy, biochemical failure-free survival rate in the flutamide group did not differ from that in the LHRH group. CONCLUSION: This study suggests that flutamide monotherapy can be an acceptable modality as an option for neoadjuvant hormone therapy.