Prevention Technique of Postoperative Inguinal Hernia in Patients Undergoing Radical Prostatectomy for Localized Prostate Cancer.

To prevent inguinal hernia after retropubic radical prostatectomy, many urologists have utilized a prevention technique of inguinal hernia at the same time as retropubic radical prostatectomy. Here, we report the clinical benefit of the prevention technique of inguinal hernia as well as risk factors for the incidence of inguinal hernia. We investigated the medical records of 223 men who underwent retropubic radical prostatectomy for clinically localized prostate cancer between January 2007 and March 2013 at our medical center. We assessed the association between the postoperative inguinal hernia and variables such as age, body mass index, and previous abdominal surgery. Inguinal hernia-free survival was analyzed to verify risk factors of postoperative inguinal hernia. Of 223 patients, 67 (30 %) received prevention of inguinal hernia and 156 (70 %) did not. The median follow-up period after retropubic radical prostatectomy was 36 months (range, 3-58 months). Thirty one (14 %) patients developed unilateral or bilateral inguinal hernia after retropubic radical prostatectomy. The rate of postoperative inguinal hernia in prevented and non-prevented group was 3 % (2 of 67) and 19 % (29 of 156), respectively (P < 0.01, Mann-Whitney U test). Moreover, postoperative inguinal hernia-free survival in the prevention group was significantly longer than that in the non-prevented group (P < 0.01, log-rank test). In the prevention group, 1-, 2-, and 3-year inguinal hernia-free survival rates were 100 %, 96 %, and 96 %, respectively. Other clinical factors including age, body mass index, previous abdominal surgery, and previous inguinal hernia were not associated with the incidence of inguinal hernia in our cohort. The prevention technique was simple and safe to perform, and it could increase inguinal hernia-free survival rates after retropubic radical prostatectomy.

[A case of testicular tumor presenting with acute scrotum].

A 37-year-old man visited our hospital with a chief complaint of sudden onset of right scrotal pain. Because spermatic cord torsion was suspected, an exploratory incision was made. There was no spermatic cord torsion, but an induration was palpated in a part of the right testis. Because a testicular tumor was strongly suspected, right high orchiectomy was performed. The histopathological diagnosis was a pT1 seminoma. Our experience with this case suggests that testicular tumor should be considered in the differential diagnoses of acute scrotum.

[Tubercular prostatic abscess following intravesical Bacillus Calmette-Guerin therapy].

We report a case of tubercular prostatic abscess in a male patient who had undergone intravesical Bacillus Calmette-Guerin therapy for bladder carcinoma in situ. The abscess was successfully treated with transurethral resection of the prostate for drainage and subsequent antituberculous regime of chemotherapy.

[A case of domestic violence-related Page kidney].

Page kidney is caused by the accumulation of blood in the perinephric or subcapsular space, resulting in compression of the involved kidney, renal ischemia and high renin hypertension. We describe a case of domestic violence-related Page kidney. This report also reviews previously described cases of Page kidney.

AMP-activated protein kinase phosphorylates glutamine : fructose-6-phosphate amidotransferase 1 at Ser243 to modulate its enzymatic activity.

Glutamine : fructose-6-phosphate amidotransferase 1 (GFAT1) was identified as a protein phosphorylated in glucose-deprived cells by immunoprecipitation using the anti-phospho Akt substrates (PAS) antibody, which recognizes the phosphorylation motif site by AMP-activated protein kinase (AMPK), followed by mass fingerprinting analysis. Glucose depletion-induced phosphorylation of endogenous GFAT was potentiated by 2-deoxyglucose (2-DG), an AMPK activator, and the 2-DG-stimulated phosphorylation of FLAG-tagged GFAT1 in transfected cells was suppressed by Compound C, an AMPK inhibitor. The 2-DG induced phosphorylation of GFAT1 was attenuated by the introduction of the kinase-negative mutant of AMPK, and the phosphorylation was observed in the cells expressing the constitutively active mutant of AMPK even in the absence of 2-DG. Subsequent analysis revealed that the PAS antibody recognized GFAT1 phosphorylated at Ser243, which is conserved among different species. The assay of the GFAT enzymatic activity in the cell lysates indicated that the 2-DG-treatment inhibited the enzymatic activity, and Compound C-preincubation partially prevented the 2-DG-induced decrease of the activity. Furthermore, the mutant replacing Ser243 by alanine partially prevented the decrease of GFAT activity by 2-DG treatment. These results indicate that the phosphorylation of GFAT1 at Ser243 by AMPK has an important role in the regulation of the GFAT1 enzymatic activity.

Crossover comparison study on the therapeutic effects of tamsulosin hydrochloride and naftopidil in lower urinary tract symptoms associated with benign prostatic hyperplasia.

There is no consensus on the evaluated efficacy of individual alpha(1)-blockers in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). This study compared the clinical benefits of tamsulosin hydrochloride with those of naftopidil in BPH. Men aged 54-84 years with a main complaint of BPH were randomly assigned to receive consecutive treatment with tamsulosin then naftopidil (T-N group, 25 patients), or naftopidil then tamsulosin hydrochloride (N-T group, 20 patients). The therapeutic effects were compared in a crossover design. Administration was continued for 28 days in each treatment period. Both groups showed similar improvements during the first treatment period. However, during the second treatment period after crossover, therapeutic effects were greater in the N-T group. Tamsulosin was more effective than naftopidil on intermittency, nocturia and quality of life scores. Tamsulosin and naftopidil have different efficacy profiles for LUTS associated with BPH.

Two cases of female acute urinary retention caused by an impacted pelvic mass.

We report two cases of acute urinary retention in women with an impacted pelvic mass. In both cases, all urinary symptoms resolved completely after the surgical removal of the mass.

Progressive anemia following combination therapy with interferon-alpha and interleukin-2 in a patient with metastatic renal cell carcinoma.

Various toxicities have been observed during the treatment of advanced renal cell carcinoma with interferon-alpha (IFN-alpha) and/or interleukin-2 (IL-2). We report a case of severe anemia, which responded well to steroid therapy, in a patient receiving IL-2 plus IFN-alpha for metastatic renal cell carcinoma.

[Post-traumatic high-flow priapism: a case report].

A 48-year-old man, who previously had normal erectile function, visited our hospital complaining of a painless erection that had persisted for 6 days. He had suffered perineal trauma in a traffic accident 9 days earlier. A diagnosis of post-traumatic high-flow priapism was suggested from the findings on penile blood gas analysis. Selective internal pudendal arteriography showed an arterial blush along the bilateral cavernous arteries. Subsequently, embolization of a cavernous fistula was performed with an autologous clot. However, the embolus was removed within a minute, so the procedure was repeated with Gelfoam. This patient had normal erectile function after 11 months, with no recurrence of priapism.

[A case of acid burn of the penis].

A 27-year-old man presented to our hospital complaining of multiple mild injuries sustained in an attack of violence at the workplace. He had received chemical burns to the penis induced by hydrochloric acid and had developed severe phimosis. He complained of pain on erection and ballooning during urination. The foreskin was partially resected with foreskin grafting for the stricture. The postoperative outcome was favorable and his symptoms were relieved.

[Assessment of surgical invasiveness of augmentation ileocystoplasty applying the systemic inflammatory response syndrome score in patients with spina bifida].

PURPOSE: Applying the systemic inflammatory response syndrome (SIRS), we investigated the surgical invasiveness of augmentation ileocystoplasty in patients with spina bifida. MATERIALS AND METHODS: A total of 23 patients with spina bifida underwent augmentation ileocystoplasty. We diagnosed the cases as SIRS when they fulfilled at least 2 of the 4 SIRS criteria. We developed SIRS score, the sum of the number of positive items for the duration of SIRS, as a parameter of surgical invasiveness. We investigated the relationships between SIRS score and various factors and compared SIRS scores of augmentation with those of other urological operations as a control, which consisted of radical prostatectomy (25 patients) and radical nephrectomy (20 patients). RESULTS: We found a positive relationship between SIRS score and the operation time of augmentation. SIRS scores were significantly higher in the patients who underwent operations diverting ventriculoperitoneal shunt to ventriculoatrial shunt concurrently with augmentation. However, the operation times were not significantly different between the cases with and without shunt operations. SIRS scores in cases of augmentation were significantly higher than those of the major urological operations compared. CONCLUSION: When evaluated by the SIRS score, the factors related to the surgical invasiveness of augmentation ileocystoplasty were a longer operating time and concurrent shunt diversion. The higher invasiveness of this operation compared with major urological operations was also revealed. These facts should be considered carefully when the indications for augmentation ileocystoplasty are determined.