Comparisons of in-hospital fee and surgical outcomes between robot-assisted, laparoscopic, and open radical cystectomy: a Japanese nationwide study.

OBJECTIVE: To evaluate in-hospital fees and surgical outcomes of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) using a Japanese nationwide database. METHODS: All data were obtained from the Diagnosis Procedure Combination database between April 2020 and March 2022. Basic characteristics and perioperative indicators, including in-hospital fees, were compared among the RARC, LRC and ORC groups. Propensity score-matched comparisons were performed to assess the differences between RARC and ORC. RESULTS: During the study period, 2931, 1311 and 2435 cases of RARC, LRC and ORC were identified, respectively. The RARC group had the lowest in-hospital fee (median: 2.38 million yen), the shortest hospital stay (26 days) and the lowest blood transfusion rate (29.5%), as well as the lowest complication rate (20.9%), despite having the longest anesthesia time (569 min) among the three groups (all P < 0.01). The outcomes of LRC were comparable with those of RARC, and the differences in these indicators between the RARC and ORC groups were greater than those between the RARC and LRC groups. In propensity score-matched comparisons between the RARC and ORC groups, the differences in the indicators remained significant (all P < 0.01), with an ~50 000 yen difference in in-hospital fees. CONCLUSIONS: RARC and LRC were considered to be more cost-effective surgeries than ORC due to their superior surgical outcomes and comparable surgical fees in Japan. The widespread adoption of RARC and LRC is expected to bring economic benefits to Japanese society.

Intranodal glue embolization for lymphorrhea following inguinal lymphadenectomy in penile cancer: A case report.

An 86-year-old man underwent total penectomy and bilateral inguinal lymphadenectomy (ILND) for penile cancer with an enlarged right inguinal lymph node. The accumulation of 100-150 ml of lymphatic fluid was observed in the right inguinal drain in a day after surgery. Compression was performed, without any improvement in lymphorrhea. During the right inguinal lymphangiography performed on postoperative day (POD) 28, lymphorrhea was still detected. Lymphorrhea was improved 2 days after intranodal glue embolization (IGE) was performed using a mixture of lipiodol and n-butyl-2 cyanoacrylate (NBCA). IGE was effective for intractable lymphorrhea after ILND in penile cancer.

Gradual resolution over time of recurrent dystrophic calcification after bipolar transurethral resection of the prostate: A case report.

Dystrophic calcification (DC) after transurethral resection of prostate (TURP) is rare. In our patient, bipolar TURP was performed by an experienced urologist, without complications. Seven months later, he developed a tingling urethral sensation, difficulty in urination, urgency, and perineal discomfort. Computed tomography (CT) showed a high-density area occupying the prostatic resection cavity. Re-surgery involved laser ablation of the DC. Two months later, the DC recurred. At the second re-surgery, the DC was removed without using electricity. Repeat CT at 13 months showed near complete disappearance of the DC. Wound healing might interrupt the vicious cycle of DC recurrence.

Differential treatment responses to immune checkpoint inhibitor (ICI) therapy in a case of multiple primary malignancies: the programmed death ligand-1 (PD-L1) negative ureteral and lung metastasis from a clear cell renal cell carcinoma appearing after robotic-assisted partial nephrectomy progressed after ICI therapy, while synchronous PD-L1-positive primary lung squamous cell carcinoma responded very well to ICI therapy: a case report.

BACKGROUND: Renal cell carcinoma (RCC) and non-small cell lung cancer (NSCLC) are representative malignancies that respond well to immune checkpoint inhibitors (ICIs). Research has been conducted to identify biomarkers, such as programmed death ligand-1 (PD-L1), that would allow the response to ICI therapy to be predicted; however, the complex tumor immune system consisting of both host and tumor factors may also exert an influence. CASE PRESENTATION: Computed tomographic imaging (CT) incidentally revealed a left renal mass, and a left pulmonary nodule with multiple lymph node metastases (LNMs). Firstly, video-assisted thoracic surgery revealed a lung tumor invading the chest wall. Histologically, the findings of the tumor were consistent with squamous cell carcinoma (SCC), and immunohistochemistry (IHC) showed positive PD-L1 expression. The renal tumor was excised by robotic-assisted partial nephrectomy (RAPN). Histologically, the renal tumor showed the features of clear cell carcinoma (CCC). Four months after the RAPN, CT revealed left hydronephrosis caused by an enhancing ureteral tumor. Then, multiple right lung metastases appeared, and the left lung tumor increased. Following treatment including atezolizumab, the primary lung SCC and the multiple LNMs almost disappeared completely, while the ureteral and right lung metastases showed progression. The ureteral metastasis was resected by left open nephroureterectomy. Histology of the ureteral tumor revealed features consistent with CCC. Histological examination of the multiple right lung metastases that were resected by partial lobectomy via a small thoracic incision also revealed features consistent with CCC. Two months after nephroureterectomy, a solitary left lung metastasis was treated by nivolumab and ipilimumab. Six months after nephroureterectomy, the patient died of RCC. Further studies of specimens revealed that the tumor cells in the primary RCC and the ureteral and lung metastases showed negative results of IHC for PD-L1. CONCLUSIONS: The responses to ICI therapy of concomitant RCC and NSCLC were quite different. The PD-L1 expression status in individual tumors in cases of multiple primary malignancies (MPMs) may directly predict the response of each malignancy to ICI therapy, because the host immune system, which may affect the response to ICI therapy, could be the same in MPMs.

Bladder metastasis with additional metastases in multiple other organs 4 years after radical nephrectomy for clear cell renal cell carcinoma: a case report and review of the literature.

BACKGROUND: Renal cell carcinoma rarely metastasizes to the bladder, and its biological behavior is not yet fully understood. CASE PRESENTATION: In our case (54-year-old Japanese woman), computed tomography evaluation suggested the presence of a bladder metastasis, associated with additional metastases in the lungs, mediastinal lymph nodes, ribs, and renal bed, 4 years after radical nephrectomy for renal cell carcinoma. The histological findings of the metastatic bladder tumor were consistent with those of clear cell carcinoma. The mediastinal lymph node, rib, and renal bed metastases responded to treatment with an immune checkpoint inhibitor administered for 12 months after surgery for the bladder and lung metastases. In patients with bladder metastasis, absence of metastases in other organs and an interval of more than 1 year after nephrectomy are known to be favorable prognostic factors. Interestingly, in our case, the bladder metastasis was detected more than 1 year after nephrectomy, which was a favorable factor, but there were also metastases in other organs, which was an unfavorable factor. Therefore, we reviewed the literature, including that pertaining to targeted therapy and immune checkpoint inhibitor therapy published in the last two decades, to analyze the clinical significance of the presence of additional metastasis in other organs in renal cell carcinoma (clear cell type, which is the predominant subtype) patients with bladder metastasis. CONCLUSIONS: Patients with bladder metastasis after nephrectomy for renal cell carcinoma also having metastases in other organs may respond to targeted therapy and immune checkpoint inhibitor therapy. This may suggest that the interval to relapse in the bladder after nephrectomy may be a more important prognostic factor than the presence of synchronous metastases in other organs.

[Efficacy and safety of imidafenacin in female patients with urge and mixed urinary incontinence].

The effect of imidafenacin for the treatment of overactive bladder (OAB), in female patients with urge and mixed urinary incontinence was examined. Prior to administration and at 1, 2, 3, 4, 6, 8, 10 and 12 weeks after administration, symptoms and quality of life were assessed using the overactive bladder symptom score (OABSS) and the international consultation on incontinence questionnaire-short form (ICIQ-SF), respectively. After administration, OABSS and ICIQ-SF scores were improved significantly when compared to baseline values. The incidence of adverse events was 7. 9% and none were serious. Imidafenacin was effective in female patients with urge and mixed urinary incontinence. In addition, imidafenacin rapidly improved incontinence one week after administration.

Relationship between testicular size by ultrasonography and testicular function: measurement of testicular length, width, and depth in patients with infertility.

OBJECTIVES: The relationships between simple testicular sizes, including the testicular length, width, and depth and testicular function were evaluated to determine the usefulness of measuring these simple parameters. METHODS: The mean of right and left testicular length, width and depth were measured in 408 men with infertility (mean age, 35.9 +/- 5.3 years) using ultrasonography. The ultrasonographic testicular volumes were calculated as the length x width x depth x 0.71. To evaluate the relationship between the testicular size and function, the patients were divided into seven to ten groups according to each testicular size parameter. RESULTS: The mean testicular volume, length, depth, and width were 13.4 ml, 3.86 cm, 1.80 cm, and 2.59 cm, respectively. These three testicular dimensions significantly correlated with sperm density, total sperm count, total motile sperm count, serum follicle-stimulating hormone and luteinizing hormone equal to ultrasonographic testicular volume. The mean sperm density was in the oligozoospermic range in patients with a mean testicular volume below 10 ml, a mean length below 3.5 cm, a mean depth below 1.75 cm, and a mean width below 2.5 cm. The mean total sperm count was subnormal in patients with a mean testicular volume below 10 ml, a mean length below 3.5 cm, a mean depth below 1.5 cm, and a mean width below 2.25 cm. CONCLUSIONS: The testicular length, width, and depth measured by ultrasonography significantly correlated with the testicular function as well as the ultrasonographic testicular volume. A simple measurement of the testicular length, width, and depth is useful for evaluating the testicular function.

Detection of circulating urothelial cancer cells in the blood using the CellSearch System.

BACKGROUND: Circulating tumor cells (CTCs) have been shown to aid in the therapeutic management of patients. But, only a few attempts have been made at the detection of urothelial cancer cells in the blood. The purpose of this study was to test the hypothesis that CTCs are detected in patients with urothelial cancers using newly developed CellSearch Assay. METHODS: Firstly, the bladder cancer cell lines were used to evaluate the reagents for immunocytochemical detection. After, mixed with peripheral blood mononuclear cells (PBMCs) of healthy volunteers, bladder cancer cells were stained with antibodies then multiparameter flow cytometric analysis was performed for the identification of bladder cancer cells in the PBMCs. Secondary, recovery of known numbers of spiked bladder cancer cells from whole blood was examined using CellSearch Assay. Finally, blood samples from nonmetastatic and metastatic urothelial cancer patients were investigated for CTC detection using CellSearch Assay. RESULTS: 1: Flow cytometric analysis revealed that it is possible to identify bladder cancer cells in PBMCs. 2: Sensitivity examination for detection of urothelial cancer cells with CellSearch Assay: Single regression analysis of the spiked number of cells vs. the recovered number of cells yielded a good correlation in this experiment. 3: Urothelial cancer cells were detected in 8 of fourteen patients (57.1%) with distant metastasis. Despite, no patient with nonmetastatic urothelial cancers showed positive result for this assay. CONCLUSION: This is the first report of attempt to detect circulating urothelial cancer cells in the peripheral blood of the patients with metastatic and nonmetastatic urothelial cancers by CellSearch Assay.

Testicular microlithiasis identified ultrasonographically in Japanese adult patients: prevalence and associated conditions.

OBJECTIVES: To determine the prevalence of testicular microlithiasis (TM) seen by testicular ultrasonography (US) in Japanese adult men referred for andrologic symptoms and evaluate associations of TM with pathologic conditions. METHODS: For 7 years, US was performed in 969 patients (mean age 40.9 years) at one institution. The patients were divided into groups with infertility (n = 550), unilateral testicular tumor (n = 46), or other andrologic conditions (n = 373). TM was identified as multiple small hyperechogenic foci. In the tumor group, only images of the tumor-free testis were reviewed. Patients with TM accompanying tumor or infertility completed follow-up questionnaires and US examinations. RESULTS: TM was diagnosed in 46 patients (mean age 38.5 years, range 23 to 75). The prevalence of TM was 17.4% in the tumor group, 5.6% in the infertility group, and 1.9% in the other-conditions group. TM was associated with testicular tumor and infertility, but not with other conditions. In patients with unilateral testicular germ cell tumor, the prevalence of carcinoma in situ in the contralateral testis was greater when TM was present in that testis (2 of 8 patients) than when TM was absent (0 of 32, P = 0.0037). No new testicular tumor developed subsequently. In the infertility group, the 31 patients with TM showed no subsequent testicular tumor development, and neither patient undergoing testicular biopsy had carcinoma in situ. CONCLUSIONS: TM, as demonstrated by US, was associated with infertility, as well as testicular tumor. TM in a testis contralateral to a unilateral testicular germ cell tumor may increase the risk of carcinoma in situ.

Anatomic variations of cavernous arteries and their effect on measurement of hemodynamic parameters: a power Doppler study.

OBJECTIVES: To assess the cavernous arterial (CA) anatomy with power Doppler imaging and evaluate the effects of any anatomic variations on the measurement of hemodynamic parameters. METHODS: Thirty-three patients with and 26 without a vascular component to their erectile dysfunction were examined. The CA anatomy was evaluated, and hemodynamic variables were measured at multiple sites, including sites in each artery, if multiple CAs were present. RESULTS: The frequency of anatomic variation was similar between the two groups. A single CA, considered normal, was observed in 57.7% of 52 corpora in the nonvasculogenic group and in 63.6% of 66 corpora in the vasculogenic group. Seven patients (26.9%) in the nonvasculogenic group and 11 (33.3%) in the vasculogenic group had CA anatomy that was different between the right and left corpora. In both groups, a single CA ordinarily showed at least a 35.0% decrement in the mean peak systolic velocity (PSV) between the crura and the proximal shaft; double, triple, and bifurcated CAs also had distally decreased PSV. However, two corpora with a single CA showed an increased PSV distally; in 1 patient, arterial communication between the corpora was responsible. In 86.7% of corpora with double CAs in the vasculogenic group and in 52.6% in the nonvasculogenic group, the CA distant from the crura showed a greater PSV than that near the crura. CONCLUSIONS: CA anatomy is variable, and the PSV differs between sites, irrespective of the presence of a vascular component to erectile dysfunction. Thus, anatomic variations should be considered when interpreting Doppler sonography.