High pressure balloon dilation for vesicourethral anastomotic strictures after radical prostatectomy.

BACKGROUND: Vesicourethral anastomotic stricture (VAS) is a rare but serious complication following radical prostatectomy (RP), and various types of managements for VAS have been proposed. We investigated the efficacy of transurethral balloon dilation in the management of VAS after RP. METHODS: A total of 128 consecutive patients underwent open RP at our hospital between 2008 and 2013; of these, 10 patients (7.8%) developed VAS. Transurethral balloon dilation was performed in all 10 patients, using a high pressure balloon catheter under fluoroscopic and endoscopic guidance. Follow-up endoscopy was performed, and patients in whom the stricture had recurred underwent repeat dilation. We retrospectively evaluated the management of VAS and short-term efficacy of high pressure balloon dilation. RESULTS: The mean time from RP to diagnosis of VAS was 9 months (2-40 months); eight patients (80%) were diagnosed within 6 months of RP. Balloon dilation of VAS was technically successful in all patients, and no perioperative complications were recorded. The median follow-up after balloon dilation was 24 months (7-67 months). There was no recurrence of VAS in eight patients (80%) after the first balloon dilation, and all patients were controlled within the twice. CONCLUSION: High pressure balloon dilation is a highly effective and minimally invasive procedure for treating VAS.

[RISK FACTORS FOR INTRAVESICAL RECURRENCE AFTER SURGICAL MANAGEMENT OF UROTHERIAL CARCINOMA OF THE UPPER URINARY TRACT].

OBJECTIVES: To identify risk factors for developing recurrent bladder cancer in patients who underwent surgical resection for urothelial carcinoma of the upper urinary tract. METHODS: We retrospectively analyzed 322 patients who underwent surgical resection for urothelial carcinoma of the upper urinary tract at the Jikei University Hospital and our affiliated hospitals between January 2005 and July 2011. Univariate and multivariate analyses by using the Cox proportional hazards model were performed to determine the risk factors for intravesical recurrence after nephroureterectomy in these 322 patients. RESULTS: Of the 322 patients, 111 patients (34.5%) developed recurrent bladder cancer after a median interval of 8.0 months. On multivariate analysis, the presence of a superficial tumor and the presence of a ureteral tumor were independent predictors for intravesical recurrence. CONCLUSION: The risk factors for developing recurrent bladder cancer were the presence of a superficial tumor and the presence of a ureteral tumor. Further investigation is required to evaluate the efficacy of perioperative intravesical therapy for the prevention of intravesical recurrence.

[Docetaxel for small cell carcinoma of the prostate with a metastatic pelvic tumor: a case report].

Small cell carcinoma of the prostate is known to have a poor prognosis. We report a case of a large pelvic tumor with small cell carcinoma, which responded well to docetaxel. A 72-year-old man who was receiving androgen-deprivation therapy for prostatic adenocarcinoma presented with constipation. Although the prostate specific antigen level had decreased, a large pelvic tumor was detected between the prostate and the rectum, which caused bowel obstruction. A biopsy of the pelvic tumor revealed small cell carcinoma of the prostate, and chemotherapy with docetaxel and prednisolone was administered. Five months after the administration of docetaxel, the pelvic tumor disappeared completely. At the time of the last follow up, the response was still maintained.

[Clinical studies on TUR-P using clinical path: report of 50 cases and review of literature].

PURPOSE: This study was undertaken to clarify the usefulness and problems involved in the clinical path of transurethral prostatectomy (TUR-P) in hospital. PATIENTS AND METHODS: The subjects consisted of 50 patients, for whom the Department of Urology, Jikei Medical University Hospital introduced its own clinical path and performed TUR-P during a period of 9 months from July 1999 to March 2000. The mean length of hospital stay, rate of postoperative complications, and the medical insurance claims made by these patients were clarified and compared with those of 73 patients before introduction of the clinical path. RESULTS: With the introduction of the clinical path, the length of hospital stay decreased by an average of 3.4 days and the total medical insurance claims decreased by an average of 18.5%. The rate of postoperative complications before and after introduction was almost equal. CONCLUSION: Our clinical path for TUR-P was well accepted by both patients and comedicals. However, the present medical treatment system in Japan is not as yet prepared to promote the introduction of this clinical path, and it will take some time before this clinical path is introduced on a full scale.