Metabolic changes with degarelix vs leuprolide plus bicalutamide in patients with prostate cancer: a randomized clinical study.

PURPOSE: In a mouse model, degarelix generated the least metabolic consequences via low follicle-stimulating hormone (FSH) levels compared with orchiectomy and leuprolide after 4 months of androgen deprivation therapy (ADT). Here, we comparatively investigated the influence of ADT with degarelix or leuprolide on the development of metabolic syndrome in patients with prostate cancer (PCa). METHODS: Patients with hormone-naive PCa were recruited. Eligible patients were randomized (1:1) to monthly degarelix or monthly leuprolide for 6 months. Key trial variables were monitored monthly. The primary endpoint was changes in fasting blood sugar (FBS). Secondary endpoints were changes in body weight, abdominal circumference, lipid profiles, and hemoglobin A1c (HbA1c) and FSH levels. Computed tomography was performed to measure subcutaneous and visceral fat areas before and after 6 months of ADT. Data were analyzed using the χ2 test, Student's t test, and analysis of variance. RESULTS: From the 100 patients registered, 85 completed the trial (degarelix: 40 patients; leuprolide: 45 patients). Mean increases in FBS did not differ between the two arms. Similarly, there were no differences between the arms in mean increases in body weight, abdominal circumference, lipid profiles, HbA1c, or subcutaneous and visceral fat areas. Follicle-stimulating hormone levels were significantly lower in the degarelix arm than in the leuprolide arm (p < 0.05). CONCLUSIONS: Lipid and glucose metabolism did not differ significantly between the arms, while FSH levels were significantly lower in the degarelix arm.

Impact of Androgen Deprivation Therapy on Non-Alcoholic Fatty Liver Disease in Patients with Prostate Cancer: A CT Evaluation.

PURPOSE: The aim of this study was to investigate the influence of androgen deprivation therapy (ADT) on the progression of non-alcoholic fatty liver disease (NAFLD) in patients with prostate cancer (PCa) by evaluation of hepatic steatosis on computed tomography (CT). METHODS: The study included 77 PCa patients who underwent abdominal CT at baseline and after 6 months of ADT. The degree of hepatic steatosis was evaluated according to the attenuation value for liver parenchyma (CTLP), the attenuation ratio for liver and spleen (LSratio), and the difference in attenuation between LS (LSdif). The associations between these 3 indices and various metabolic syndrome-related factors were analyzed. RESULTS: The number of NAFLD patients increased from 9 (11.6%) at baseline to 16 (20.7%) after ADT. The CTLP, LSratio, and LSdif values were significantly lower after ADT than before (p < 0.05). There were significant correlations between the percent change in CTLP and the percent change in HbA1c, between the percent change in LSratio and the percent change in abdominal circumference, and between the percent change in LSdif and the percent change in BMI. CONCLUSIONS: Six months of ADT was associated with significant progression of NAFLD in PCa patients. This progression was strongly correlated with changes in HbA1c, abdominal circumference, and BMI.

Increased nucleophosmin expression is a strong predictor of recurrence and prognosis in patients with N0M0 upper tract urothelial carcinoma undergoing radical nephroureterectomy.

PURPOSE: We aimed to evaluate whether increased nucleophosmin expression predicts recurrence and survival in upper tract urothelial carcinoma (UTUC). METHODS: Specimens from 101 patients with N0M0 UTUC undergoing radical nephroureterectomy were evaluated. Nucleophosmin expression was determined immunohistochemically and categorized into two groups according to nucleophosmin staining intensity. The association between nucleophosmin expression and various clinicopathological factors including Ki-67 expression was analyzed. Multivariate analyses were performed to identify the independent predictors of extraurothelial recurrence and cancer-specific survival. RESULTS: High nucleophosmin expression was significantly correlated with tumor location, pT ≥3, lymphovascular invasion, lymph node metastasis, and high Ki-67 expression. Patients whose tumors demonstrated high nucleophosmin expression had a significantly higher rate of extraurothelial recurrence and a lower survival rate than those with low nucleophosmin expression. Multivariate analysis showed that pT ≥3, lymph node metastasis, high nucleophosmin expression, and high Ki-67 expression were independent predictors of extraurothelial recurrence. When patients were stratified into three groups according to the number of risk factors, the 2-year extraurothelial recurrence-free survival rates were 92.9% in patients with 0 or 1 risk factor, 76.5% in patients with 2 risk factors, and 9.1% in patients with 3 or 4 risk factors. Regarding cancer-specific survival, lymphovascular invasion and high nucleophosmin expression were independent predictors. CONCLUSIONS: Increased nucleophosmin expression was a strong predictor of extraurothelial recurrence and cancer-specific survival in patients with N0M0 UTUC undergoing radical nephroureterectomy. Our risk stratification models integrating nucleophosmin expression may provide valuable information on disease recurrence and prognosis.

[Usefulness of comparing of magnetic resonance imaging (MRI) findings prior to repeat biopsy and negative initial biopsy as a decision-making method for repeat prostate biopsy].

We retrospectively reviewed the data from a cohort of 44 patients with one initial negative transrectal ultrasound-guided prostate biopsy who underwent a repeat biopsy from 2006 to 2013. At each biopsy session, we checked patient age, serum prostate specific antigen (PSA), prostate volume, PSA density, PSA velocity, months from the initial biopsy session, multiparametric magnetic resonance imaging (MRI) findings (T2-weighted, dynamic contrast-enhanced and diffusion-weighted, 1.5 Tesla pelvic-phased array) prior to repeat biopsy and initial negative biopsy. Mean age was 68.2±8.82 years. PSA was 11.5±7.65 ng/ml before repeat biopsy. Prostate cancer was detected in 15 (34.0%) patients at repeat biopsy. In univariate and multivariate analysis, positive MRI findings before repeat biopsy were significant independent predictors of a positive repeat biopsy. At per patient analysis, the sensitivity, specificity, positive and negative predictive values were 66.6, 68.9, 71.4 and 80.0% for MRI before repeat biopsy. No suspicious lesion on MRI before repeat biopsy was relevant to negative biopsy. According to the comparison of MRI findings prior to repeat biopsy and negative initial biopsy, suspicious MRI findings at the peripheral zone before repeat biopsy and initial negative biopsy were relevant to a high cancer detection rate (83.3%) at repeat prostate biopsy. These results suggested that the absence of a suspicious lesion on MRI before repeat biopsy could guide the avoidance of repeat biopsy and suspicious MRI findings at the peripheral zone before repeat biopsy and initial negative biopsy could guide repeat biopsy.

Efficacy of Enzalutamide Rechallenge for Metastatic Castration-Resistant Prostate Cancer.

OBJECTIVE: There have been several reports on rechallenge with docetaxel, cabazitaxel, abiraterone acetate, or ethinylestradiol for metastatic castration-resistant prostate cancer (mCRPC). However, the efficacy of enzalutamide rechallenge for mCRPC has not been evaluated. METHODS: We retrospectively reviewed 63 consecutive patients who received enzalutamide for mCRPC at our institution between 2014 and 2022. Eight of these patients underwent rechallenge with enzalutamide after disease progression on prior enzalutamide and other therapy and were the focus of this study. The prostate-specific antigen (PSA) response (PSA decrease >50%), PSA progression-free survival, treatment duration, overall survival (OS) after CRPC, and treatment-related adverse events were evaluated. RESULTS: PSA decline to enzalutamide rechallenge was observed in 6 patients (75%), of which 2 patients had a PSA response. The median treatment duration was 4 months (range 1-12) and median PSA progression-free survival was 3 months (range 1-7). Median OS after CRPC was 41 months. OS after CRPC was not increased in patients with a PSA response. No toxicities were worse than grade ≥3. CONCLUSION: Enzalutamide rechallenge achieved a PSA response in a quarter of our patients with mCRPC after disease progression on prior enzalutamide. However, no improvement of OS was identified in these patients.

A prospective comparative study of intravesical bacillus Calmette-Guérin therapy with the Tokyo or Connaught strain for nonmuscle invasive bladder cancer.

PURPOSE: We prospectively compared the efficacy and adverse events of the bacillus Calmette-Guérin Tokyo 172 and Connaught strains for nonmuscle invasive bladder cancer. MATERIALS AND METHODS: Between January 2004 and May 2012 patients with pTa/T1 and pTis, multiple tumors and a recurrence-free period of 3 months or less who required intravesical bacillus Calmette-Guérin therapy were prospectively allocated randomly to receive the Tokyo or Connaught strain. The primary study end points were the complete response rate in patients with pTis and concomitant carcinoma in situ (pTa or pT1), recurrence-free survival in patients with pTa, pT1 and carcinoma in situ who achieved a complete response after therapy and the frequency of adverse events. RESULTS: Administration of the Connaught strain ceased because its production was suspended in June 2012. Therefore, analysis was performed using data gathered to date. Overall, 66 and 63 patients who received the Tokyo and Connaught strains, respectively, were included in efficacy analysis. Patient and tumor characteristics were well balanced between the 2 groups. Median followup was 855 days. Adverse events were similar in the groups. The complete response rate was 90.3% and 85.0% in patients given the Tokyo and Connaught strains, respectively, which did not significantly differ (p = 0.896). The 2-year recurrence-free survival rate was 73.2% and 68.8%, respectively. CONCLUSIONS: Results suggest no significant differences between the Tokyo and Connaught strains in the complete response, recurrence-free survival or adverse event rate.

[Percutaneous renal mass biopsy after indeterminate diagnostic imaging results].

We conducted a retrospective study to examine the efficacy of renal mass biopsies in our hospital. Twenty-six patients (18 male, 8 female ; median age, 69 years ; range, 42-85 years) with renal masses were divided into two groups. Group 1 (n＝9) underwent renal mass biopsies after completion of diagnostic imaging tests that needed a pathological diagnosis before treatment other than extirpative surgery, and group 2 (n＝17) underwent renal mass biopsies after completion of indeterminate diagnostic imaging tests that did not rule out malignancy. The median tumor size was 2.8cm (range, 0.8-15 cm), and the median number of biopsy cores obtained was two (range, 2-4). There were no biopsy-associated complications that required intervention. In group 1, 100% (9 of 9) of the renal mass biopsies were diagnostic, and the pathological findings corresponded to the respective diagnosis obtained by imaging tests, most of which were clear cell carcinoma. In group 2, 59% (10 of 17) of the biopsies were diagnostic. The imaging characteristics of the seven nondiagnostic biopsies in group 2 were low blood flow and poor peripheral clarity. On the other hand, renal mass biopsies were indispensable for some patients in group 2 in whom the pathological findings led to a decision of treatment strategy. In conclusion, renal mass biopsies should be considered in view of their ability to compensate for limitations of imaging tests and their low frequency of complications.

A case of squamous cell carcinoma arising from a suprapubic cystostomy tract in a patient with spinal bifida: Immunohistochemical analysis and literature review.

Introduction: Squamous cell carcinoma arising from a suprapubic cystostomy tract is a rare complication of an indwelling catheter and is caused by long-term inflammation and mechanical irritation. Prognosis is relatively poor. Biomarkers in the cancer pathway have not been investigated. Case presentation: A 61-year-old woman with a 34-year history of suprapubic catheter placement presented with a rapidly growing elevated lesion around the cystostomy site. Tumor biopsy confirmed squamous cell carcinoma. Local excision with partial cystectomy was performed. Multiple metastases were identified 5 months later. The patient died 14 months after the initial treatment. Immunohistochemical analysis of the resected specimen revealed alterations in vascular endothelial growth factor, epidermal growth factor receptor, cyclooxygenase-2, and Ki-67. Conclusion: We encountered a case of squamous cell carcinoma arising from a suprapubic cystostomy tract. Immunohistochemical analysis revealed activation of multiple carcinogenic pathways in cancer cells, including those for angiogenesis, signal transduction by epidermal growth factor receptor, inflammation, and cell proliferation.

[The factors for continuing docetaxel-based chemotherapy for castration-resistant prostate cancer].

A cohort of patients with castration-resistant prostate cancer (CRPC) that were treated with docetaxel (DOC) were retrospectively analyzed in order to examine the factors for continuing DOC therapy. In total, 26 patients treated with DOC at our hospital from August 2007 to August 2011 were recruited into the study. The participants were divided into two groups ; the first comprising 13 patients who received short-term DOC therapy (less than 5 cycles) and the second comprising 13 who received long-term DOC therapy (5 or more cycles). There was no significant difference in the indicators including age, prostate specific antigen level (at initial diagnosis), clinical stage and Gleason score between the groups. Patients with pain or poor performance status were more likely to be found in the short-term DOC group. The Hemoglobin-level was significantly higher in the long-term DOC group. In contrast, alkaline phosphatase, lactate dehydrogenase and C-reactive protein levels were significantly higher in the short-term DOC group. The period from the start of primary endocrine therapy to CRPC diagnosis was significantly longer in the long-term DOC group (p=0.0008). This latter finding suggests that DOC therapy can be continued for a longer time, in CRPC cases which have a long-term response to endocrine therapy, and may be associated with a more favorable survival outcome. However, to validate this suggestion, further investigation with a larger cohort of cases is necessary.

[A multi-institutional questionnaire survey on surgical treatment for a small renal mass: factors related with decision-making in indications for partial nephrectomy].

This study aimed to investigate factors taken into account when considering the indication of partial nephrectomy (PN). In October 2011, a questionnaire prepared with reference to the American Urological Association small renal mass survey and RENAL nephrometry score, and focusing on the factors taken into account when considering the use of PN, such as differences among candidates for open PN or laparoscopic PN was sent to 40 institutions. We received replies from 32 of the 40 institutions (average 611 beds) to which the questionnaire was sent. The total number of surgeries performed for renal tumors at the 32 institutions was 844 in 2009 and 889 in 2010. The number of PNs performed was 174 in 2009 (open : 61, laparoscopic : 113), and 241 in 2010 (open : 103, laparoscopic : 138), which represents a 38.3% increase. All respondents reported that renal function prior to PN was considered to be important, followed by tumor size, tumor number, and hereditariness. There were significantly more indications for open PN than for laparoscopic PN, and they were based on tumor size, degree of protrusion, and distance from the renal sinus. In addition, a clear tendency toward avoiding laparoscopic PN for cystic renal cancer was found. In addition, the institutions with a larger number of PNs tended to indicate more complicated cases including larger tumor size or entirely endophytic cases. This study has a limitation in that it was intended for a relatively large hospital, but these results can be useful information for institutions that are considering the introduction of open or laparoscopic PN.

Combined antegrade and retrograde endoscopic treatment of complete ureteroenteric obstruction following cystectomy with ileal conduit: A case report.

Management of ureteroenteric anastomotic stricture after urinary diversion remains challenging. Although open surgical repair is the gold standard procedure, less invasive endourological intervention is often preferred. In the event of complete obstruction of anastomosis, combined simultaneous antegrade and retrograde endoscopic treatment is required to achieve through-and-through access. Herein we report a case of complete obstruction of ureteroenteric anastomosis following cystectomy with ileal conduit. The cut-to-the-light method was used with a combination of a percutaneous antegrade flexible ureteroscope and a retrograde flexible cystoscope. A holmium:YAG laser incision was made along the full length of the stricture, and through-and-through access was achieved.

Androgen receptor-neuroendocrine double-negative tumor with squamous differentiation arising from treatment-refractory metastatic castration-resistant prostate cancer.

INTRODUCTION: Treatment-refractory metastatic castration-resistant prostate cancer is a heterogeneous disease classified into androgen receptor-high prostate cancer, androgen receptor-low prostate cancer, amphicrine prostate cancer co-expressing androgen receptor and neuroendocrine genes, double-negative prostate cancer lacking androgen receptor and neuroendocrine gene expression, and small cell or neuroendocrine prostate cancer without androgen receptor activity. Double-negative tumors can convert to the squamous phenotype. CASE PRESENTATION: A 62-year-old man was newly diagnosed with prostate cancer (serum prostate-specific antigen 2613 ng/mL, Gleason score 4 + 5 = 9, cT3aN1M1b) that progressed to castration resistance 4 months after starting abiraterone with androgen deprivation therapy. After enzalutamide and docetaxel failed, a right ilium metastasis newly emerged. Needle biopsy confirmed a metastatic tumor with squamous differentiation that was CK5/6-positive and chromogranin A-, synaptophysin-, and androgen receptor-negative. CONCLUSION: We encountered a case of double-negative prostate cancer with squamous differentiation identified by needle biopsy of a right ilium metastasis after abiraterone, enzalutamide, and docetaxel failure.

Expression of L-Type Amino Acid Transporter 1 is a Predictive Biomarker of Intravesical Recurrence in Patients with Non-Muscle Invasive Bladder Cancer.

PURPOSE: L-type amino acid transporter 1 (LAT1), a Na+-independent amino acid transporter, is highly expressed in various cancer types. We evaluated the prognostic value of LAT1 expression in non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS: We retrospectively reviewed 119 consecutive patients who underwent initial transurethral resection of bladder tumor. Of these, 75 patients with NMIBC were included in this study. Patients were classified into two groups according to the proportion of LAT1-positive cells, as determined by immunohistochemistry. Associations between LAT1 expression and clinicopathological factors were analyzed. Cox multivariate analyses were performed to identify independent predictors of intravesical recurrence (IVR). The LAT1 integrated risk model was compared with the European Organization for Research and Treatment of Cancer (EORTC) risk model to evaluate the predictive ability for IVR based on the c-index. RESULTS: The median follow-up was 37 months. Twenty-eight patients (37.3%) had IVR. LAT1 expression was not correlated with any other clinicopathological factors. Patients with high LAT1 expression had a worse IVR-free survival than that of patients with low LAT1 expression (P = 0.038). Cox multivariate analyses indicated that tumor multiplicity and high LAT1 expression were independent predictors of IVR. The LAT1 integrated risk model had a significantly improved performance over the EORTC model for assessing recurrence risk (c-index: 0.695, improvement: 0.091, P = 0.001). When patients were stratified into three groups according to the score calculated by the LAT1 integrated risk model, the 2-year IVR-free survival rates were 93.3% in patients with 0 points, 66.9% for those with 2 points, and 37.5% for those with 4 points. CONCLUSION: High LAT1 expression was an independent predictor of IVR in patients with NMIBC. The LAT1 integrated risk model had good predictability for IVR.

Expressions of P-Glycoprotein, Multidrug Resistance Protein 1 and Annexin A2 as Predictive Factors for Intravesical Recurrence of Bladder Cancer after the Initial Transurethral Resection and Immediate Single Intravesical Instillation of Adriamycin.

OBJECTIVE: Immediate single instillation of chemotherapy following transurethral resection of bladder tumor (TURBT) is suggested for non-muscle invasive bladder cancer (NMIBC) patients. However, no study has evaluated molecular marker that was involved in intravesical recurrence (IVR) after single instillation of chemotherapy. Therefore, this study aimed to evaluate whether P-glycoprotein, multidrug resistance protein 1 (MRP1), Annexin A2 (ANXA2) or nucleophosmin (NPM) expression predicts IVR after initial TURBT and immediate single intravesical adriamycin instillation. METHODS: We retrospectively reviewed consecutive 443 patients who underwent TURBT. Of these, 54 patients who underwent initial TURBT and single instillation of adriamycin for NMIBC were included. The expressions of P-glycoprotein, MRP1, ANXA2 and NPM were evaluated immunohistochemically and were divided into 2 groups (low or high) according to the staining intensity and/or proportion of positive cells. IVR was assessed by Kaplan-Meier method. Cox`s multivaritate analyses were performed to identify independent predictors for IVR. RESULTS: Nineteen patients (35.1%) had IVR. High P-glycoprotein expression was significantly correlated with multiplicity, pT stage and high grade. High ANXA2 expression was significantly correlated with high grade. MRP1 and NPM were not correlated with any clinicopathological variables. MRP1 expression and ANXA2 expression were significantly correlated with P-glycoprotein expression. Patients with high P-glycoprotein expression had significantly worse IVR-free survival (IVRFS) than those with low P-glycoprotein expression (P =0.015). The difference in IVRFS rates between patients with high ANXA2 expression and those with low ANXA2 expression was nearly significant (P =0.057). Univariate analyses indicated multiplicity, high grade and high P-glycoprotein expression were significant predictors for IVR. Multivariate analysis indicated high grade was an independent predictor for IVR. CONCLUSIONS: High P-glycoprotein expression was associated with IVR. Further study was needed to determine significance of P-glycoprotein expression in IVR after single intravesical adriamycin instillation.

Incidence of upper urinary tract stone during 15 years in Tajima area, Japan: a hospital-based study.

Time trend of incidence of upper urinary tract stone during 15 years was evaluated by hospital-based cohort study in Tajima area, northern part of Hyogo prefecture, Japan, which has only two general hospitals with Department of Urology. Due to isolation in terms of traffic network and geographic circumstances, almost all patients with urinary stone in Tajima area are referred to the two hospitals. During the period 2005-2007, patients of the two hospitals with radiologically proven upper urinary tract stone were included in this study. The survey included the age and gender, location of stones, history of urinary stone, treatment received, and stone composition, if available. Annual incidence of upper urinary tract stone was estimated using the data of population census of Japan 2005 and compared with the data of Tajima during 1991-1993. 1,305 patients were included in this study. Age-adjusted incidence (+/-95% CI) was 157 (+/-22.4) for men, and 57 (+/-12.6) for women, compared with 141 (+/-20.7) for men, and 63 (+/-13.4) for women during 1991-1993. In total, 30.7% of patients received interventional treatment including shock wave lithotripsy, endoscopic lithotripsy and open surgery, whereas 25.3% in 1991-1993. Calcium oxalate/phosphate stone was 89.6%, struvite stone was 4.5%, cystine stone was 1.0%, uric acid stone was 4.0%, and others were 1.0%. In Tajima area, incidence of upper urinary tract stone has not changed during 15 years.

Malignant fibrous histiocytoma arising from the renal capsule and gene mutation screening: A case report.

Malignant fibrous histiocytoma (MFH) is an aggressive soft tissue sarcoma. Renal MFH is rare and information about its molecular characterization is limited. We present here the case of a 77-year-old man who was incidentally found to have a huge right renal mass on computed tomography. Radical nephrectomy was performed. Pathological diagnosis was MFH arising from the renal capsule. We used Ion AmpliSeq Cancer Hotspot Panel version 2 primers to perform gene mutation screening. We detected 13 mutations in 11 hotspot oncogenes (CSF1R, FGFR3, KDR, APC, PDGFRA, TP53, FLT3, ERBB4, KIT, STK11, RET), but these were not matched to driver mutations.

[Squamous cell carcinoma of the bladder presenting with spontanenous intraperitoneal bladder rupture: a case report].

A-90-year-old woman visited complaining of nausea, vomiting, and abdominal pain. She had abdominal rigidity and signs of generalized peritonitis. On computed tomography (CT) gastrointestinal perforation was denied and irregular thickness of the bladder wall was pointed out. Cystography was performed, but bladder rupture was not confirmed. Post-cystogram-CT revealed the leakage of contrast material in the peritoneal cavity from the urinary bladder. Spontaneous intraperitoneal bladder rupture was diagnosed. Cystoscopy was performed, but no information could be obtained due to severe cloudy urine. Open laparotomy was performed. At surgery, cloudy fluid was aspirated from the abdominal cavity. Abdominal organs were normal when explored, but a small perforation was found on the vault of the bladder and primary closure was performed. Postoperatively, cystoscopy was performed again after the medication with antibiotics. A huge, nonpapillary tumor was seen on the left lateral wall. Tumor biopsy was performed. Histological examination of specimens revealed squamous cell carcinoma. On abdominal CT, invasive bladder carcinoma, left hydronephrosis and hydroureter were pointed out. Considering her age, general health status and prognosis, only right ureterocutaneostomy was performed.

[Gluteal muscular metastasis from renal pelvic tumor].

We present a case of gluteal muscular metastasis from a renal pelvic tumor. A 57-year-old man had undergone right nephroureterectomy and received 2 courses of adjuvant chemotherapy (MEC: methotrexate, epirubicin, cisplatin) for invasive renal pelvic tumor. Five months after the operation, computed tomography (CT) revealed pulmonary metastasis and right adrenal gland recurrence. He underwent 2 courses of chemotherapy (gemcitabine, paclitaxel). Postchemotherapy-CT scan showed a 2.2 cm mass in the right gluteal muscle. Since the size of the pulmonary metastasis and right adrenal gland recurrence showed no change, the gluteal mass was excised. Pathological diagnosis was metastatic urothelial carcinoma. Adjuvant chemotherapy (TIN: paclitaxel, ifosfamide, nedaplatin) 3 courses were performed, but postchemotherapy-CT scan showed a new 2.4 cm mass in the right gluteal muscle. He received radiation therapy (total 30 Gy) for the new gluteal mass. The common metastatic sites of renal pelvic tumor are lungs, liver, bone, and lymph nodes. Gluteal muscle is an uncommon site of metastasis of urothelial carcinoma. This is the 1st case of gluteal muscle metastasis from renal pelvic tumor in the literature.

[A case of angiomyolipoma in a horseshoe kidney].

The patient was 52 years old. She had undergone a breast cancer operation 4 years before this visit. On computed tomography (CT), a left renal tumor in a horseshoe kidney was incidentally pointed out. CT scan showed a 1.8-cm enhanced tumor in the upper pole of the left kidney. It was hyperechoic on ultrasonography. Since renal cell carcinoma could not be excluded preoperatively, left partial nephrectomy was performed. Pathological diagnosis was a renal angiomyolipoma. The incidence of horseshoe kidney is 1 in 400. The occurrence of hydronephrosis, infection and calculous disease is not uncommon. However, a case of angiomyolipoma simultaneously with a horseshoe kidney is very rare, this being the 7th case in the literature.

[Ureteral avulsion: a rare complication of ureteroscopy].

A case of ureteral avulsion as a complication of ureteroscopy is presented. A 55-year-old woman was admitted to the hospital with the complaint of hematuria. The intravenous pyelography revealed a calculus measuring 16 x 12 mm located in the left upper ureter. Transurethral ureterolithotripsy was performed with 8 F rigid ureteroscopy. A safety guide wire was inserted and left ureteral olifice was dilated to 9 F. The ureteroscopy was smoothly introduced just under the stone. The stone was fragmentated with a pneumatic lithotripter. A part of the stone was pushed back to the renal pelvis, so the ureteroscope was passed to that stone and fragmentation was done as much as possible. The ureteroscopy was gently pulled out to the bladder, but the distal ureter was torn at the ureteral orifice and could be seen at the urethral orifice. Pelvis, upper ureter and middle ureter were intact, so open intervention for repair was not performed. A 6Fr double pigtail stent was placed over the safety guidewire. Cystscopy indicated a part of the distal ureter was protruded from the ureteral orifice. Eight weeks later, the protruded part of ureter was necrotic and calcified for ischemia. Transurethral resection of necrotic ureter was performed. Histologically, resected ureter changed necrotic tissue for ischema. Postoperatively intravenous pyelography did not reveal left hydronephrosis and cystoscopy indicated that the left ureteral orifice was almost normally repaired.