[The Efficacy of Fesoterodine Switched from Solifenacin for Overactive Bladder Patients].

We investigated the efficacy of Fesoterodine, in 51 patients who did not respond to treatment with Solifenacin from January 2017 to December 2018. We assessed the overactive bladder symptom score (OABSS), thirst, constipation, and residual urine at baseline, as well as at 3 and 6 months from the start of drug administration. The mean age of the patients was 83. 0±6. 55 years. The OABSS indicated significant improvement in urge urinary incontinence and residual urine at 6 months, and significant aggravation in urgency at 3 months. Thus, Fesoterodine is considered useful for patients who did not respond to treatment with Solifenacin.

[Efficacy of mirabegron, a ß3-adrenergic agonist, switched from an anticholinergic agent for female patients aged over 70 years].

In the present study, we investigated the efficacy of mirabegron, a ß3-adrenergic agonist, in patients aged ＞70 years who did not respond to treatment with an anticholinergic agent. From February 2012 to May 2012, we examined 37 patients who did not respond to treatment with an anticholinergic agent. We assessed the overactive bladder symptom score (OABSS), thirst, and constipation at baseline, as well as at 3 and 6 months from the start of drug administration. Theme an age of the female patients was 79.9±6.08 years. The OABSS indicated significant improvement in nocturia and urge incontinence at 3 and 6 months. Furthermore, mirabegron significantly relieved thirst (in 95.2% of cases) and constipation (in 87.5% of cases). Thus, mirabegron is considered useful for female patients aged ＞70 years who did not respond to treatment with an anticholinergic agent.

[Clinical study of stage a prostatic cancer detected incidentally by transurethral resection of the prostate].

Transurethral resection of the prostate was performed on 584 consecutive patients with clinically diagnosed benign prostatic hyperplasia between April 2001 and July 2007. Pathological examinations revealed prostatic cancer in 30 (5.1%) of them. Seventeen patients had stage A1, and 13 stage A2 cancer. Prostatic biopsy was performed on 7 patients. The mean patient age was 69.4 years (range 60-78 years) for stage A1 cancer and 76.6 years (range 62-90 years) for stage A2. The mean serum PSA concentration was 8.9 ng/ml (range 1.18-41.3 ng/ml) for stage A1 cancer and 9.55 ng/ml (range 2.0-23.9 ng/ml) for stage A2. The mean follow-up period was 25.8 months (range 3-82 months) for stage A1 cancer and 27.3 months (range 1-82 months) for stage A2. In stage A1, all patients had a Gleason sum of 6 or less. In stage A2, 11 patients had a Gleason sum of 7 and 2 patients were 8 or more. Total prostatectomy was performed on 2 patients and no therapy on 15 patients with stage A1. Endocrine therapy was given to 1 patient, radiation therapy to 1 patient and no therapy to 11 patients with stage A2. Adjuvant therapy was given to 2 patients with stage A1 and to no one with stage A2. We concluded that PSA monitoring is an option in stage A2 cancer.

[Case of extensive retroperitoneal abscess in a subcutaneous mass].

A 69-year-old woman consulted a doctor for subcutaneous mass and left hydronephrosis. Abdominal CT showed a left retroperitoneal abscess from the left perirenal lesion to the ileocccal region, subcutaneous abscess and left ureteral stone. Percutaneous drainage and double J stent indwelling was performed. Retrograde pyelography revealed extravasation from upper calyx to perirenal space. The abscess fluid culture proved to be methicillin-resistant Staphylococcus aureus.

[Case of fungal endophthalmitis from pyelonephritis caused by ureterolithiasis].

A 63-year-old woman presented with visual disturbance. A fever had been noted for 11 days. Right eye visual acuity was 20/50. Left eye visual acuity was 20/20. Inflammatory cclls wcrc present in the right aqueous and the vitreous humor. Tbc right retina was edematous. The left retina and left ocular humors were normal. Urinalysis showcd many white blood cells. Urine culture showed Candida albicans. KUB revealed many small ureteral calculi bilaterally. A diagnosis of fungal endophthalmitis due to pyeloncphritis caused by ureterolithiasis was rendered. The paticnt rcccivcd an intravenous course of fosfiuconazole and fluconazole.

[Open adrenalectomy for adrenal metastases from lung cancer--usefulness and problem of laparoscopic adrenalectomy].

We examined the outcome of open adrenalectomy performed at our hospital to determine the effectiveness and problems of laparoscopic adrenalectomy for adrenal metastases from lung cancer. Between January 2001 and June 2004, eight open adrenalectomies were performed on six patients with adrenal metastases from lung cancer. Surrounding adhesion was observed in five of the eight cases (63%). The recurrence period was 17.8 months and 5.3 months in the cases with and without adhesion, respectively. Laparoscopic adrenalectomy for adrenal metastases may be safe and effective. However, potential surrounding adhesions meed to be adequately considered, if the primary lesion is the lung.

Management of concomitant ureteral carcinoma in situ at radical cystectomy.

OBJECTIVE: We conducted a retrospective study to evaluate and define the management of concomitant ureteral carcinoma in situ (CIS) at radical cystectomy. METHODS: For 158 consecutive patients, who underwent radical cystectomy for invasive bladder cancer, ureteral CIS missed by preoperative examinations were evaluated by intraoperative analysis of frozen sections or postoperative histological analysis. The median follow-up period was 3.4 years. RESULTS: In total, 15 concomitant ureteral CIS were diagnosed by intraoperative (n=9) or postoperative analysis (n=6). Additional ureteral resection achieved no malignancies in the final ureteral margins of eight patients. During the follow-up period, five patients (3.6%) suffered from tumor recurrence in the upper urinary tract in total, as did three (20%) among the 15 patients with ureteral CIS missed by preoperative examinations. No recurrence was identified in the eight patients with no malignancy in the final ureteral margins after additional resection. Furthermore, multivariate analysis indicated that the presence of bladder CIS was a risk factor for the presence of concomitant ureteral CIS. CONCLUSIONS: Detection of concomitant ureteral CIS by intraoperative studies, in combination with complete resection of ureteral CIS, might be beneficial for patients with risk factors such as bladder CIS.

[Adenocarcinoma of the prostate associated with anti Jo-1 antibody positive polymyositis].

A 76-year-old male was hospitalized with elevation of prostate specific antigen. We closely examined him further because creatine phosphate kinase was found to be 2,841 IU/l in the pre-operative examination. He was positive for anti Jo-1 antibody, and was found to have muscular atrophy of lower extremities on magnetic resonance imaging, and fibrillation and positive sharp waves on the electromyogram. He was therefore diagnosed with polymyositis. Adenocarcinoma was classified as Gleason score 8 by needle biopsy of the prostate and the stage of the prostate carcinoma was cT3aN1M0. The patient was treated with hormonal ablation and oral steroids.

[Prostate cancer with penile metastasis: a case report].

A 77-year-old man presented with complaints of dysuria, nocturia and painless nodule on his penis. Laboratory examination revealed elevated serum prostate-specific antigen (PSA) and CA19-9. Pathological examinations on prostate and penile biopsy specimens revealed prostate adenocarcinoma with penile metastasis. The patient was diagnosed as having prostate cancer stage D2 (T4N1M1) with bone, lymph node and penile metastases. There was no response to initial hormonal therapy with the surgical castration and diethylstilbestrol. However, decrease of the tumor size, as well as PSA and CA19-9 values were achieved after the combined chemotherapy with Estramustine, Paclitaxel and Carboplatin.

[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.

[Clinical study of modified M-VAC therapy with one 21-day cycle for advanced urothelial cancer].

Although M-VAC therapy is a standard chemotherapy for advanced transitional cell carcinoma, the treatment schedule has to be delayed or cancelled in many patients because of the toxicity. To reduce the toxicity we modified the treatment schedule of M-VAC treatment. The dosages of this simplified M-VAC therapy were 30 mg/m2 methotrexate (on day 1), 3 mg/m2 vinblastine (on day 2), 30 mg/m2 doxorubicin (on day 2) and 70 mg/m2 cisplatin (on day 2), with courses repeated every 21 days for four cycles as a principle. Seventeen patients with histologically proven advanced transitional cell carcinoma were treated with this simplified M-VAC therapy without dose modification or delay. The median number of cycles was 4. Neutropenia, anemia and thrombopenia (grade 4) was observed in 2, 1 and 2 patients respectively, but no drug-related deaths were observed. Complete response and partial response were achieved in 2 (12%) and 10 (59%) patients respectively. Of 2 complete responders one patient was alive without evidence of disease at 12 months and another patient died of the disease at 42 months. Of 10 partial responders 6 patients underwent the additional surgical resection of residual tumors. Of these 6 patients 3 patients are alive without evidence of disease at 6, 30 and 31 months. The remaining 3 developed recurrence and 2 died of the disease at 13 and 29 months. Five non-responders died of the disease at 5 months after the start of the therapy. Response rate of simplified M-VAC therapy was excellent and treatment duration was short. However, relapses were commonly observed as well as the original M-VAC treatment.