[EXPERIENCES OF CONTACT LASER VAPORIZATION OF THE PROSTATE (CVP) FOR TREATING BENIGN PROSTATIC HYPERPLASIA IN THE LOCAL HOSPITAL].

(Objective) We started contact laser vaporization of the prostate (CVP) for treating benign prostatic hyperplasia at our hospital in July 2019. Forty-five patients were treated with CVP from July 2019 to April 2021. (Methods) Patients were assessed preoperatively and at one and three months after CVP treatment by using the International Prostate Symptom Score (IPSS), quality of life index (QOL index), peak urinary flow rate (Qmax), and postvoid residual urine volume (PVR). (Results) IPSS, QOL index, Qmax, and PVR significantly improved three months after CVP (p<0.05). Regarding adverse events, five patients developed early external urinary meatus strictures, two had postoperative bleeding, and three had temporary urinary retention. (Conclusions) In our hospital, elderly patients and patients who cannot discontinue an antithrombotic drug were treated by CVP for benign prostatic hyperplasia relatively safely.

A CASE OF AN AROMATASE-PRODUCING SERTOLI CELL TUMOR PRESENTING WITH GYNECOMASTIA.

A 64-year-old man had complained of a left scrotal mass and gynecomastia since June 2012. A left testicular tumor was suspected and the patient was referred to our department in December 2013. He presented with bilateral gynecomastia and a painless left scrotal mass that was firm, smooth surfaced, and the size of large hen's egg. Levels of markers of testicular germ cell tumors were all within normal range. Endocrinological examination revealed a marked elevation in serum estradiol (E2) level. The patient underwent high inguinal orchiectomy in December 2013.The pathological diagnosis was a Sertoli cell tumor of the left testis. Immunohistochemistry revealed the expression of aromatase synthesis; we speculated that this E2 production by the tumor caused the gynecomastia.Serum E2 level normalized after the orchiectomy. Owing to the diagnosis of malignancy, retroperitoneal lymph node dissection was performed in January 2014. No lymph node metastasis was found in the specimen. The gynecomastia improved gradually, and the patient has been free of disease since the surgery.

[Docetaxel-based chemotherapy for hormone-refractory prostate cancer in Japanese patients : experience in a single institute].

Between April 2007 and November 2010, we treated 21 cases of hormone-refractory prostate cancer with docetaxel-based chemotherapy. The administered dose of docetaxel was from 40 to 75 mg/m2, and the treatments were repeated every 3 to 4 weeks. The patients were from 61 to 88 years old (median 78). Fourteen patients were alive, and seven had died. According to the prostate specific antigen response, the complete response rate was 30%, partial response was 10%, no change was 25%, and progressive disease was 25%, respectively. Median time to progression was 7.0 months (from 1 to 43 months), and median overall survival time after chemotherapy was 11.5 months (from 3 to 44 months). One patient died of adverse events. However, in most cases, hematological toxicities were tolerable and manageable, although neutropenia of grade 3 to 4 was observed. On the other hand, non-hematological toxicities that led to discontinuation of the therapy were observed in a few cases. Docetaxel-based chemotherapy was feasible and effective even for patients over 80 years old. In responding cases, it is important to maintain the chemotherapy as long as possible, by modifying the treatment procedures, while paying attention to the adverse events.

Implantation of autologous bone-marrow-derived cells reconstructs functional urethral sphincters in rabbits.

The purpose of this study was to determine if implantation of autologous bone-marrow-derived cells has the potential to treat stress urinary incontinence caused by intrinsic sphincter deficiency. Bone marrow cells harvested from femurs of New Zealand White rabbits were cultured for 10 days. Seven days before implantation, the urethral sphincters located at the internal urethral orifice were cryo-injured by spraying liquid nitrogen for 15 s. The cultured autologous bone-marrow-derived cells were implanted 7 days after cryo-injury. For controls, cell-free solutions were injected. At 7 and 14 days after implantation, leak point pressures were determined and the urethral sphincters were examined by immunohistochemistry. At 7 and 14 days, the cell-implanted regions contained numerous striated and smooth muscle-like cells expressing myoglobin and smooth muscle actin, respectively. The proportions of myoglobin- and smooth muscle actin-expressing areas in both the 7- and 14-day cell-implanted regions were significantly higher than in controls. By 14 days, these differentiated cells formed contacts with similar cells, creating layered muscle structures. At that time, the leak point pressure of the cell-implanted rabbits was significantly higher than that of the controls. In conclusion, autologous bone-marrow-derived cells can reconstruct functional urethral sphincters.

Autologous bone-marrow-derived mesenchymal stem cell transplantation into injured rat urethral sphincter.

OBJECTIVES: To evaluate the functional and histological recovery by autologous bone-marrow-derived mesenchymal stem cell (BMSC) transplantation into injured rat urethral sphincters. METHODS: BMSC were harvested from female Sprague-Dawley retired breeder rats for later transplantation. The cells were cultured, and transfected with the green fluorescence protein gene. The urethral sphincters were injured by combined urethrolysis and cardiotoxin injection. One week after injury, the cultured BMSC were injected autologously into the periurethral tissues. Controls included sham-operated rats and injured rats injected with cell-free medium (CFM). Abdominal leak point pressures (LPP) were measured before and after surgery during the following 13 weeks. The urethras were then retrieved for histological evaluation. The presence of green-fluorescence-protein-labeled cells and the regeneration of skeletal muscles, smooth muscles, and peripheral nerves were evaluated by immunohistochemical staining. RESULTS: LPP was significantly reduced in the injured rats. It increased gradually after transplantation, but there was no significant difference between the BMSC and CFM groups. In the BMSC group, transplanted cells survived and differentiated into striated muscle cells and peripheral nerve cells. The proportions of skeletal muscle cells and peripheral nerves in the urethra were significantly greater in the BMSC group compared to the CFM group. CONCLUSIONS: Despite a clear trend towards recovery of LPP in BMSC-transplanted urethras, no significant effect was detected. Further study is required for clinical applications for the treatment of stress urinary incontinence.

Rat Bladders Augmented with a Novel Bovine Pericardium-Derived Biomaterial Reconstruct Functional Tissue Structures.

OBJECTIVES: To determine if rat bladders augmented with an acellular Japanese bovine pericardium-derived biomaterial (CardioDISC [CD]) could support bladder reconstruction, and increase bladder volume and compliance. METHODS: Female Sprague-Dawley rats were randomly divided into three groups (n = 5 each). After partial cystectomy, bladders were closed without augmentation (non-augmentation) or augmented with porcine small intestinal submucosa (SIS) or CD, both of which are acellular. At 1, 2, 4 and 8 weeks after surgery, bladder volume and compliance were measured. The bladders were then analyzed by immunohistochemistry for smooth muscle actin (SMA), urothelium uroplakin III (UPIII), and nerve fiber S100. RESULTS: At 4 weeks after augmentation, the SMA-positive cells from the host bladder tissues were present near the regions augmented with CD. In addition, S100-positive cells were present within the CD-augmented tissues. At 8 weeks after surgery, the CD-augmented tissues contained layered SMA-positive cells, urothelium uroplakin III -positive urothelium, and S100 fibers, similar to normal bladder tissue. The SIS-augmented bladders showed similar results. At 8 weeks after augmentation, the bladder volume of CD-augmented bladders was larger than that at 4 weeks, while the SIS-augmented bladders were the same as those at 4 weeks. The bladder volume of the non-augmented group did not increase. The bladder compliance of the CD-augmented bladders at 8 weeks was significantly higher than at earlier times. The bladder compliance of neither the non-augmented nor the SIS-augmented groups increased during the study period. CONCLUSION: Acellular bovine pericardium-derived material could be a suitable biomaterial for bladder augmentations.

[Traumatic subcapsular renal lymphocele: an unusual form of Page kidney].

A 17-year-old boy who received a kick on his right back during the training of karate complained of gross hematuria. Computed tomography revealed slight bleeding at the lower pole of right kidney. His general condition was stable and the gross hematuria was improved immediately. After one month, CT revealed a large right subcapsular renal fluid accumulation with parenchymal compression and his blood pressure became elevated. We diagnosed as Page kidney associated with subcupsular renal lymphocele after trauma. Percutaneous drainage and laparoscopic cyst fenestration were performed. After the procedures, the fluid accumulation was recurred and the blood pressure became elevated again. We disclosed a case of Page kidney associated with subcupsular renal lymphocele and propose that careful management should be needed in a patient like our case.

[Concurrent perirenal liposarcoma associated with renal cell carcinoma].

Here, we present a case of concurrent perirenal liposarcoma associated with renal cell carcinoma (RCC) in a 60-year-old man. The tumor was detected by ultrasonography, computed tomography and magnetic resonance imaging. However, the preoperative qualitative diagnosis was difficult due to unusual image findings. The patient was treated by surgical resection and has been free of disease for 24 months. To our knowledge, this is the third case of RCC associated with primary retroperitoneal liposarcoma reported to date. We discuss the imaging and pathological findings of the case and review the relevant literature.

Implanted mouse bone marrow-derived cells reconstruct layered smooth muscle structures in injured urinary bladders.

This study is a preliminary investigation to determine if bone marrow-derived cells, when implanted into freeze-injured urinary bladders, differentiate into smooth muscle cells and reconstruct smooth muscle layers. Bone marrow cells were harvested from femurs of male ICR mice and cultured in collagen-coated dishes for 7 days. After 5 days of culture, the cells were transfected with green fluorescent protein (GFP) genes for identification in recipient tissues. Three days prior to implantation, the posterior urinary bladder walls of female nude mice were injured with an iron bar refrigerated by dry ice. Seven days after the culture and 3 days after the injury, adherent, proliferating GFP-labeled bone marrow-derived cells (1.0 x 10(5) cells) were implanted into the injured regions. For controls, a cell-free solution was injected. At 14 days after implantation, the experimental urinary bladders were analyzed by histological, gene expression, and cystometric investigations. Just prior to implantation, the injured regions did not have any smooth muscle layers. After 14 days, the implanted cells surviving in the recipient tissues were detected with GFP antibody. The implanted regions had distinct smooth muscle layers composed of regenerated smooth muscle marker-positive cells. The implanted GFP-labeled cells differentiated into smooth muscle cells that formed into layers. The differentiated cells contacted each other within the implanted region as well as smooth muscle cells of the host. As a result, the reconstructed smooth muscle layers were integrated into the host tissues. Control mice injected with cell-free solution developed only few smooth muscle cells and no layers. Cystometric investigations showed that mice with implanted the cells developed bladder contractions similar to normal mice, whereas control mice did not. In summary, mouse bone marrow-derived cells can reconstruct layered smooth muscle structures in injured bladders to remediate urinary dysfunction.

Direct induction of layered tissues from mouse embryonic stem cells: potential for differentiation into urinary tract tissue.

The aim of this study was to induce organized layered tissues with characteristics of the urinary tract from embryonic stem (ES) cells alone. We seeded embryoid bodies (EBs) originating from mouse ES cells onto mono-layered collagen membranes and cultured them in four different media. Group 1 was grown in a mixed medium of keratinocyte serum-free medium (KSFM) and Medium 199, Group 2 in a mixed medium of KSFM and conditioned medium collected from 3T3 fibroblasts, Group 3 in an EB formation medium (control group), and Group 4 in KSFM only (control group). After 28 days, cultured tissues were transplanted into nude mice. Cultured tissues from Groups 1 and 2 formed four-layered structures comprising a stratified epithelium, a submucosal loose connective tissue layer, a smooth muscle cell layer identified immunohistochemically by alpha-smooth muscle actin, and a deep loose connective tissue layer identical to the adventitia. Immunohistochemistry showed that the epithelia were positive for cytokeratins. Tissues also expressed uroplakin as detected by reverse transcription/polymerase chain reaction. In contrast, specimens from Groups 3 and 4 demonstrated necrotic features. Uroplakin-positive (i.e., urothelium-like) cells developed only in Group 2 in the transplanted culture tissues in nude mice. In addition to inducing organized layered tissues from mouse ES cells directly in vitro, these findings demonstrate that tissues cultured in KSFM plus conditioned medium from 3T3 fibroblasts differentiate into luminal walls similar to those of urinary tract in vivo. These findings suggest a new approach to urinary tract regeneration.

Leptomeningeal metastases in a patient with an extragonadal germ cell tumor.

We present a case of leptomeningeal metastases in a 30-year-old man with an extragonadal germ cell tumor. The patient was referred to our hospital for treatment of an occipital brain metastasis. This lesion was resected, followed by whole brain radiotherapy and further chemotherapy, and a temporary complete remission was achieved. However, leptomeningeal recurrence developed, and despite salvage chemotherapy, the patient died of disease. Although multidisciplinary treatment is given to treat brain metastases of germ cell tumors, the patients' prognosis has been unsatisfactory. The identification of a standard/effective treatment is required.

Testicular cancer with tumor thrombus extending to the inferior vena cava successfully removed using veno-venous bypass: a case report.

A 33-year-old man with a left testicular tumor was referred to Shinshu University Hospital for advanced therapy. Radiographic imaging revealed multiple metastases in the retroperitoneal lymph nodes (RPLN) and bilateral lungs, as well as tumor thrombus that extended from the left renal vein to the inferior vena cava (IVC) adjacent to the right atrium. After orchidectomy, a diagnosis of embryonal carcinoma was made with a clinical stage of T1N2M1bS3, which has a poor prognosis, based on the International Germ Cell Cancer Collaborative Group consensus. After eight courses of chemotherapy, the patient's tumor markers normalized and the lung metastases disappeared, but the RPLN and tumor thrombus remained. Retroperitoneal lymph node dissection and thrombectomy were performed using a veno-venous bypass (VVB). The pathological examination of the thrombus revealed a mature teratoma. The patient has been disease-free since surgery.

Relapsed prostate cancer with neuroendocrine differentiation and high serum levels of carcinoembryonic antigen without elevation of prostrate-specific antigen: a case report.

A 62-year-old man had been treated with combined androgen blockade due to cT2bN1M0 prostate cancer, and his serum prostate-specific antigen (PSA) levels decreased and remained under the level of 0.5 ng/mL during therapy. Approximately 40 months after the initial therapy, difficulty on urination and constipation developed gradually, and serum carcinoembryonic antigen (CEA) and pro-gastrin-releasing peptide (ProGRP) levels were high at this point. He underwent transrectal and transurethral biopsy of the prostate, which revealed adenocarcinoma positive for CEA and chromogranin A. He received palliative pelvic irradiation, and oral estramustine phosphate and etoposide combined therapy. Tumor markers decreased and clinical symptoms improved for several months. The patient died of encephalopathy of unknown etiology approximately 11 months after the relapse.

Annular rectal constriction due to infiltration by bladder cancer.

Invasive bladder cancers frequently show lymphatic or hematogenous metastasis. Furthermore, aggressive local invasion into adjacent structures is also commonly observed. However, the occurrence of rectal stricture due to infiltration by bladder cancer is relatively rare. Here, we report three patients with aggressive bladder cancer causing rectal obstruction.

Thrombolytic therapy for traumatic unilateral renal artery thrombosis.

We report a case of traumatic unilateral renal artery thrombosis that was successfully treated by thrombolytic therapy. The patient was a 17-year-old woman, who had put her left upper abdomen between a wall and the handle of a ground roller when using it. A computed tomography scan with intravenous contrast showed a lack of contrast in the left kidney. Angiography showed complete occlusion of the left renal artery, and the diagnosis was traumatic left renal artery thrombosis. Following angiography, thrombolytic therapy was performed. Urokinase was administered into the left renal artery, and 360,000 units per 1.5 h was required. Thrombus disappeared and flow of left renal artery was observed. Recovery of left renal function was seen on renoscintigraphy. Surgical maneuvers for traumatic renal artery thrombosis are autotransplantation or thrombectomy generally, but we think that thrombolytic therapy following angiography is a less invasive method and saves warm ischemic time.

[The serum concentration of interleukin-2 in a hemodialysis patient--report from interleukin adjuvant therapy for local recurrent renal cancer].

We started interleukin-2 (IL-2) adjuvant therapy after resection of a repeated local recurrence of renal cell carcinoma in a hemodialysis patient. It is reported that IL-2 is mainly metabolized in proximal tubules of the kidney. To determine the IL-2 concentration, we employed the ELISA method using anti-human IL-2 antibodies. At the concentration of 350,000 Japan reference unit (JRU) in a hemodialysis patient, the change in serum IL-2 was almost the same speed compared to 700,000 JRU in normal renal function patients, which was reported previously. This report may also be a good tool to define the ideal dose of IL-2 in hemodialysis patients.

Recurrent retroperitoneal malignant nerve sheath tumor associated with neurofibromatosis type 1 responding to carboplatin and etoposide combined chemotherapy.

A 25-year-old man was referred to our hospital with left flank pain, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed large retroperitoneal masses. Physical examination revealed many café-au-lait spots and superficial neurofibromas, and a diagnosis of neurofibromatosis type 1 (von Recklinghausen's disease) was made. The tumor was resected, and the pathological diagnosis was malignant peripheral nerve sheath tumor (MPNST). Six months after the operation, lung metastases were detected. Surgical resection was incomplete, as there were too many lesions. He received four courses of chemotherapy with carboplatin and etoposide, and the metastatic lung lesions were markedly decreased. After chemotherapy, complete resection of the remaining lung lesions was performed, and there has been no recurrence to date.

Prostate-specific antigen, Gleason sum and clinical T stage for predicting the need for radionuclide bone scan for prostate cancer patients in Japan.

AIM: In the present study, we evaluated the relationships between prostate-specific antigen (PSA) level and bone metastasis, between Gleason sum and bone metastasis, and between clinical T stage and bone metastasis in Japanese patients. METHODS: Between November 1998 and June 2004, we performed ultrasound-guided biopsies on 709 patients (mean age: 70.5 years, range: 39-90). Prostate cancer was detected in 339 patients (47.8%), 297 (87.6%) of whom underwent a radionuclide bone scan. In close collaboration with orthopedists, bone computed tomography scans, bone magnetic resonance imaging and/or plain rentogenograms were performed for cases that were difficult to diagnose as bone metastasis through radionuclide bone scans only. RESULTS: We detected 61 (20.6%) bone metastasis cases in 296 patients. A simple linear regression analysis between log[PSA] and bone metastasis (n = 296) produced a significant relationship (P < 0.05). When we set the cut-off PSA value for the indication for a bone scan at 15 ng/mL, the possibility of bone metastasis was 10%. However, from our experience, there was no bone metastasis in the patients whose Gleason sums were less than five, and in the patients whose Gleason sum were five or more, and the PSA levels were less than 15, there was no bone metastasis. The rate of bone metastasis increased with the increase of PSA level. In the clinical T1-T2 stage cases, there were significant higher PSA levels in the cases with bone metastasis. In the T1-T2 patients whose PSA levels were less than 16, there was no bone metastasis. CONCLUSIONS: From the analysis of PSA, Gleason sum and clinical T stage, we suggest that bone scan is unnecessary for patients whose PSA level is less than 15 ng/mL or Gleason sum is less than five.

Resection of local recurrence of renal cell carcinoma in a hemodialysis patient 6 years after radical nephrectomy.

Left radical nephrectomy was performed on a 39-year-old-man because of renal cell carcinoma (grade 1, clear cell and granular cell carcinoma: pT3b pN0 pM0), 6 years after the beginning of hemodialysis. The second surgical intervention for local recurrence was performed 6 years after the first operation (grade 2 > 3, clear cell and granular cell carcinoma). This is the second published case report of the resection of a local recurrence of renal cell carcinoma after nephrectomy in a hemodialysis patient. Even after the curative operation, follow up for local recurrence should be continued in hemodialysis patients, especially for high stage renal cell carcinoma.