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1.
Int J Urol ; 27(3): 244-248, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31965649

ABSTRACT

OBJECTIVES: To compare the optimal administration period of antimicrobial prophylaxis in patients undergoing transurethral enucleation of the prostate for benign prostatic hyperplasia. METHODS: We carried out a randomized controlled trial to compare the differences in incidence of perioperative genitourinary tract infection between single and multiple (3 days) administrations of cefazolin for transurethral enucleation of the prostate in benign prostatic hyperplasia patients without pyuria or bacteriuria between January 2015 and December 2018. RESULTS: This multicenter randomized controlled trial included 203 patients who underwent a transurethral enucleation of the prostate procedure. All received antimicrobial prophylaxis, and were randomized into those who received single-dose (n = 101) or multiple-dose (n = 102) therapy. The rate of genitourinary tract infection after transurethral enucleation of the prostate for all patients was 1.5%, whereas that in the single-dose group was 1.0% and in the multiple-dose group was 2.0%, which were not significantly different (P = 1.00). CONCLUSIONS: A single dose of antimicrobial prophylaxis as a prophylactic antibacterial drug is sufficient for patients undergoing transurethral enucleation of the prostate who do not have presurgical pyuria or bacteriuria.


Subject(s)
Laser Therapy , Prostatic Hyperplasia , Transurethral Resection of Prostate , Urinary Tract Infections , Cefazolin/therapeutic use , Humans , Japan/epidemiology , Male , Prospective Studies , Prostate/surgery , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/adverse effects , Treatment Outcome , Urinary Tract Infections/epidemiology , Urinary Tract Infections/etiology , Urinary Tract Infections/prevention & control
2.
Hinyokika Kiyo ; 55(2): 71-4, 2009 Feb.
Article in Japanese | MEDLINE | ID: mdl-19301610

ABSTRACT

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.


Subject(s)
Biomarkers, Tumor/urine , Blood Cells/cytology , Nuclear Proteins/urine , Urinary Bladder Neoplasms/diagnosis , Urine/cytology , Aged , Female , Hematuria/urine , Humans , Male , Pyuria/urine , Reagent Kits, Diagnostic , Sensitivity and Specificity , Urologic Diseases/diagnosis
3.
Hinyokika Kiyo ; 54(7): 475-8, 2008 Jul.
Article in Japanese | MEDLINE | ID: mdl-18697491

ABSTRACT

From February 2005 to April 2007, 48 consecutive patients with BPH underwent holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation. The first 14 cases (group 1) underwent HoLEP according to Gilling's method. In the next consecutive 17 cases (group 2), in addition to HoLEP performed as in group 1, the urethral external sphincter was stimulated electrically with a needle electrode inserted in a transperineal manner to prevent sphincteric injury. In the latter 17 consecutive cases (group 3), we used a modified HoLEP procedure, which partially preserved the apical adenoma in the 10-to 2-o'clock position. International Prostate Symptom Score, quality of life index, urinary flow (Qmax) data, and postvoid residual urine were significantly improved postoperatively in each group, there being no differences among them with the exception that group 3 had better Qmax data than group 3 at one month after operation. On the other hand, postoperative transient urinary incontinence was significantly reduced in group 3 on the day of discharge and 1 month after the operation. These results demonstrate that our modified HoLEP procedure is a promising method to avoid postoperative transient urinary incontinence.


Subject(s)
Holmium/therapeutic use , Lasers, Solid-State/therapeutic use , Postoperative Complications/prevention & control , Prostatectomy/methods , Prostatic Hyperplasia/surgery , Urinary Incontinence/prevention & control , Aged , Aged, 80 and over , Humans , Male , Middle Aged
4.
Hinyokika Kiyo ; 54(5): 345-7, 2008 May.
Article in Japanese | MEDLINE | ID: mdl-18546858

ABSTRACT

We report a case of lung and lymph node metastasis treated with carbon ion radiotherapy after radical nephrectomy five years earlier. The patient was a 70-year-old woman. She was diagnosed with lung and neck lymph node metastasis by chest computed tomography four years after surgery. The metastatic mass increased gradually despite interferon-alpha and interleukin-2 treatment. Carbon ion radiotherapy was applied to the metastatic mass, and it has not increased in size to date. Carbon ion radiotherapy is thus regarded as an effective treatment for metastatic renal cell carcinoma masses, and it can be an important option for treatment of renal cell carcinoma.


Subject(s)
Carbon Radioisotopes/therapeutic use , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/surgery , Kidney Neoplasms/pathology , Kidney Neoplasms/surgery , Lung Neoplasms/radiotherapy , Lung Neoplasms/secondary , Lymphatic Metastasis/radiotherapy , Nephrectomy , Aged , Female , Humans
5.
Int Urol Nephrol ; 40(1): 85-9, 2008.
Article in English | MEDLINE | ID: mdl-17619162

ABSTRACT

To assess the diagnostic efficacy of prostate-specific antigen (PSA)-related parameters, using a total of 226 patients with gray zone PSA who underwent prostate biopsy, various cutoff points of free to total ratio of PSA (f/t PSA) and PSA velocity (PSAV) were evaluated. Higher cutoff points of f/t PSA resulted in high sensitivity and negative predictive value (NPV): at f/t PSA <15%, sensitivity was 82.0% (41/50) and NPV 84.7% (50/59), and at f/t PSA <20%, 96.0% (48/50) and 92.3% (24/26). Lowering cutoff points also resulted in higher sensitivity and NPV: at PSAV >or=0.75 ng/ml per year, sensitivity was 71.4% (15/21) and NPV 82.4% (28/34), and at PSAV >or=0.40 ng/ml per year, 95.2% (20/21) and 95.2% (20/21). Further, among the patients with both of these parameters available, both sensitivity and NPV achieved 100% (10/10 and 7/7) when the indication for biopsy was determined as f/t PSA <15% or PSAV >or=0.40 ng/ml per year. Our results showed that unnecessary prostate biopsies could be more effectively avoided among patients with "gray zone PSA" by combination of f/t PSA and PSAV than single usage of these indexes.


Subject(s)
Prostate-Specific Antigen/blood , Prostatic Hyperplasia/diagnosis , Prostatic Neoplasms/diagnosis , Aged , Biopsy, Needle , Humans , Japan , Male , Prostatic Hyperplasia/blood , Prostatic Neoplasms/blood , Reference Values , Sensitivity and Specificity , Unnecessary Procedures
6.
Magn Reson Imaging ; 24(10): 1389-93, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17145411

ABSTRACT

A 35-year-old woman was referred to our institution for additional examinations to evaluate bilateral suprarenal masses incidentally found on abdominal ultrasonographic images obtained during an annual medical health checkup. Our computed tomographic scans showed bilateral and well-circumscribed low-density suprarenal masses, while MRI revealed the tumors to be heterogeneous with low intensity on T1-weighted images and high intensity on T2-weighted images. A laparoscopic adrenalectomy was performed under the suspicion of a malignant tumor, such as a malignant fibrous histiocytoma. Pathologic findings indicated a retroperitoneal ancient schwannoma of two histologic types: Antoni A and Antoni B. We considered that elucidation of the characteristic features of a schwannoma would provide helpful preoperative information for diagnosis.


Subject(s)
Magnetic Resonance Imaging , Neurilemmoma/pathology , Retroperitoneal Neoplasms/pathology , Tomography, X-Ray Computed , Abdomen/diagnostic imaging , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/pathology , Adult , Diagnosis, Differential , Female , Humans , Neurilemmoma/diagnostic imaging , Retroperitoneal Neoplasms/diagnostic imaging , Ultrasonography
7.
Hinyokika Kiyo ; 52(10): 777-80, 2006 Oct.
Article in Japanese | MEDLINE | ID: mdl-17131866

ABSTRACT

We have performed holmium laser enucleation of prostate (HoLEP) in 14 cases since February 2005. The patient's age ranged from 62 to 84 years old (average: 75). The preoperative results of International Prostate Sympton Score (IPSS), quality of life index, maximum urinary flow rate and residual urine volume were compared with those 3 months after surgery. The mean operation time, the mean estimated prostate volume and the mean enucleated prostate volume were 143 min, 50 cm3 and 35 g, retrospectively. All cases showed improvement in each parameter, and all but one case recovered continence in 3 months after surgery. A periurethral abscess had developed in the patient, suffering from incontinence. We concluded that HoLEP is an effective treatment. The relatively higher incidence of urinary incontinence in HoLEP remains to be resolved in the future.


Subject(s)
Laser Therapy , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Prostatic Hyperplasia/physiopathology , Quality of Life , Urodynamics
8.
Gan To Kagaku Ryoho ; 33(12): 1765-7, 2006 Nov.
Article in Japanese | MEDLINE | ID: mdl-17212101

ABSTRACT

We present a case of a 70-year-old man with an anamnesis of intra-cerebral bleeding that resulted in right half of the body paralysis and right diaphragm paralysis, The present clinical history indicated hepatocellular carcinoma (HCC) caused by hepatitis C and liver cirrhosis during a regular hospital visit, and the patient had a total of 4 TAEs enforced from three years before. A 4 x 3.5 cm neoplasm at the left adrenal was detected by CT inspection this time. The diagnosis was a metastatic adrenal gland tumor from HCC. Since HCC is controlled by TAE, the metastatic lesions were not found in other organs and were isolated, of 10 cm or less in size. Hence, laparoscopic adrenalectomy was performed in March, 2006. He started having a meal from the 2nd day after the operation. He left the hospital on the 9th day. Pathologial diagnosis was a metastatic adrenal gland tumor from moderately differentiated hepatocellular carcinoma. When observing the adaptation standard strictly to the high-risk case, it was thought that the metastatic tumor extraction under laparoscopic surgery could become a low stress cure in consideration of QOL being useful as a local treatment for cancer.


Subject(s)
Adrenal Gland Neoplasms/secondary , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Carcinoma, Hepatocellular/pathology , Laparoscopy , Liver Neoplasms/pathology , Aged , Humans , Male , Quality of Life
9.
Hinyokika Kiyo ; 51(11): 747-9, 2005 Nov.
Article in Japanese | MEDLINE | ID: mdl-16363707

ABSTRACT

A case of renal oncocytoma associated with acquired cystic disease of kidney (ACDK) in a 56-year-old man is reported. He had received hemodialysis for 15 years because of chronic renal failure. Computed tomography (CT) was performed because of distention in the upper abdomen, revealing a right renal tumor. He underwent laparoscopic right nephrectomy, and was diagnosed with renal oncocytoma. There have been reported 8 cases of renal oncocytoma in hemodialysis patients, and our case was the third one associated with ACDK in the literature.


Subject(s)
Adenoma, Oxyphilic/complications , Kidney Diseases, Cystic/complications , Kidney Neoplasms/complications , Adenoma, Oxyphilic/diagnosis , Adenoma, Oxyphilic/pathology , Carcinoma, Renal Cell/diagnosis , Diagnosis, Differential , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Male , Middle Aged
10.
Hinyokika Kiyo ; 51(10): 695-7, 2005 Oct.
Article in Japanese | MEDLINE | ID: mdl-16285626

ABSTRACT

We report a case of bladder hernia. A 68-year-old man was admitted to our hospital for the management of prostate cancer. An egg-sized soft mass was palpated at his right inguinal region. Magnetic resonance imaging and cystography revealed that the mass was a bladder hernia. During radical prostatectomy, we had to resect the bladder hernia for safe regional lymphadenectomy. This hernia was the extraperitoneal type. The stage of prostate cancer was pT3b N0 M0. This is the third reported case of inguinal bladder hernia associated with prostate cancer in Japan.


Subject(s)
Adenocarcinoma/complications , Hernia, Inguinal/etiology , Prostatic Neoplasms/complications , Urinary Bladder Diseases/etiology , Adenocarcinoma/surgery , Hernia, Inguinal/diagnosis , Hernia, Inguinal/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Prostatectomy , Prostatic Neoplasms/surgery , Urinary Bladder Diseases/diagnosis , Urinary Bladder Diseases/surgery
11.
J Urol ; 174(6): 2111-4, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16280738

ABSTRACT

PURPOSE: We evaluated the efficacy of a renal displacement simulator originally developed at our department for retroperitoneal laparoscopic nephrectomy. MATERIALS AND METHODS: A total of 12 patients with a malignant localized renal (7) or ureteral (5) neoplasm underwent multidetector row computerized tomography. Imaging data were sent to a dedicated work station to create volume rendering and virtual laparoscopic images of the kidney, which was displaced ventral using a retroperitoneal balloon. These findings were compared with video images obtained during laparoscopy surgery. RESULTS: The kidney displacement simulator depicted all renal arteries (100% sensitivity) and 13 of 14 renal veins (93% sensitivity). Hilar anatomy, including the tumor, as well as major vessels and their relationships were visualized by the simulator in the laparoscopic views. The major vessel portions completely corresponded to those seen during surgery, and the left adrenal and gonadal veins were also synchronized quite well. CONCLUSIONS: Our kidney displacement simulator was able to visualize the major vessel portions and branched small vessels, such as the adrenal and gonadal veins, prior to surgery. It is considered useful for providing guidance to surgeons and decreasing operative risks and possible complications.


Subject(s)
Computer Simulation , Kidney Neoplasms/surgery , Laparoscopy , Nephrectomy/instrumentation , Nephrectomy/methods , Ureteral Neoplasms/surgery , Aged , Aged, 80 and over , Carcinoma, Renal Cell/surgery , Carcinoma, Transitional Cell/surgery , Equipment Safety , Female , Humans , Kidney Neoplasms/diagnostic imaging , Male , Middle Aged , Retroperitoneal Space , Sensitivity and Specificity , Software , Tomography, X-Ray Computed/methods , Treatment Outcome , Ureteral Neoplasms/diagnostic imaging , Video Recording
12.
Hinyokika Kiyo ; 51(12): 797-9, 2005 Dec.
Article in Japanese | MEDLINE | ID: mdl-16440726

ABSTRACT

A 55-year-old woman presented with sudden right lower abdominal pain. Computed tomography demonstrated retroperitoneal hematoma associated with minus-density area, diagnosed as spontaneous rupture of angiomyolipoma. Super-selective transarterial embolization was performed, but anemia and right abdominal pain became worse in spite of conservative therapy including transfusion, indicating re-rupture of the renal tumor. Although partial nephrectomy was planned, right nephrectomy was finally performed because of massive intraoperative bleeding. Accurate diagnosis and prompt treatment are required when life-threatening rupture of renal tumor is suspected.


Subject(s)
Angiomyolipoma/surgery , Kidney Neoplasms/surgery , Nephrectomy , Abdomen, Acute , Angiomyolipoma/therapy , Embolization, Therapeutic , Female , Humans , Kidney Neoplasms/therapy , Middle Aged , Rupture, Spontaneous
13.
Hinyokika Kiyo ; 50(12): 885-7, 2004 Dec.
Article in Japanese | MEDLINE | ID: mdl-15682864

ABSTRACT

The patient was a 36-year-old male with a chief complaint of painless mass in the perineum. An elastic and immobile mass with the tip of thumb finger size was palpable in the left perineum and magnetic resonance imaging (MRI) showed the tumor with high intensity on T2 weighted image from perineum through left scrotum. The tumor was surgically removed and a histopathological study revealed epidermoid cyst.


Subject(s)
Epidermal Cyst/surgery , Genital Neoplasms, Male/surgery , Perineum , Scrotum , Adult , Epidermal Cyst/pathology , Genital Neoplasms, Male/pathology , Humans , Magnetic Resonance Imaging , Male , Urogenital Surgical Procedures/methods
14.
Hinyokika Kiyo ; 49(9): 543-5, 2003 Sep.
Article in Japanese | MEDLINE | ID: mdl-14598694

ABSTRACT

We report a case of CA19-9 producing urothelial carcinoma of the right ureter. A 61-year-old male patient who had an extremely high value of serum CA19-9 (1,185 U/ml) with right hydronephrosis was referred to us. Magnetic resonance urography and retrograde ureterography revealed a long irregular filling defect in the right distal ureter. Under the diagnosis of right ureteral tumor, we performed right total nephroureterectomy and pelvic lymphadenectomy. The tumor was histologically diagnosed as grade 1 transitional cell carcinoma and pelvic lymphnodes were positive (pT1N2M0). The tumor cells showed positive immunostaining for CA19-9. The serum CA19-9 level was normalized after the operation and successive adjuvant chemotherapy (M-VAC 2 course). No recurrence was found for 15 months after operation. In this case, the serum CA19-9 level was useful as a tumor marker.


Subject(s)
Biomarkers, Tumor/blood , CA-19-9 Antigen/blood , Carcinoma, Transitional Cell/immunology , Ureteral Neoplasms/immunology , Carcinoma, Transitional Cell/diagnosis , Humans , Male , Middle Aged , Ureteral Neoplasms/diagnosis
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