Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
1.
IJU Case Rep ; 7(2): 173-176, 2024 Mar.
Article in English | MEDLINE | ID: mdl-38440718

ABSTRACT

Introduction: In addition to reduced nectin-4 expression, the upregulation of ATP-binding cassette transporters has been suggested as a potential mechanism of resistance to enfortumab vedotin. Case presentation: A 76-year-old man previously treated with platinum-containing chemotherapy and pembrolizumab for metastatic bladder cancer was administered enfortumab vedotin because of disease progression. Subsequently, metastasectomy was performed for oligometastatic lesions (in the lung and adrenal gland) that exhibited growth during enfortumab vedotin therapy. Immunostaining analysis revealed decreased nectin-4 expression and elevated MDR1, MRP1, and BCRP expression in the metastatic lesions. Conclusion: Decreased nectin-4 expression and increased ATP-binding cassette transporter expression are potential factors in the development of enfortumab vedotin resistance in urothelial carcinoma. Immunohistochemical evaluation of these proteins may aid in predicting treatment efficacy.

2.
IJU Case Rep ; 7(1): 83-86, 2024 Jan.
Article in English | MEDLINE | ID: mdl-38173461

ABSTRACT

Introduction: Intensive treatment is typically considered for very high-risk patients with locally advanced prostate cancer and an expected survival time of 5 years or longer. Herein, we report a case of locally advanced prostate cancer with rectal infiltration treated with laparoscopic total pelvic exenteration combined with transanal total mesorectal excision. Case presentation: A 73-year-old man presented with a ring-shaped mass around the rectum. He was diagnosed with prostate cancer with rectal infiltration and underwent laparoscopic total pelvic exenteration combined with transanal total mesorectal excision following neoadjuvant androgen deprivation therapy. Twenty-two months postoperatively during ongoing androgen deprivation therapy, no biochemical recurrence was observed. Conclusion: To our knowledge, this is the first report of a laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for prostate cancer with rectal infiltration. We believe this surgery may be considered a new option for high-risk prostate cancer patients with rectal infiltration.

3.
Cancers (Basel) ; 15(23)2023 Nov 26.
Article in English | MEDLINE | ID: mdl-38067295

ABSTRACT

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC); however, validating body composition-related biomarkers for their efficacy remains incomplete. We evaluated the association between body composition-related markers and the prognosis of patients with mRCC who received ICI-based first-line therapies. PATIENTS AND METHODS: We retrospectively investigated 60 patients with mRCC who underwent ICI-based therapy as their first-line treatment between 2019 and 2023. Body composition variables, including skeletal muscle, subcutaneous fat, and visceral fat indices, were calculated using baseline computed tomography scans. Sarcopenia was defined according to sex-specific cut-off values of the skeletal mass index. The associations between body composition indices and objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS: Patients with sarcopenia had lower ORR and DCR than those without sarcopenia (33.3% vs. 61.1%, p = 0.0436 and 52.4% vs. 94.4%, p = 0.0024, respectively). Patients with sarcopenia had a significantly shorter median PFS (14 months vs. not reached, p = 0.0020) and OS (21 months vs. not reached, p = 0.0023) than patients without sarcopenia did. Sarcopenia was a significant predictor of PFS (hazard ratio [HR], 4.31; 95% confidence interval [CI], 1.65-14.8; p = 0.0018) and OS (HR, 5.44; 95% CI, 1.83-23.4; p = 0.0013) along with poor IMDC risk. No association was found between the subcutaneous, visceral, and total fat indices and the therapeutic effect of ICI-based therapy. CONCLUSIONS: Sarcopenia was associated with a lower response and shorter survival rates in patients with mRCC who received first-line ICI-based therapy.

4.
IJU Case Rep ; 6(6): 334-336, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37928299

ABSTRACT

Introduction: Bladder cancer is characterized by spatial and temporal recurrence in the urinary tract. We describe a case of recurrence at a uretero-ileal anastomosis after radical cystectomy and nephroureterectomy. It was difficult to control bleeding from the tumor, but hemostasis was achieved. Case presentation: A 73-year-old man with a history of radical cystectomy and reconstruction of the ileal conduit and right nephroureterectomy was diagnosed with recurrence at the uretero-ileal anastomosis site. Bleeding from the tumor could not be controlled by flexible gastrointestinal endoscopy. The patient underwent coagulation via an ileal conduit approach using a rigid scope and bipolar electrocautery, which is usually a modality for transurethral resection. Conclusion: This is the first report in which a modality normally used for transurethral resection was used to control bleeding in a patient with an ileal conduit. This application is useful in cases open surgery or additional irradiation might be difficult.

5.
IJU Case Rep ; 6(6): 440-444, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37928308

ABSTRACT

Introduction: Although undifferentiated pleomorphic sarcomas are aggressive, a subset of these tumors are immunogenic and may respond to immunotherapy. Case presentation: A 69-year-old man developed bilateral adrenal tumors and underwent bilateral adrenalectomy. Pathological examination revealed undifferentiated pleomorphic sarcoma harboring tertiary lymphoid structures and infiltration of CD8+ T cells. Genome profiling revealed PD-L1 amplification, microsatellite instability, and a high tumor mutation burden. He developed local recurrence and multiple peritoneal dissemination 2 months after surgery; adriamycin chemotherapy was ineffective for these lesions. Sustained complete remission of all lesions was achieved by administering pembrolizumab. Conclusion: Immunohistochemical analysis focusing on tertiary lymphoid structures and genome profiling to evaluate microsatellite instability and tumor mutation burden are essential for precision medicine and informed clinical decision-making when treating advanced undifferentiated pleomorphic sarcoma.

6.
BMC Cancer ; 23(1): 940, 2023 Oct 05.
Article in English | MEDLINE | ID: mdl-37798659

ABSTRACT

BACKGROUND: This study aimed to identify patients with upper urinary tract urothelial carcinoma (UTUC) having potential Lynch syndrome (pLS) by immunohistochemistry (IHC) of DNA mismatch repair gene-related proteins (MMRPs) and Amsterdam criteria II and explore their clinical characteristics. METHODS: We retrospectively collected the clinical data of 150 consecutive patients with UTUC who underwent surgical resection at our institution between February 2012 and December 2020, and immunohistochemistry (IHC) of four MMRPs (MLH1, MSH2, MSH6, and PMS2) on all UTUC specimens was performed. Patients who tested positive for Amsterdam criteria (AMS) II and/or IHC screening were classified as having pLS and others as non-pLS, and their characteristics were explored. RESULTS: In this study, 5 (3%) and 6 (4%) patients were positive for AMS II and IHC screening, respectively. Two patient were positive for both AMS II and IHC screening, resulting in 9 (6%) patients with pLS. The pLS group was predominantly female (67% vs. 36%; p = 0.0093) and had more right-sided tumors (100% vs. 43%; p = 0.0009) than the non-pLS group. Of the 6 patients who were positive for IHC screening, 4 showed a combined loss of MSH2/MSH6 (n = 3) and MLH1/PMS2 (n = 1). Other two patients showed single loss of MSH6 and PSM2. CONCLUSIONS: AMS II and IHC screening identified pLS in 6% of patients with UTUC. The IHC screening-positive group tends to have relatively high rate of combined loss, but some patients have single loss. AMS II may overlook patients with LS, and a universal screening may be required for patients with UTUC as well as those with colorectal and endometrial cancer.


Subject(s)
Carcinoma, Transitional Cell , Colorectal Neoplasms, Hereditary Nonpolyposis , Kidney Neoplasms , Ureteral Neoplasms , Urinary Bladder Neoplasms , Urinary Tract , Humans , Female , Male , Carcinoma, Transitional Cell/diagnosis , Carcinoma, Transitional Cell/epidemiology , Carcinoma, Transitional Cell/genetics , Colorectal Neoplasms, Hereditary Nonpolyposis/diagnosis , Colorectal Neoplasms, Hereditary Nonpolyposis/epidemiology , Colorectal Neoplasms, Hereditary Nonpolyposis/genetics , Mismatch Repair Endonuclease PMS2/genetics , Mismatch Repair Endonuclease PMS2/metabolism , Retrospective Studies , Prevalence , MutS Homolog 2 Protein/genetics , MutS Homolog 2 Protein/metabolism , MutL Protein Homolog 1/genetics , MutL Protein Homolog 1/metabolism , Ureteral Neoplasms/diagnosis , Ureteral Neoplasms/epidemiology , Urinary Tract/metabolism , Urinary Tract/pathology , DNA Mismatch Repair
7.
Clin Nutr ; 42(9): 1537-1544, 2023 09.
Article in English | MEDLINE | ID: mdl-37478808

ABSTRACT

BACKGROUND & AIMS: Recently, the strength, assistance with walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire has been developed to screen patients with signs of sarcopenia. However, its clinical benefit remains uncertain in elderly patients undergoing elective major surgeries. This study aimed to explore the role of the SARC-F questionnaire as a screening tool for patients who plan to undergo elective major surgery for urologic cancer and to also evaluate correlations of SARC-F scores with established indicators of sarcopenia. METHODS: This retrospective observational study enrolled 815 patients over 40 years of age undergoing elective major surgery for urologic cancer and who were screened with the SARC-F questionnaire, preoperatively. The primary endpoint was an association between SARC-F scores and postoperative ambulation failure. Here we define postoperative ambulation failure as a condition where a patient is unable to walk independently within 2 days after surgery and required physical rehabilitation or was transferred to other hospitals in a bedridden state. The secondary endpoint was an association between SARC-F scores and overall survival (OS). Psoas muscle density (PMD) and psoas muscle index (PMI) were calculated from abdominal computed tomography images, and their correlations with SARC-F scores grouped by sex. RESULTS: Of the 815 patients, 738 (91%) were male and the median age was 72 years. Although SARC-F scores weakly correlated with PMD in males and moderately correlated in females (ρ = -0.222 and ρ = -0.474, respectively), their correlation with PMI was negligible (ρ = -0.179 and ρ = -0.084, respectively). SARC-F scores successfully discriminate postoperative ambulation failure in both males and females with the respective area under the receiver operating characteristic curve of 0.856 and 0.813. Multivariate analysis also showed that SARC-F scores greater than 4 are an independent risk factor of postoperative ambulation failure along with older age, lower PMD, and poor performance status. SARC-F scores greater than 4 were significantly associated with a shorter OS in the whole cohort (P < 0.001) and a subgroup of patients undergoing radical cystectomy (P = 0.03; median follow-up of 515 days). CONCLUSIONS: The SARC-F questionnaire might be applicable to identify elderly patients at a higher risk of unfavourable outcomes after major urologic cancer surgery. A randomised controlled trial is necessary to confirm this finding.


Subject(s)
Neoplasms , Sarcopenia , Female , Humans , Male , Adult , Middle Aged , Aged , Sarcopenia/diagnosis , ROC Curve , Elective Surgical Procedures/adverse effects , Walking , Surveys and Questionnaires , Geriatric Assessment/methods , Mass Screening/methods
8.
Indian J Surg Oncol ; 14(2): 361-365, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37324313

ABSTRACT

This case series reported on five patients with radiation-recurrent localized prostate cancer (PCa) who underwent salvage robot-assisted radical prostatectomy (sRARP). Median postoperative follow-up period was 8 months. Median (range) peri-operative parameters such as operative time, the estimated blood loss, and length of hospital stay were 127 min (113-158), 61 ml (54-111), and 9 days (8-11), respectively. None of the five patients required conversion to an open approach or required a blood transfusion, or experienced a rectal/ureteral injury. Urinary leakage was present in one patient (20%) at the initial cystogram. Transurethral electrocoagulation under spinal anesthesia was required to control hematuria in one patient (20%). Two patients (40%) experienced biochemical progression; no patient died from PCa or other causes during the follow-up period. Of five patients, three (60%) were continent. For patients with radiation-recurrent localized PCa, sRARP might become a feasible surgical option with acceptable outcomes.

9.
IJU Case Rep ; 6(3): 190-193, 2023 May.
Article in English | MEDLINE | ID: mdl-37144083

ABSTRACT

Introduction: Robot-assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery. Case presentation: In this report, robot-assisted total laparoscopic hysterectomy and robot-assisted nephroureterectomy were performed simultaneously for a 69-year-old Japanese female with giant cervical polyp and ureteral cancer. All specimens could be removed from the vagina. The operative time was 379 min, the estimated intraoperative blood loss was 29 mL, and the patient was discharged on the sixth postoperative day without complications. Conclusion: We reported our experience with simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy. To our knowledge, this is the first report of simultaneous robot-assisted nephroureterectomy and robot-assisted total laparoscopic hysterectomy surgery.

10.
J Geriatr Oncol ; 14(3): 101468, 2023 04.
Article in English | MEDLINE | ID: mdl-36870222

ABSTRACT

INTRODUCTION: This study aimed to evaluate whether functional screening, as assessed by the Geriatric-8 (G8) and the instrumental activities of daily living (IADL)-modified G8, are associated with the inability to manage a stoma by themselves in patients with bladder cancer who underwent robot-assisted radical cystectomy. MATERIALS AND METHODS: We analyzed a total of 110 consecutive patients with bladder cancer who underwent robot-assisted radical cystectomy and were screened preoperatively using the G8 and the IADL-modified G8 at our institution between January 2020 and December 2022. Patients who could not undergo geriatric screening at the preoperative clinic before surgery and patients who underwent orthotopic neobladder construction were excluded. We evaluated the association between clinical factors, including scores of G8 and IADL-modified G8, and the inability to manage a stoma by oneself. For both G8 and IADL-modified G8, a cutoff value of ≤14 was set. RESULTS: Of the 110 patients, the median age was 77 years, 92 (84%) patients were male and 47 (43%) patients were unable to manage a stoma by themselves. The geriatric assessment indicated that 64 patients (58%) were classified in the low G8 (≤14) group and 66 patients (60%) were classified in the low IADL-modified G8 (≤14) group. The values of area under the receiver operating characteristic curve for predicting inability to manage stoma by oneself were 0.725 for the G8 and 0.734 for the IADL-modified G8, respectively. Multivariate analysis including the G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and G8 ≤ 14 (odds ratio [OR] = 4.9; 95% confidence interval [CI] = 1.8-13.0; P = 0.002) were independent risk factors for inability to manage a stoma by oneself. Likewise, multivariate analysis including the IADL-modified G8 revealed that age ≥ 80, Charlson comorbidity index of ≥3, and IADL-modified G8 ≤ 14 (OR = 5.4; 95% CI = 1.9-14.0; P = 0.001) were independent risk factors for inability to manage a stoma by oneself. DISCUSSION: Screening using G8 and IADL-modified G8 may predict patients who have difficulty self-managing their stomas.


Subject(s)
Urinary Bladder Neoplasms , Urinary Diversion , Humans , Male , Aged , Female , Activities of Daily Living , Urinary Diversion/adverse effects , Urinary Bladder Neoplasms/surgery , Cystectomy , Risk Factors
11.
J Robot Surg ; 17(4): 1485-1491, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36788149

ABSTRACT

The aim of this study is to evaluate the association of perinephric fat volume (PNFV) and the Mayo Adhesive Probability (MAP) score with time to clamping (TTC) in robot-assisted partial nephrectomy (RAPN). The study subjects consisted of 73 tumors in 72 patients who underwent transperitoneal RAPN at a single cancer center between February 2020 and July 2022. Clinical characteristics including R.E.N.A.L. nephrometry score, MAP score and PNFV were evaluated in a multivariate analysis in relation to TTC, which was classified into two groups based on median TTC. PNFV and MAP score were analyzed separately. PNFVs were measured by SYNAPSE VINCENT® by a single expert urologist. Median TTC was 67 (range: 36-119) min. Spearman's rank correlation analysis indicated that a significant correlation was observed between PNFV and MAP score with a value of 0.81 (p < 0.0001). Univariate analysis revealed that R.E.N.A.L. nephrometry score ≥ 7 (p = 0.036), posterior tumor location (p = 0.033), MAP score ≥ 3 (p = 0.02) and PNFV ≥ 250 ml (p = 0.02) were significant factors for prolonged TTC. In a multivariate analysis including PNFV (analysis 1), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and PNFV ≥ 250cm3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Similarly for MAP score (analysis 2), R.E.N.A.L. nephrometry score ≥ 7 (OR 3.54, p = 0.018) and MAP score ≥ 3 (OR 3.94, p = 0.010) were independent factors for prolonged TTC. Both MAP score and PNFV may have a significant impact on TTC.


Subject(s)
Kidney Neoplasms , Robotic Surgical Procedures , Robotics , Humans , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Constriction , Robotic Surgical Procedures/methods , Nephrectomy , Probability , Retrospective Studies , Treatment Outcome
12.
IJU Case Rep ; 6(1): 14-17, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36605684

ABSTRACT

Introduction: We present a case of simultaneous robot-assisted radical nephroureterectomy (RANU) and robot-assisted radical cystectomy (RARC) for muscle-invasive bladder cancer with concomitant upper urinary tract urothelial carcinoma. Case presentation: A 59-year-old Japanese man was diagnosed with right ureteral cancer and muscle-invasive bladder cancer. We performed RANU and RARC simultaneously; three of the ports used for RANU were diverted to RARC. Console times for RANU and RARC were 66 and 207 minutes, respectively. Total operative time was 386 minutes. The intraoperative blood loss was estimated 255 ml. The patient was discharged on postoperative day 18 without complications. Conclusion: We reported our experience with simultaneous RANU and RARC for muscle-invasive bladder cancer with concomitant right ureteral cancer. To the best of our knowledge, this is the first report of its kind in Japan.

13.
J Surg Oncol ; 127(6): 1071-1078, 2023 May.
Article in English | MEDLINE | ID: mdl-36695780

ABSTRACT

OBJECTIVES: The purpose of this study was to develop a new composite score to accurately predict postoperative delirium (POD) after major urological cancer surgery. METHODS: Our retrospective analysis included, in total, 449 consecutive patients who experienced major urological cancer surgery and a preoperative geriatric functional assessment at our institution (development cohort). Geriatric functional assessments included Geriatric 8, Instrumental Activities of Daily Living, and mini-cognitive assessment instrument (Mini-Cog). Multivariate analysis was used to identify factors related to POD and combined to create a predictive score. The composite score was externally validated using a cohort of 92 consecutive pancreatic cancer patients who underwent pancreaticoduodenectomy and a preoperative geriatric functional assessment (validation cohort). The predictive accuracy and performance of the composite score were evaluated using the area under the receiver operating characteristic curves (AUC) and calibration plots. RESULTS: In multivariate analysis of a development cohort, the following factors were significantly associated with POD: a Mini-Cog score of <3 (odds ratio [OR] = 9.5; p < 0.001), disability in the responsibility for medication (OR = 4.1; p = 0.03), and the preoperative use of benzodiazepine (OR = 6.4; p < 0.001). The composite score of these three factors showed excellent discrimination in predicting POD, with AUC values of 0.819 and 0.804 in development and validation cohorts, respectively. Calibration plots showing predicted probability and actual observation in both cohorts showed good agreement. CONCLUSIONS: A combined model of Mini-Cog, a disability in the responsibility for medication, and preoperative benzodiazepine use showed excellent discriminative power in predicting POD.


Subject(s)
Delirium , Emergence Delirium , Humans , Aged , Retrospective Studies , Activities of Daily Living , Postoperative Complications/prevention & control , Delirium/diagnosis , Geriatric Assessment , Risk Factors
14.
Turk J Urol ; 48(5): 322-330, 2022 Sep.
Article in English | MEDLINE | ID: mdl-36197139

ABSTRACT

OBJECTIVE: To improve perioperative outcomes, robot-assisted radical cystectomy has gained increasing interest. This study aimed to assess the detailed perioperative complications of robot-assisted radical cystectomy in elderly aged ≥80 years and compare them with those of non-elderly. MATERIAL AND METHODS: We retrospectively analyzed the clinical features of 74 patients who underwent robotassisted radical cystectomy for bladder cancer between September 2018 and September 2021. Perioperative complication was classified by the Clavien-Dindo classification and organ system-based categories. We assessed the relationship between age or Charlson comorbidity index score (≥3 or <3) and the incidence of perioperative complication or rehospitalization rate within 90 days postoperatively. RESULTS: Of the 74 patients, perioperative complication of all grades and grade ≥IIIa occurred in 54 (73%) and 15 (20%) patients, respectively. The postoperative rehospitalization rate was 20%, and the perioperative mortality rate was 0%. Elderly (n = 20) showed no difference in the incidence of perioperative complication of all grades or grade ≥IIIa compared with non-elderly, and no organ system-based category had a higher incidence in elderly than that in non-elderly. Gastrointestinal tract-related perioperative complication incidence was higher in non-elderly and those with Charlson comorbidity index ≥3 (P = .044, .039, respectively); cardi ovasc ular- relat ed perioperative complication incidence was higher in those with Charlson comorbidity index ≥ 3 (P = .0068). CONCLUSION: The incidence perioperative complication of robot-assisted radical cystectomy in elderly was not different from those in non-elderly, suggesting that robot-assisted radical cystectomy may be an option for the treatment of bladder cancer in elderly as well as non-elderly.

15.
BMC Urol ; 22(1): 145, 2022 Sep 07.
Article in English | MEDLINE | ID: mdl-36071427

ABSTRACT

BACKGROUND: We assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). METHODS: Clinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. RESULTS: Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (< 25 kg/m2) (p = 0.040), longer preoperative MUL (≥ 9.5 mm) (p = 0.013), longer postoperative MUL (≥ 9 mm) (p < 0.001), higher PVUA (< 14.5 mm) (p = 0.019) and shorter operating time (< 170 min) (p = 0.013) were significantly associated with continence recovery at 3 months in univariate analysis. Multivariate analysis revealed that postoperative MUL (OR 3.75, 95% CI 1.90-7.40, p < 0.001) and higher PVUA (OR 2.02, 95% CI 1.07-3.82, p = 0.032) were independent factors for continence recovery. Patients were divided into 3 groups based on the multivariate analysis, with urinary continence recovery rates found to have increased in turn with rates of 43.7% versus 68.2% versus 85.0% (p < 0.001) at 3 months. CONCLUSIONS: PVUA and postoperative MUL were significant factors for short-term continence recovery. Preservation of urethral length might contribute to continence recovery after RARP.


Subject(s)
Laparoscopy , Robotics , Anastomosis, Surgical , Humans , Male , Prostatectomy/adverse effects , Recovery of Function
16.
Nihon Hinyokika Gakkai Zasshi ; 113(1): 46-49, 2022.
Article in Japanese | MEDLINE | ID: mdl-36682813

ABSTRACT

Of the patients who have had artificial urinary sphincter (AUS) implantation, 30%-50% require reoperation because of recurrent stress urinary incontinence (SUI) or infection. The most common cause of recurrent postoperative SUI is the mechanical failure of the AUS. This case report describes AUS replacement without urethral manipulation after the mechanical failure of the AUS. A 63-year-old man underwent AUS implantation to treat severe SUI that developed after robot-assisted laparoscopic total prostatectomy. Intraoperatively during AUS implantation, the cuff was inflated under direct vision and the AUS was confirmed to work properly; however, SUI did not improve when the AUS was activated 7 weeks after surgery. Urethroscopy confirmed that the urethra was not contracted, and computed tomography indicated that the tube was not continuous with partially deflated pressure-regulating balloon (PRB). On reoperation, the tube was found to be disconnected at the intended point of connection. By refilling PRB and performing urethroscopy, we confirmed the PRB without leakage and good urethral cuff coaptation, respectively.The AUS replacement procedure was then completed with only the replacement of the control pump and reconnection of the tubing. After the surgery, AUS was immediately activated to confirm the improvement of SUI. After 3 months post-surgery, the patient have enjoyed urinary continence. If the defective part of the AUS system can be identified during replacement, the procedure can be completed with only partial replacement and without manipulation of the urethra, thus avoiding the risk of urethral injury.


Subject(s)
Urinary Incontinence, Stress , Urinary Sphincter, Artificial , Male , Humans , Middle Aged , Urinary Sphincter, Artificial/adverse effects , Urinary Incontinence, Stress/surgery , Postoperative Complications/therapy , Urologic Surgical Procedures , Reoperation/adverse effects , Treatment Outcome , Retrospective Studies
17.
Urol Case Rep ; 33: 101318, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33102020

ABSTRACT

A 68-year-old man visited our hospital complaining of painless left scrotal swelling. Stony hard mass was palpable at cephalad side of the testis. MRI showed a solid component mass mimicking epididymal tumor. Thus, exploratory surgery was performed. Since the tumor was firmly adhesive to the spermatic cord, an orchiectomy was unavoidable. The pathological result was hematocele of the spermatic cord.

18.
BMJ Case Rep ; 13(9)2020 Sep 09.
Article in English | MEDLINE | ID: mdl-32912886

ABSTRACT

Immune-related myositis is one of the rare immune-related adverse events whose underlying precise mechanisms are not fully understood. Here, we describe a case of immune-related myositis that developed after four cycles of combination therapy with nivolumab plus ipilimumab for the treatment of metastatic renal cell carcinoma. Negative results of autoimmune antibodies, including anti-acetylcholine receptor and anti-muscle-specific kinase antibodies suggested a T-cell-mediated mechanism. After recovery with steroid therapy, the patient resumed nivolumab monotherapy and survived without any evidence of disease progression or refractory of myositis. Differential diagnosis between T-cell-mediated and B-cell-mediated immune-related myositis and its impact on optimal management are discussed.


Subject(s)
Bone Neoplasms , Carcinoma, Renal Cell , Ipilimumab , Lung Neoplasms , Myositis , Nephrectomy/methods , Nivolumab , Antineoplastic Agents, Immunological/administration & dosage , Antineoplastic Agents, Immunological/adverse effects , Antineoplastic Agents, Immunological/immunology , Bone Neoplasms/diagnosis , Bone Neoplasms/secondary , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/physiopathology , Carcinoma, Renal Cell/therapy , Diagnosis, Differential , Humans , Immune Checkpoint Inhibitors/administration & dosage , Immune Checkpoint Inhibitors/adverse effects , Immune Checkpoint Inhibitors/immunology , Immunologic Tests/methods , Ipilimumab/adverse effects , Ipilimumab/immunology , Lung Neoplasms/diagnosis , Lung Neoplasms/secondary , Male , Middle Aged , Myositis/etiology , Myositis/immunology , Myositis/therapy , Neoplasm Staging , Nivolumab/administration & dosage , Nivolumab/adverse effects , Nivolumab/immunology , Patient Care Management/methods , Tomography, X-Ray Computed/methods
19.
Foods ; 8(2)2019 Feb 22.
Article in English | MEDLINE | ID: mdl-30813296

ABSTRACT

Near-infrared spectroscopy (NIRS) is a powerful tool for the nondestructive evaluation of organic materials, and it has found widespread use in a variety of industries. In the food industry, it is important to know the district in which a particular food was produced. Therefore, in this study, we focused on determining the production area (five areas and three districts) of green coffee beans using classification analysis and NIRS. Soft independent modeling of class analogy (SIMCA) was applied as the classification method. Samples of green coffee beans produced in seven locations-Cuba, Ethiopia, Indonesia (Bari, Java, and Sumatra), Tanzania, and Yemen-were analyzed. These regions were selected since green coffee beans from these locations are commonly sold in Japan supermarkets. A good classification result was obtained with SIMCA for the seven green bean samples, although some samples were partly classified into several categories. Then, the model distance values of SIMCA were calculated and compared. A few model distance values were ~10; such small values may be the reason for misclassification. However, over a 73% correct classification rate could be achieved for the different kinds of green coffee beans using NIRS.

SELECTION OF CITATIONS
SEARCH DETAIL
...