The efficacy of ultrasonography for the detection of upper tract urothelial carcinoma.

PURPOSE: Ultrasonography and computed tomography urography are two commonly used modalities to image the upper tracts for the evaluation of hematuria. This study evaluated the efficacy of ultrasonography for the detection of upper tract urothelial carcinoma compared to computed tomography urography as a standard reference. METHODS: This retrospective study included patients with urothelial carcinoma of the renal pelvis and/or ureter who were diagnosed using computed tomography urography and underwent surgical treatment. We calculated the sensitivity of ultrasonography in upper tract urothelial carcinoma diagnosis, further classified the degree of hydronephrosis on ultrasonography, and analyzed the relationship between the sensitivity and the degree of hydronephrosis and tumor location. Additionally, the usefulness of the combination of the screening ultrasonography findings, the presence of gross hematuria, and/or urine cytology was analyzed. RESULTS: This study included 136 patients with upper urothelial carcinoma. Ultrasonography in the diagnosis had 45.6% sensitivity, and ultrasonography findings, including the detection of hydronephrosis, were present in 72.8%. The presence of hydronephrosis and tumor location were associated with detection by ultrasonography. The tumor was identified in a total of 134 (98.5%) patients by combining tumor detection and hydronephrosis using ultrasonography with gross hematuria and positive urine cytology as screening. CONCLUSION: Ultrasonography showed acceptable sensitivity for upper tract urothelial carcinoma diagnosis. Considering the hydronephrosis findings, ultrasonography is a useful screening tool for upper tract urothelial carcinoma. Additionally, excessive computed tomography examinations can be reduced by adding gross hematuria and positive urine cytology.

Safety and efficacy of ureteroscopy for urolithiasis in octogenarians.

OBJECTIVE: To examine the safety and efficacy of ureteroscopy (URS) for urolithiasis in octogenarians, and identify preoperative risk factors for the incidence of postoperative complications. METHODS: The patients who underwent URS for urolithiasis were divided into octogenarians and younger patients (age: <80 years), and the groups were compared regarding their clinical characteristics, intraoperative and postoperative complications, and stone-free rate. The predictors of postoperative complications were evaluated using logistic regression models. RESULTS: A total of 1207 patients were included, 166 in the octogenarian patient group and 1041 in the younger patient group. The proportion of female patients (p < 0.001), American Society of Anesthesiologists (ASA) score (p < 0.001), rate of preoperative pyelonephritis (p < 0.001), and diabetes mellitus (p = 0.003) were higher in the octogenarian group. No statistically significant differences were found between the two groups regarding stone size, location, and intraoperative complications. Postoperative complications, which reached a significant difference, were observed in 34 (20.5%) octogenarians and 117 (11.2%) younger patients (p = 0.002). However, age itself was not significantly associated with postoperative fever, the most frequent postoperative complication, in multivariate analysis. Female sex, ASA score of ≥3, history of diabetes mellitus, and prolonged operative time (≥120 min) were the significant predictors of fever. The stone-free rate in the octogenarian group was superior to that in the younger patient group (80.1% vs. 70.6%, respectively; p = 0.035). CONCLUSION: Our results suggest that URS for urolithiasis can be safely and effectively applied to octogenarians in selected cases.

[Clinical Study of Bladder Tamponade at Takeda Hospital].

This retrospective study examined bladder tamponade in 58 patients (male, n＝36 ; female, n＝22 ; average age, 78.5 years old) at Takeda Hospital between 2006 and 2016. Twenty-four of the patients were prescribed anticoagulants, and 18 had an indwelling urethral catheter. The underlying diseases comprised of cystitis (male, n＝7; female, n＝19), iatrogenic lower urinary tract injury (male, n＝13), bladder neoplasms (male, n＝6 ; female, n＝1), prostatic hemorrhage (male, n＝7), renal cell carcinoma (male, n＝1 ; female, n＝1), and bladder stone (male, n＝2 ; female, n＝1). The ratios of cystitis and iatrogenic injury were significantly higher in females and males, respectively (p＜0.0001). Elderly women in particular might be more in need of care due to a tendency towards bladder tamponade. Continuous bladder irrigation and transurethral coagulation were required more frequently for males than females. Radiation cystitis was not the cause of bladder tamponade in any of our patients, indicating that the incidence of bladder tamponade due to radiation cystitis has sharply decreased in Japan over the past 10 years.

Collagenolytic activity in sonic extracts of Tannerella forsythia.

OBJECTIVE: The purpose of the present study was to characterize the collagenolytic activity in a sonicated extract of Tannerella forsythia and to investigate the activation of proMMMP-2 and -9 by the T. forsythia extract. METHODS: The T. forsythia extract was incubated with type I collagen. The cleaved products were then analyzed by SDS-PAGE using the method of Laemmli. We studied the effects of cysteine, DTT, CaCl(2), and various proteinase inhibitors on collagenolytic activity. A HT1080 cell culture supernatant containing proMMP-2 and -9 was incubated with the T. forsythia extract and analyzed for the activation of proMMP-2 and -9 by gelatin zymography. RESULTS: The T. forsythia extract degraded type I collagen. Cysteine increased the collagenolytic activity of the extract, and 5mM CaCl(2) was required for this activity. The collagenolytic activity of T. forsythia was inhibited by N-ethylmaleimide, iodoacetamide, iodoacetic acid, EDTA, and leupeptin, but not by PMSF, E-64, TLCK, or TPCK. When proMMP-2 and -9 were incubated with the T. forsythia extract, gelatinases with the relative molecular masses of MMP-2 and -9 were produced. CONCLUSION: The present study suggests that T. forsythia extract is able to degrade type I collagen and activate proMMP-2 and -9.

[Acute urethritis caused by Neisseria meningitidis and Chlamydia trachomatis].

A 16-year-old heterosexual man presented to our hospital with a purulent urethral discharge and pain at voiding. These symptoms began seven days after oral-genital contact (fellatio) with his partner. A Gram-stained smear from the urethral discharge showed Gram-negative diplococci, and the antigen of Chlamydia trachomatis from urine was positive. We initially made a diagnosis of urethritis caused by Neisseria gonorrhoeae and C. trachomatis. However, N. meningitidis was isolated by culture. Clinicians should pay attention to the possibility of N. meningitidis infection in all cases resembling gonococcal urethritis.

[Bladder contracture following intravesical BCG immunotherapy treated by hydrodistention: a case report].

A 35-year-old man had undergone retroperitoneoscopic radical nephrouretectomy in May 2002 (pTisNxM0). He later developed carcinoma in situ (CIS) of the bladder, and underwent intravesical instillation of 80 mg of Bacillus-Calmette-Guerin (BCG) once a week for 6 weeks in January 2004. After the treatment, irritative symptoms (frequency and dysuria) developed, and he was diagnosed with bladder contracture. Conventional treatment with anti-cholinergics, analgesics, anti-tuberculous drugs, and steroids was ineffecsive, but hydrodistention improved the subjective symptoms. Hydrodistention seems to be useful for bladder contracture following intravesical BCG immunotherapy.

[Nontraumatic perirenal hematoma: a case report].

A patient with non-traumatic perirenal hematoma is reported. A 56- year-old woman visited our hospital with a complaint of left back pain. Computed tomographic scan showed left perirenal hematoma. Selective renal arteriogram demonstrated no apparent vascular abnormality but minor leakage of contrast medium was detected from the branch of the renal artery. The patient was treated with selective transcatheter arterial embolization. The patient has been followed up after the embolization without any complications. A total of 149 cases of non-traumatic perirenal hematoma were collected from the literature and discussed.

[Clinical study of chemoradiotherapy using low dose cisplatinum as X-ray intensifier in patients with urothelial carcinoma].

Chemoradiotherapy using cisplatinum (CDDP) as the X-ray intensifier was performed on patients with urothelial carcinoma. Ten lesions in 9 patients, 6 patients with postoperative relapse and 3 who received the therapy as a palliative treatment for progressive carcinoma, were evaluated. Four of the patients with postoperative relapse had undergone adjuvant chemotherapy. On the day of the treatment, the 9 patients were given continuous intravenous infusion of CDDP at the dose level of 5-12 mg/day prior to external irradiation at 50-66 Gy. The response to the therapy was categorized as complete response in 5 patients, partial response in 4, and no change in 1. The response rate was 90%, indicating achievement of a good local control. Pain relief and improvement of hydronephrosis were also observed in patients who underwent the therapy for treatment of progressive carcinoma. All adverse reactions were mild in intensity. These results suggest that the chemoradiotherapy is useful for both patient groups, those who have a postoperative relapse and those who undergo the therapy as a palliative treatment for progressive carcinoma.

[Rupture of renal artery aneurysm during pregnancy].

We report a case of renal artery aneurysm ruptured during pregnancy. A 32-year-old woman presented at 38th week of gestation with left flank pain. We performed a cesarean delivery for fetal distress, and found retroperitoneal hemorrhage. After delivery, she entered a pre-shock state, and abdominal computed tomography and angiography showed a left renal artery aneurysm and hemorrhage from the aneurysm. Left nephrectomy was performed, and both mother and baby were rescued. Renal artery rupture during pregnancy is a fatal event, but with quick diagnosis and adequate treatment, if possible nephron sparing surgery, most patients, including babies, can be rescued.

[A case of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer].

A 76-year-old man complained of difficulty in urination and miction pain with abacterial pyuria after radiation therapy for prostate cancer. Transurethral resection of the prostate was performed and histopathologically widespread necrosis was observed in the prostate. Thereafter retention of urine and fever occurred and computed tomography scan revealed an abscess of the penile corpus. The abscess was drained, but the fever continued. He developed an abacterial lung abscess and abacterial necrotic ulcerating lesions on his back, his left leg and his lower abdomen. Macroscopic findings demonstrated typical features of pyoderma gangrenosum. Steroid treatment was initiated and the response to steroid therapy was dramatic. Finally urinary diversion using an ileal conduit was performed. We found few cases of pyoderma gangrenosum involving lesions other than those of the skin in the literature. This is the first report of pyoderma gangrenosum involving the prostate gland after radiation therapy for prostate cancer.

[A case of corpus cancer presenting with positive urine cytology].

A 76-year-old woman was admitted with a chief complaint of gross hematuria. Although no abnormality was found on excretory pyelography, class IV transitional cell carcinoma was suspected based on urinary cytology. However, no malignancy was observed on cystoscopy or on biopsy of the mucosa of the urinary bladder. Thereafter, class IV or class V carcinoma was continuously found by urinary cytology, and cervical lymphadenopathy was also observed. Since computed tomography showed the uterus enhanced heterogenously, the possibility of a gynecological tumor was considered. Poorly differentiated endometrioid adenocarcinoma was found on histological examination of the endometrium, and similar adenocarcinoma was also found on biopsy of cervical lymph node. Furthermore, infiltration of adenocarcinoma into the proper lamina of urinary bladder was found. These findings suggested that this tumor originated in the uterine body, followed by lymph node metastasis and infiltration into the urinary bladder. Concerning the route of emergence of carcinoma cells in urine, joining in urine via vagina seemed most likely. When malignant cells are found in urine, tumors of the urinary system should primarily be suspected, but at the same time, the possibility of a gynecological tumor should be kept in mind.

[A case of membranous glomerulonephritis in renal allograft].

A 39-year-old man who had been diagnosed with immunoglobulin A (IgA) nephropathy underwent renal transplant from his father. The operation was performed under cyclosporine, prednisolone and mizoribine treatment. Renal function was stable following transplantation, but proteinuria ranged between 1 g/day and 3 g/day. Protocol biopsy 1 year after transplantation revealed membranous glomerulonephritis, with IgG and C3 deposits under immunofluorescence, and subepithelial deposits detected on electron microscopy. The patient was treated by limiting protein intake, controlling blood pressure and administering candesartan. Proteinuria decreased from 5.6 g/day to 1 g/day, but a graft biopsy was performed 2 years after transplantation because of a slightly increasing creatinine level. There was no sign of rejection, and IgG and C3 deposits observed under immunofluorescence had decreased. After the graft biopsy, the creatinine level was stable and proteinuria decreased to 0.7 g/day. In conclusion, de novo nephropathy such as membranous glomerulonephritis should also be considered a possible cause of proteinuria following renal transplantation.

Encrusted cystitis with ammonium acid urate calculi: a case report.

We present a case of encrusted cystitis with ammonium acid urate calculi. An 88-year-old man was referred to our hospital to determine the cause of hematopyuria. He was a patient at another hospital for treatment of interstitial pneumonia with predonisolone. After admission to our hospital, kidney, ureter, bladder X-ray, computed togography and cystoscopy revealed calcification of about two-thirds of the mucosa of the bladder, and biopsy of the bladder revealed bacterial colonies with inflammation and calcification. Calculographic analysis revealed ammonium acid urate calculi. After treatment with antibiotics and irrigation with solita T1, an acidic solution of pH 3.5-6.5, inflammation and calcification were significantly reduced.