[A case of osteomyelitis of the pubis after radical prostatectomy: a case report].

A 74-year-old man visited our hospital, because of high prostate specific antigen (PSA). Retropubic radical prostatectomy was performed for prostatic cancer. Suddenly right inguinal lesion pain appeared at 25 days after operation with disturbance of gait. Pelvic magnetic resonance imaging (MRI) demonstrated inflammatory change in right pubic bone, pectineal muscle, adductor muscle, which suggested the diagnosis of osteomyelitis of the pubis. After long-term administration of antibiotic therapy, osteomyelitis of the symphysis pubis and gait possible. There was no recurrence of osteomyelitis of the symphysis pubis at one year after operation. In addition to our case, we review the 8 cases of osteomyelitis of the pubis after radical prostatectomy previously reported in Japanese publications.

[Clinical study of carcinoma of the penis].

We retrospectively analyzed the records of 21 patients with penile carcinoma treated between January 1993 and February 2007. According to TMN classification (UICC 2002), 9, 8, 2 and 2 patients belonged to stages I, II, III and IV, respectively. During the follow up period of 4 to 144 months (median 15 months), the overall 5-year survival rate was 75.8%. All three patients having N2 died within one year. Lymph node metastasis (p = 0.001) and organ metastasis (p = 0.007) were found to be unfavorable prognostic factors for patients with penile cancer.

[Influence of blood cells in urine samples on results of screening for urothelial carcinoma with NMP22 bladder chek].

We compared the sensitivity of Bladder Chek NMP22 with that of urine cytology in bladder cancer patients. Further, we evaluated the usefulness of Bladder Chek NMP22 in patients with benign diseases such as cystitis, urolithiasis, and benign prostate hyperplasia (BPH) and examined how blood cells in urine samples affect the results of Bladder Chek NMP22. Patients with macroscopic hematuria were excluded from this study. Of 77 bladder cancer patients, Bladder Chek NMP22 showed positive in 46.8%, while urine cytology in 33.8% (p = 0.16). Bladder Chek NMP22 and urine cytology showed positive in 31.8 and 0.0% in G1 (p = 0.004), 51.2 and 46.3% in G2 (p = 0.66) and 57.1 and 50% in G3 (p = 0.71); 44.4 and 88.9% in Tis (p = 0.052), 25.6 and 15.4% in Ta (p = 0.27), 72.2 and 33.3% in T1 (p = 0.02) and 81.8 and 54.5% in T2 or higher (p = 0.18), respectively. In bladder cancer patients with microscopic hematuria or pyuria, the positive rates of Bladder Chek NMP22 were 82.1 and 73.1%, respectively, whereas they were 26.5% (p < 0.001) and 33.3% (p = 0.002), respectively, in those without hematuria or pyuria. In 36 cystitis, 20 urolithiasis, and 19 BPH patients, the positive rates of Bladder Chek NMP22 were 58.3, 25.0 and 5.5%, respectively. Bladder Chek NMP22 showed higher sensitivity for detection of bladder cancer, especially in low-grade and low-stage cancers than urine cytology, but the result was likely affected by blood cells in urine samples. Thus, although Bladder Chek NMP22 may be less useful as the first device for screening of urothelial cancer in patients with hematuria or pyuria, it may show results of high quality when used in patients with negative urine cytology after excluding benign diseases.

[Prostate cancer in a relatively young adult: a case report].

We report a case of prostate cancer in a 45-year-old. The patient was found to have an elevated prostate specific antigen (PSA) level at a general health check and was referred to our division. Serum level of PSA was 6.9 ng/ml. Digital rectal examination and magnetic resonance imaging revealed a small nodule on the right lobe. Transperineal needle biopsy of the prostate revealed adenocarcinoma at the bilateral lobe (Gleason score 3+4). Computed tomography and a bone scan showed no evidence of metastasis. The patient was diagnosed as cT2b, NO, MO, and underwent a radical prostatectomy. Patients younger than 45 with prostate cancer are rare, although the incidence of prostate cancer is increasing. Here, 25 cases previously reported in Japan in addition to the present case, are reviewed.

[A case of emphysematous cystitis: a case report].

A 86-year-old woman presented with asymptomatic gross hematuria,and visited our hospital, and a vesicorectal fistula was suspected from a computed tomographic (CT) scan. She had a lower abdominal mass and urinary retention on arrival. Pclvic CT demonstrated intramural gas in the urinary bladder,which suggested a diagnosis of emphysematous cystitis. Cystoscopy demonstrated reddish mucosa and gas within the bladder wall. The gross hematuria was improved and the intramural gas disappeared on a CT scan after urinary drainage and antibiotic therapy. Although emphysematous cystitis is almost always cured with conservative therapy, an accurate diagonosis and prompt treatment are required because rarely emphysematous cystitis can result in rupture of the urinary bladder and lead to septic shock.

[Prostatic duct adenocarcinoma with pagetoid spread on the glans penis: a case report].

A 75-year-old male visited our division with asymptomatic erythema on the glans penis which he first noticed six months earlier. The patient underwent total cystoprostatectomy under the diagnosis of urothelial carcinoma of the urinary bladder four years earlier. At the time, the prostatectomy specimen incidentally revealed a prostatic acinar adenocarcinoma at the bilateral peripheral zone. A skin biopsy of the erythema revealed intraepithelial Paget's cells, and the patient underwent total penectomy under the diagnosis of extramammary Paget's disease. Histopathological examination revealed continuous intraepithelial Paget's cells from the glans penis to the urethral navicular fossa, and a ductal carcinoma was detected beneath the urethral mucosa to the excisional margin. Because the Paget's cells expressed cytokeratin 20, the tumor was diagnosed as Pagetoid spread rather than Paget's disease. Re-examination of the previous prostatectomy specimen revealed prostatic duct adenocarcinoma with prostatic acinar adenocarcinoma. Therefore, the final diagnosis was prostatic duct adenocarcinoma with Pagetoid spread to the glans penis. Follow up at nine months revealed neither local recurrence, nor distant metastases, although no adjuvant therapy has been given.