[Efficacy of Neoadjuvant Endocrine Therapy for Prostate Ductal Carcinoma with Large Multiple Cysts Prior to Robot-Assisted Laparoscopic Radical Prostatectomy].

A 71-year-old man with gross hematuria and urinary retention showed a 7×8 cm polycystic mass compressing the prostate on the right ventral side on pelvic magnetic resonance imaging (MRI). The prostate specific antigen (PSA) level was 6.47 ng/ml. Prostate biopsy histopathology was consistent with prostate ductal carcinoma. Considering the difficulty of surgical therapy, endocrine therapy was undertaken prior to surgery for seven months. Almost all of the cyst disappeared ; robot-assisted laparoscopic radical prostatectomy was then successfully performed. Prostate ductal carcinoma is a relatively rare pathology for which radical prostatectomy plays an important role if the disease is localized. However, when ductal carcinoma involves large cysts, surgical treatment may be difficult. This report discusses the usefulness of neoadjuvant endocrine therapy to reduce the size of the cystic lesions.

[Laparoscopic renal surgery in the elderly].

It is clear that laparoscopic renal surgery has significant advantages over open renal surgery. However, current data on whether these benefits carry over to the elderly are less robust. The objective of this study was to compare the perioperative parameters of laparoscopic nephrectomy and nephroureterectomy in patients aged 70 and over versus those under 70 years of age. The new scoring system, the "E-PASS" (estimation of physiologic ability and surgical stress) was also studied. This scoring system predicts the postsurgical risk by quantifying the patient's reserve and surgical stress. E-PASS comprises the perioperative risk score (PRS), the surgical stess score (SSS), and the comprehensive risk score (CRS) that is determined using the other two scores. Between January 2006 and December 2009, a total of 55 patients who underwent laparoscopic renal surgery met the study inclusion criteria. The perioperative parameters were comparable in the younger patients and the older patients, including SSS, the postoperative complication rate, the operation time and the hospital stay. Laparoscopic renal surgery is feasible and well tolerated in elderly patients, with a low perioperative morbidity and surgical stress. Further examination on the E-PASS scoring system for application to urologic surgery was considered to be necessary. Age alone should not exclude elderly patients from definitive treatment at the outset.

[An analysis of upper urinary tract recurrence following radical cystectomy for bladder cancer].

Transitional cell carcinoma of the urothelium is often multifocal, and subsequent tumors may occur anywhere in the urinary tract afer treating the initial carcinoma. The risk of an upper urinary tract recurrence following a radical cystectomy has been reported to be approximately 2 to 8%, but there are few reports with regard to the pattern and predictive factors of upper tract recurrence. We report here the incidence and pattern of upper tract recurrence following a radical cystectomy. Of the 166 patients 5 (3%) had upper tract recurrence. The prognosis of upper urinary tract recurrence is significantly better than other site of recurrence.

[The persisting mesonephric duct with contralateral cryptorchism and ipsilateral renal aplasia: a case report].

A 30-year-old man with azoospermia underwent an examination for infertility. He had a history of right orchiopexy due to cryptorchism. Radiological examinations showed an absence of the left kidney and the left seminal vesicle. A testicular biopsy revealed normal spermatogenesis in the left testis, but no spermatogenesis in the right testis. The right vasograph demonstrated obstruction of the vas deferens at the inguinal region. The left vasograph showed that the left vas drained into a cystic lesion, which then drained into the bladder neck. The left ureter was connected to this cystic lesion. The final diagnosis was a persistent mesonephric duct which was open to the bladder neck. The pathogenesis of the persistent mesonephric duct combined with the ectopic opening of the ureter and the vas deferens is discussed. The patient was treated by testicular extraction of the testicular sperm, and intracytoplasmic sperm injection.

[Retroperitoneal malignant peripheral nerve sheath tumor (MPNST) in a patient with neurofibromatosis I: a case report].

A 64-year-old man who was diagnosed with type I neurofibromatosis was referred to our hospital with a pelvic mass incidentally found by ultrasonography. When examined by CT and MRI, the mass in the pelvis was 5 x 3 x 2 cm. In addition, another mass was found close to the obturator nerve at the S1-2 level. Transrectal biopsy was carried out, and a diagnosis of neurofibroma suspicious for low grade malignancy was made. We performed surgical resection of both of the tumors. The resected tumor was pathologically diagnosed as retroperitoneal malignant peripheral nerve sheath tumor (MPNST). We report our case and review the literature of MPNST detected in type I neurofibromatosis.

[Retroperitoneal ganglioneuroma presenting as a soft tissue mass surrounding the aorta: report of a case].

A 37-year-old man was hospitalized for a soft tissue mass around the aorta which had been incidently found by abdominal CT. Radiological finding and laboratory data were nonspecific for retoroperitoneal fibrosis, lymphnode metastasis of testicular carcinoma and lymphoma. Ultrasonography guided biopsy of the mass revealed ganglioneuroma of the retoroperitoneum. No growth of the mass was observed at 14 months follow up.

[Right ectopic ureter with ipsilateral renal agenesis presenting with infertility: a case report].

A 30-year-old man was referred to our hospital with a complaint of male infertility, presenting abnormal semen analysis (semen volume 0.1 ml, sperm concentration 1.2 x 10(6)/ml, sperm motility 0%). Radiological examinations demonstrated right renal agenesis and a cystic mass extending from the prostate to the posterior of the bladder. Our final diagnosis was obstruction of the ejaculatory duct secondary to right ectopic ureter associated with ipsilateral renal agenesis. The patient was treated by transurethral unroofing of the cyst. Three months after the surgery, the cystic mass disappeared and the seminal findings showed marked improvement.

Insulin-like growth factor-binding protein-3 gene -202 A/C polymorphism is correlated with advanced disease status in prostate cancer.

The circulating level of insulin-like growth factor-binding protein-3 (IGFBP-3) is inversely associated with the risk of prostate cancer (PCa) and its progression and may be modulated by the A/C polymorphism at position -202 in the promoter region of IGFBP-3. This study was conducted to evaluate the role of the A/C polymorphism as a genetic modifier in the etiology of PCa and its disease status. The polymorphism was analyzed by a PCR restriction fragment-length polymorphism technique in 307 PCa patients, 221 benign prostatic hyperplasia (BPH) patients, and 227 male controls. No significant difference in the genotype frequency was found between the PCa or BPH patients and controls (PCa versus control, P = 0.316; BPH versus control, P = 0.964). Regarding the tumor stage, the C allele was more frequently observed in patients having tumors with higher stage (P for trend = 0.002). When the PCa patients with localized disease (stage A + B + C) were considered as reference, those with CC and AC genotype had a significantly increased risk of metastatic disease (stage D) compared with those with AA genotype [age-adjusted odds ratio (aOR) = 3.89, 95% confidence interval (CI) = 1.42-10.64, P = 0.008, and aOR = 1.68, 95% CI = 1.01-2.79, P = 0.044, respectively]. The presence of the C allele appeared to be associated with an increased risk of metastatic PCa with a gene dosage effect (aOR = 1.82, 95% CI = 1.23-2.68, P = 0.002). Similarly, significant findings were also observed when PCa patients were compared between those with organ-confined disease (stage A + B) and those with extra-prostatic extension (stage C + D). Furthermore, the C allele was present more frequently in patients with higher tumor grade. In conclusion, the IGFBP-3 -202 A/C polymorphism was not associated with susceptibility to PCa and BPH in Japanese men, but the presence of the C allele may cumulatively increase the risk for tumor metastasis and for having tumors with a biologically more aggressive phenotype. Because of the significant differences in incidence of clinically evident PCa according to racial backgrounds, the conjecture should be further examined in different racial populations.