[A Case of Ammonium Acid Urate Staghorn Calculi Lost Only in the Drug Therapy].

We report a case of a staghorn stone containing ammonium acid urate that was effectively treated with drug therapy alone. A 46-year-old man had recurring urinary tract stones. He had no previous episode of urinary tract stones that required hospitalization and operation. He received only drug therapy for hyperuricemia in another hospital. Ultrasonography and computed tomography revealed a left staghorn stone measuring 37×34 mm. The kidney-ureter-bladder radiograph did not show any stones. His urine was acidic, and we estimated that the left staghorn stone consisted of urate. Oral administration of sodium hydrogen carbonate was initiated to alkalize the urine, and treatment with transurethral lithotripsy (TUL) was scheduled. Before the TUL, analysis of an excreted stone sample revealed that it consisted of ammonium acid urate. The staghorn stone was completely removed in 10 months after the first medical examination. At present, the patient is free of urinary tract stones.

[Port-Site Metastasis of an Urothelial Carcinoma after Laparoscopic Nephroureterectomy : A Case Report].

We report a case of ureteral carcinoma in which port site metastasis was found after a laparoscopic nephroureterectomy. The patient was a 77-year-old woman with a chiefcomplaint ofgross hematuria. A tumor was found in her left ureter by computed tomography (CT). The patient was diagnosed with a left ureter carcinoma with T2N0M0 or less. She underwent retroperitoneoscopic radical nephroureterectomy. The pathological diagnosis was an urothelial carcinoma, Grade 2, pT2Nx. She was carefully followed up without any adjuvant therapy. At 26 months postoperatively, a subcutaneous tumor was found at a port site without any disseminated disease or distant metastasis by CT and positron emission tomography-CT (PETCT). She underwent surgical resection ofthe subcutaneous tumor. Pathological diagnosis was port site metastatic urothelial carcinoma. She had no recurrence or metastasis at 24 months after the surgical resection without any adjuvant therapy.

Perilesional Targeted Biopsy Combined with MRI-TRUS Image Fusion-Guided Targeted Prostate Biopsy: An Analysis According to PI-RADS Scores.

A prostate-targeted biopsy (TB) core is usually collected from a site where magnetic resonance imaging (MRI) indicates possible cancer. However, the extent of the lesion is difficult to accurately predict using MRI or TB alone. Therefore, we performed several biopsies around the TB site (perilesional [p] TB) and analyzed the association between the positive cores obtained using TB and pTB and the Prostate Imaging Reporting and Data System (PI-RADS) scores. This retrospective study included patients who underwent prostate biopsies. The extent of pTB was defined as the area within 10 mm of a TB site. A total of 162 eligible patients were enrolled. Prostate cancer (PCa) was diagnosed in 75.2% of patients undergoing TB, with a positivity rate of 50.7% for a PI-RADS score of 3, 95.8% for a PI-RADS score of 4, and 100% for a PI-RADS score of 5. Patients diagnosed with PCa according to both TB and pTB had significantly higher positivity rates for PI-RADS scores of 4 and 5 than for a PI-RADS score of 3 (p < 0.0001 and p = 0.0009, respectively). Additional pTB may be performed in patients with PI-RADS ≥ 4 regions of interest for assessing PCa malignancy.

Chronological Changes of Lower Urinary Tract Symptoms in Elderly Patients with Prostate Cancer after Low-Dose-Rate Prostate Brachytherapy.

BACKGROUND: To compare chronological changes in lower urinary tract symptoms (LUTS) after low-dose-rate prostate extended-release therapy (LDR-BT) using the overactive bladder symptom score (OABSS) in patients aged ≥ 75 years (elderly group) versus those aged < 75 years (control group). MATERIALS AND METHODS: Patients with prostate cancer who underwent LDR-BT at Gifu University Hospital were included in this study. The International Prostate Symptom Score (IPSS), OABSS, and quality of life-based on urinary symptoms (IPSS-QOL) were evaluated before and after LDR-BT. We compared chronological changes in IPSS, OABSS, and IPSS-QOL in the elderly group with those in the control group and assessed the association between the resolution of OABSS and clinicopathological covariates. RESULTS: A total of 484 patients were enrolled in this study. In the elderly group, the total IPSS, OABSS, and frequency scores increased at 1 month postoperatively, whereas the control group showed an increase at 3 months postoperatively. Multivariate analysis identified changes from baseline to the maximum OABSS and pre-treatment OABSS as significant predictors of delayed resolution of OABSS after LDR-BT. CONCLUSIONS: Changes in pre-treatment OABSS and pre- and post-LDR-BT OABSS values were independent predictors of delayed resolution of OABSS; however, no correlation was found with age.

[Two cases of prostatic stromal tumor of uncertain malignant potential (STUMP) on pathological diagnosis after surgery for benign prostatic hyperplasia].

Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare neoplasm characterized by an atypical, unique stromal proliferation of the prostate. Two patients consulted our hospital with the complaint of urinary retardation. We performed holmium laser enucleation of the prostate since by digital rectal examination, magnetic resonance imaging and needle biopsy suggested benign prostatic hyperplasia. The pathologic examination of the surgical specimens revealed prostatic STUMP. Urologic and radiologic examinations have revealed no abnormalities after more than 2 years of follow-up.

A pretreatment nomogram predicting recurrence- and progression-free survival for nonmuscle invasive bladder cancer in Japanese patients.

PURPOSE: Our aim was to provide nomograms that allow urologists to easily calculate a nonmuscle invasive bladder cancer patient's risk of recurrence and progression. MATERIALS AND METHODS: We retrospectively analyzed 800 nonmuscle invasive bladder cancer patients newly diagnosed between 1991 and 2001 from the Gifu urothelial cancer registry program. We developed the nomogram using the original 500 patients and validated it using the remaining 300 patients. The prognostic factors of recurrence and progression were identified by multivariate analysis in 500 patients. RESULTS: In the multivariate analysis, tumor number, shape, grade, and intravesical instillation were associated with recurrence-free survival. Tumor shape and grade were associated with progression-free survival. Six factors for recurrence and three factors for progression were used to make the nomogram. Using the original 500 patients who were modeled for the nomogram, the areas under the receiver operating characteristic curves (AUCs) were calculated to be 0.61 for recurrence and 0.71 for progression. To validate nomogram performance, we applied an additional 300 patients to the nomograms. The AUCs were 0.57 for recurrence and 0.67 for progression. CONCLUSIONS: The nomograms that have been developed can be used to predict the probability of recurrence and progression of nonmuscle invasive bladder cancer.

Period from Loss of the Ability to Access Toilets Independently to Death in End-Stage Cancer Patients.

Background: Toileting independence is considered to be important factors for achieving a "good death" for terminally ill patients. Aim: To clarify the period from loss of the ability to access toilets independently to death in end-stage cancer patients. Design: Observational study. Setting/Participants: The medical records of all end-stage cancer patients who had died while using home care services provided by Medical Corporation Kagayaki General Home Care Clinic between September 2011 and August 2017, were retrospectively reviewed. Results: A total of 220 patients were included. The median time from total dependence in toileting to death was 6.0 (95% confidence interval: 5.0-7.0) days. When the duration was 7 days or shorter and 21 days or shorter, the cumulative death rate was 55.9% and 86.4% respectively. Conclusion: A large percentage of terminally ill cancer patients maintained the ability to access toilets independently until very close to the end of their lives, so the duration of total assistance needed was shorter. These findings may be useful to make a care plan to support achieving "good death" for patients.

[Extra-adrenal pheochromocytoma (paraganglioma) of the urinary bladder without typical symptoms: a case report].

A 33-year-old female patient was admitted to our department with bladder tumor. It was detected by a magnetic resonance imaging (MRI) in an examination for hysteromyoma. She had neither hypertention, gross hematuria nor the classic symptoms of cathecholamine excess during micturition. The diameter of the tumor was 33 mm. Cystoscopic examination showed a submucosal tumor in the left anterior wall of the bladder. Percutaneous needle biopsy was performed. Biopsy specimens revealed as a pheochromocytoma. 131 I-MIBG scintigraphy showed abnormal accumulation in the bladder, and no abnormal accumulation in the other lesion. Endocrinologic examination disclosed increased levels of serum and urinary noradrenalin. On May 18, 2005, partial cystectomy was performed. The catecholamine levels normalized after partial cystectomy. The patient has been followed up for 9 months and shown no recurrence.