Predictors of postoperative storage symptoms in male patients with lower urinary tract symptoms: A retrospective analysis of prostate surgery for benign prostatic enlargement.

OBJECTIVES: This study investigated the effects of prostate surgery on storage symptoms in male patients with lower urinary tract symptoms (LUTS) from benign prostatic enlargement (BPE). This study aimed to identify patient characteristics associated with improved, unchanged, and deteriorated post-surgical storage symptoms and to identify the risk factors for non-improvement or deterioration. METHODS: A retrospective analysis of 586 prostate surgeries performed between 2016 and 2022 at Yokosuka Kyosai Hospital was conducted on patients with LUTS and at least one storage symptom preoperatively. Patients with active urinary tract infection, prostate/bladder cancer, urethral strictures, or dementia were excluded. The study enrolled 230 patients and assessed storage symptoms using the International Prostate Symptom Score (IPSS). RESULTS: Overall, storage symptoms improved, remained unchanged, and deteriorated in 87.0%, 5.7%, and 7.4% of patients, respectively. The patients in the deteriorated group were significantly older, whereas those in the no-change group had smaller prostate volumes. Patient-reported outcome scores (IPSS, IPSS-QoL, and BII) were significantly higher in the improved group. The predictors of non-improvement included low IPSS storage score, cardiovascular disease, and diabetes mellitus. Predictors of deterioration included advanced age and low IPSS storage score. CONCLUSIONS: Patients with severe LUTS showed greater postoperative improvement in storage symptoms. A low IPSS storage score predicted non-improvement and deterioration. Advanced age, low IPSS storage score, and a history of cardiovascular disease and diabetes mellitus were identified as key predictors. Awareness of these factors may guide preoperative counseling and improve decision-making in prostate surgery, ensuring more personalized and effective treatment strategies.

Predictive factors for the success of trial without catheter for men with urinary retention.

OBJECTIVE: To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC. METHODS: This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted. RESULTS: Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes. CONCLUSIONS: This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

Predictive factors for the success of trial catheter removal for women with urinary retention.

OBJECTIVE: To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention. METHODS: Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases. RESULTS: Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p = .392), median ECOG (Eastern Cooperative Oncology Group) performance status (p = .374), diabetes mellitus (p = .842), dementia (p = .801), previous history of cerebrovascular events (p = .592), or intrapelvic surgery (p = .800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p = .598). Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p = .039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p = .038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p = .030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p = .066, OR 4.8, 95% CI of OR 0.9-25.0). CONCLUSIONS: This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.

Single-cell transcriptomes underscore genetically distinct tumor characteristics and microenvironment for hereditary kidney cancers.

Our understanding of how each hereditary kidney cancer adapts to its tissue microenvironment is incomplete. Here, we present single-cell transcriptomes of 108,342 cells from patient specimens including from six hereditary kidney cancers. The transcriptomes displayed distinct characteristics of the cell of origin and unique tissue microenvironment for each hereditary kidney cancer. Of note, hereditary leiomyomatosis and renal cell carcinoma (HLRCC)-associated kidney cancer retained some characteristics of proximal tubules, which were completely lost in lymph node metastases and present as an avascular tumor with suppressed T cells and TREM2-high macrophages, leading to immune tolerance. Birt-Hogg-Dubé (BHD)-associated kidney cancer exhibited transcriptomic intratumor heterogeneity (tITH) with increased characteristics of intercalated cells of the collecting duct and upregulation of FOXI1-driven genes, a critical transcription factor for collecting duct differentiation. These findings facilitate our understanding of how hereditary kidney cancers adapt to their tissue microenvironment.

Short-term efficacy and safety of second generation bipolar transurethral vaporization of the prostate (B-TUVP) for large benign prostate enlargement: Results from a retrospective feasibility study.

BACKGROUND: To investigate the efficacy and safety of a second-generation bipolar transurethral electro vaporization of the prostate (B-TUVP) with the new oval-shaped electrode for large benign prostatic enlargement (BPE) with prostate volume (PV) ≥100ml. MATERIALS AND METHODS: 100 patients who underwent second-generation B-TUVP with the oval-shaped electrode for male lower urinary tract symptom (LUTS) or urinary retention between July 2018 and July 2020 were enrolled in this study. The patients' characteristics and treatment outcome were retrospectively compared between patients with PV <100ml and ≥100ml. RESULTS: 17/41 (41.5%) cases of PV ≥100ml and 24/59 cases (40.7%) of PV <100ml were catheterised due to urinary retention. The duration of post-operative catheter placement and hospital-stay of PV ≥100ml (3.1±1.3 and 5.6±2.3 days) were not different from PV <100ml (2.7±1.2 and 5.0±2.4 days). In uncatheterised patients (N = 59), post-void residual urine volume (PVR) significantly decreased after surgery in both groups, however, maximum uroflow rate (Qmax) significantly increased after surgery only in PV <100ml but not in PV ≥100ml. Voiding symptoms and patients' QoL derived from International Prostate Symptom Score (IPSS), IPSS-QoL (IPSS Quality of Life Index) and BPH Impact Index (BII) scores, significantly improved after B-TUVP in both groups. Catheter free status after final B-TUVP among patients with preoperative urinary retention was achieved in 18/24 (75.0%) and 14/17 (82.1%) cases in patient with <100ml and ≥100ml, respectively. There was no significant difference in post-operative Hb after B-TUVP, which was 97.0±5.4% of baseline for PV <100ml and 96.9±6.1% for PV ≥100ml and no TUR syndrome was observed. CONCLUSIONS: This is the first study investigating short-term efficacy and safety of second-generation B-TUVP with the oval-shaped electrode on large BPE. B-TUVP appears to be effective and safe for treating moderate-to-severe lower urinary tract symptoms and urinary retention in patients with large BPE.

[Mucinous Adenocarcinoma of the Prostate Diagnosed after Transurethral Treatment of a Prostatic Abscess].

A 70-year-old man visited his doctor because of hip pain and gross hematuria. Digital rectal examination and computed tomography revealed a prostatic abscess. Although antibiotics were prescribed, his symptoms did not improve; he was transferred to our hospital, where transurethral fenestration of the prostatic abscess was performed. During prostatic fenestration, a papillary mucous membrane was confirmed inside the cavity of the prostatic abscess. Pathological examination revealed a mucinous adenocarcinoma of the prostate. Although hormonal therapy was administered, magnetic resonance imaging revealed tumor extension necessitating robot-assisted radical prostatectomy. Mucinous adenocarcinoma of the prostate is rare, and to our knowledge this is the first report of mucinous adenocarcinoma of the prostate diagnosed after transurethral treatment of a prostatic abscess.

[A CASE OF DISSEMINATED INTRAVASCULAR COAGULATION CAUSED BY ADVANCED PROSTATE CANCER].

The 79 years old man was referred to our department due to high value of serum prostate specific antigen (39.54 ng/ml). The magnetic resonance imaging demonstrated diffuse low signal at his prostate. Bone scintigraphy revealed multiple metastatic lesion. Needle biopsy was performed for definite diagnosis. Systemic purpura showed after prostate needle biopsy although he had noticed local purpura at his back before the examination. He was diagnosed as disseminated intravascular coagulation (DIC) syndrome due to advanced prostate cancer. Treatment with anti-DIC therapy, blood transfusion, subcutaneous injection of degarelix acetate settled the DIC. Abiraterone hydrochloride and prednisolone was added as we confirmed Gleason score5+4 in the pathological examination. He has been alive for 15 months after diagnosis without desease progression.

[A CASE OF PELVIC CONGESTION SYNDROME SUCCESSFULLY TREATED WITH ENDOVASCULAR THERAPY].

An 84-year-old woman was referred for lower abdominal pain lasting more than six months. Computed tomography showed a left ovarian varicose vein and a peri-uterine venous plexus. Due to suspected pelvic congestion syndrome, left ovarian venography and left ovarian embolization were performed. Blood flowed back through the dilated left ovarian vein and through the uterine venous plexus to the right ovarian vein. Embolization of the left ovarian vein with a sclerosing agent resulted in the disappearance of the venous congestion. Preoperative Visual Analogue Scale was 7, which decreased to 3 after the operation. As a result, improvements in QOL were recognized. Although pelvic congestion syndrome is a treatable disease, its recognition as a urological disease is low. Here, we have reported a case of pelvic congestion syndrome in which symptoms improved with treatment and have discussed its pathophysiology and treatment.

[A CASE REPORT OF FUNGUS BALL FOUND DURING TRANSURETHRAL URETEROLITHOTOMY].

Herein we report the confirmation of fungus balls (circular collections of C.tropicalis) during a transurethral ureterolithotomy, which is as far as we know the first reported instance. A-61-year old man was referred to the urology department with bilateral ureteral calculi. Initially a transurethral ureterolithotomy was attempted but residual stones existed. During the second operation, we found numerous white fluffy material in the renal pelvis. Because of them, we were unable to have a clear field of vision to complete operation. During the third operation, we found the fungus balls again and cultured them. Cultures yielded C.tropicalis.

[NON-SPECIFIC GRANULOMATOUS PROSTATITIS: A CASE REPORT].

We report non-specific granulomatous prostatitis in a 58-year-old man who visited a Urology clinic with fever and dysuria. Digital rectal examination revealed prostatic tenderness, and laboratory examination of the urinary sediment revealed pyuria. Thus, he was diagnosed with acute bacterial prostatitis and treated with antibiotics. He remained symptomatic despite treatment; therefore, he was referred to our hospital. A second digital rectal examination (performed at our hospital) revealed stony hard nodules in the prostate and an irregularity of its surface. Moreover, magnetic resonance imaging (MRI) suggested a prostate cancer. We performed a transperineal needle biopsy, which revealed only non-specific inflammatory cells without any evidence of neoplasm in the specimen. Therefore, a definitive diagnosis could not be established. Nevertheless, he continued to show a high index of suspicion for prostatic malignancy based on his clinical findings. Therefore, we performed a transurethral resection of the prostate and a transrectal biopsy to obtain more specimens. Microscopic findings revealed granulomatous prostatitis without any evidence of prostate carcinoma. Notably, an MRI demonstrated remarkable shrinkage of the prostate 3 months after the diagnosis. Non-specific granulomatous prostatitis is a rare inflammatory disease. Because it is difficult to differentiate this disease from prostatic neoplasms based on clinical findings or imaging modalities such as MRI, a few reports have described performing a radical prostatectomy in patients. This disease usually demonstrates a good prognosis as was noted in our patient. We conclude that establishing a preoperative histopathological diagnosis is important to avoid invasive procedures.

Case report: retroperitoneal aspergilloma in a patient with rheumatoid arthritis presenting as malignant tumor.

BACKGROUND: Aspergillosis in patients with impaired immunity usually presents with invasive pulmonary infection and dissemination to a variety of organs via hematogenous spread. Aspergilloma in the retroperitoneal cavity is a rare disease with only a few cases reported in the literature. To the best of our knowledge, the present case of a retroperitoneal aspergilloma with no surgical history is only the second report in the literature. CASE PRESENTATION: A 65 year-old man, who had been receiving immunosuppressive treatment for rheumatoid arthritis with vasculitis for 9 years, was referred to the Urology Department with a retroperitoneal mass. This was confirmed by computed tomography performed during treatment for pulmonary aspergilloma. Because it was not possible to rule out malignant disease (e.g., liposarcoma), surgical exploration was performed. Pathological examination revealed aspergillus hyphae with fat necrosis, and retroperitoneal aspergilloma was diagnosed and appropriately treated. The tumor did not recur subsequently. CONCLUSION: Our present case emphasizes that pharmacological treatments for aspergilloma in the retroperitoneal cavity have poor drug transitivity, so the relative effectiveness of pharmacological response is not useful for differentiating retroperitoneal aspergilloma from malignant disease.

[GIANT BLADDER CALCULI TREATED WITH SINGLE-STAGE SIMULTANEOUS PERCUTANEOUS SUPRAPUBIC AND TRANSURETHRAL CYSTOLITHOTRIPSY: A CASE REPORT].

An 82-year-old man presented with lower abdominal pain and general malaise. Noncontrast computed tomography revealed a remarkably enlarged prostate and a full bladder with a giant stone 80 mm in diameter causing bilateral hydroureteronephrosis. Laboratory data demonstrated systemic inflammation and renal dysfunction with hyperkalemia. Acute postrenal dysfunction caused by urinary retention was diagnosed. A urethral catheter was inserted and emergent dialysis was initiated. After renal function recovered, we performed lithotripsy for the urinary bladder calculi. To achieve stone free status with a single-stage procedure, we performed simultaneous percutaneous suprapubic and transurethral cystolithotripsy. The procedure was successfully performed without significant complications.The patient was discharged 9 days after surgery, although clean intermittent catheterization was required.Giant bladder calculi are often treated with cystolithotomy because transurethral cystolithotripsy requires time to remove all fragments. In this case, we achieved stone free status in acceptable operative time by performing simultaneous percutaneous suprapubic and transurethral cystolithotripsy. In conclusion, the endourological management is an effective treatment choice, even in a case with a giant bladder calculus.