Ureteral stent exchange under fluoroscopic guidance using the crochet hook technique in women.

PURPOSE: We developed a method for ureteral stent exchange in female patients under fluoroscopic guidance using a crochet hook technique (CHEX). PATIENTS AND METHODS: A total of 45 female patients (51 stents) underwent exchange of ureteral stents. In these patients, 21 ureteral stents were exchanged using CHEX. All procedures were carried out with the patients under conscious sedation. At the time of the procedures, we extracted the ureteral stent from the external urethral orifice using CHEX under fluoroscopic guidance and inserted the new stent under fluoroscopic guidance without cystoscopy. RESULTS: 20 of the 21 stents (95.2%) were successfully exchanged. Ureteral stent exchange using CHEX was unsuccessful in 1 patient, including migration to the ureter. CONCLUSIONS: Ureteral stent exchange using a crochet hook is easy, safe and cost-effective. This technique was also easy to learn.

[A single center experience with a lithotripsy machine "Modulith SLX-F2" : evaluation of dual focus system and clinical results].

We evaluated the usefulness of a new shock-wave lithotripsy machine with a dual focus system (large focus : 9x50 mm, standard focus : 6x28 mm), "Modulith SLX-F2" on 361 patients. In the first period, 210 patients, were treated with the large focus, and in the second period, 151 patients were treated with the standard focus. Complications, efficacy and subsequent auxiliary procedures were compared between the first and second periods. The efficacy was evaluated with efficiency quotient (EQ). Administered total energy was displayed with stortz medical lithotripsy index (SMLI). After treatment, we performed ultrasonography to evaluate renal hematoma in all cases. Average size of renal stones and ureteral stones was 14.25 and 11.0 mm, respectivery, in the first period, and 13.80 and 8.97 mm, respectivery, in the second period. EQ of renal and ureteral stones was 0.565 and 0.626, respectivery, in the first stage, and 0.553 and 0.798, respectivery, in the second period. The total EQ was 0.646. This value was good and particularly the result obtained on ureteral stones in the second period was thought to be excellent compared with other reports. In this series, 6 renal hematomas were confirmed. A statistically significant risk factor was SMLI, but the severity of hematoma was not correlated with SMLI. In hematoma patients, 2 patients had no notable risk factor, but they were thin or were small. Dual focus has a potential to improve ESWL results on ureteral stones. Excessive SMLI may be a risk factor of renal hematoma in thin or small patients.

[Clinical assessment of ammonium acid urate urinary calculi].

We investigated the patients with ammonium acid urate (AAU) calculi in relation to dietary history, habit and lifestyle. From April, 2002 to March, 2009, AAU calculi were found in 9 patients (0.66) out of 1,365 cases of stones. Three cases were pure, and 6 were mixed stones. We examined the risk factor of this stone generation, "continuation of malnutrition and dehydration" were seen in 5, "continuing urinary tract infection" was seen in 4 and "continuation of super-saturation of uric acid in urine" was seen in 3 cases. All the patients with "continuation of malnutrition and dehydration" were women, and 4 patients had a history of severe body weight loss. 2 patients were dieting consciously, and the other 2 were eating a poorly balanced diet unconsciously. One patient had no notable past history, but malnutrition was detected in blood examination. It is suggested that AAU calculi is generated even by dieting at a usual level. Compared with the report in the United States, obesity and inflammatory bowel disease were not major risk factors, and "continuation of malnutrition and dehydration" is the major factor in Japan.

[A clinical study concerning survival of operative cases for the transitional cell carcinoma of the upper urinary tract].

To identify prognostic factors influencing survival in transitional cell carcinoma (TCC) of the upper urinary tract, we retrospectively studied 189 (median age 70, 130 males and 59 females) patients who underwent surgical resection at our 3 hospitals from August 1980 to September 2006. After a median follow up of 47.8 months, 45 cases (23.8%) died of cancer and the 5-year and 10-year disease-specific survival rate (Kaplan-Meier method) was 70.5 and 67.1%. Because lymphatic and vascular involvements, pattern of infiltration and location of tumor had loss of data, only the univariate analysis was done. They were observed to be significantly different by the univariate analysis. The significant prognostic factors for survival using Cox-proportional hazard models were tumor stage, tumor grade, lymph node metastasis, and surgical margin status. Adjuvant chemotherapy was not the prognostic factor in our multivariate analysis.

[A case of hormone/docetaxel-refractory prostate cancer in which PSA level decreased after docetaxel+zoledronic acid treatment].

The patient was a 63-year-old man who had a recurrence and bone metastasis of prostate cancer after total prostatectomy. He was diagnosed with prostate cancer refractory to hormones. Subsequently, the PSA level decreased after docetaxel therapy, but then gradually increased. Thus, he was diagnosed with bone metastasis of prostate cancer refractory to therapy with hormones or docetaxel. The PSA level decreased after the start of therapy with docetaxel+ zoledronic acid. Zoledronic acid seems to be effective not only for the prevention but also for the treatment of skeletal related events(SRE)in patients with prostate cancer with bone metastases.

[Retroperitoneal Castleman's disease presenting characteristic image finding].

A 30-year-old woman was hospitalized in our institute with fever up and abdominal pain. Computerized tomography showed a retroperitoneal mass (8 cm in diameter) with arborizing calcification, which was enhanced homogeneously in the arterial phase. The operation was performed and parthological diagnosis revealed hyaline vascular type Castleman's disease. This characteristic calcification pattern is considered unique to Castleman's disease, and could be useful for future diagnosis.

[Two cases of renal cell carcinoma with diabetes mellitus that was healed after nephrectomy].

Two cases of renal cell carcinoma presenting with uncontrolled diabetes mellitus are reported. A 61 and 64-year-old women with hyperglycemia were incidentally found to have a right renal tumor. Laboratory investigation of both cases revealed glucose of 324 mg/dl and 357 mg/dl, HbAlc of 9.3% and 8.9%, respectively. Hyperglycemia had been controlled by administration of 25 and 58 units of insulin, respectively. In both cases, after a radical nephrectomy, the diabetic state completely resolved without insulin administration. Immunohistological study revealed the tumor cells positive in one case and negative in the other case for interleukin (IL) 6.

[Effectiveness of neoadjuvant chemotherapy for the patients with locally invasive bladder cancer].

OBJECTIVE: To know the survival and prognostic factors of the patients who received radical cystectomy with or without neoadjuvant cisplatin-based chemotherapy. METHODS: Between 1977 and 2001, 201 patients underwent radical cystectomy at Yokohama City University and Yokosuka Kyosai Hospital whose tumor were clinically diagnosed as locally invasive bladder cancer (T2-4NxM0). Survival rates and 9 prognostic factors (Age, Size, Multiplicity, Type, Grade, p-stage, n,neoadjuvant chemotherapy, adjuvant chemotherapy) were analysed by Kaplan-Meier methods and Cox-proportional hazard model. RESULTS: The independent prognostic factors of these patients were size, multiplicity, type, grade, p-stage, n, neoadjuvant by univariate analysis. Of these 7 factors, n, neoadjuvant, p-stage and size are significant by multivariate analysis. Survival of the patients who received neoadjuvant cisplatin-based chemotherapy followed cystectomy is better than cystectomy only group by Kaplan-Meier method. CONCLUSIONS: From these rusults, neoadjuvant cisplatin-based chemotherapy play some role for survival of the patients with invasive bladder cancer.

[Three cases of pulmonary hamartoma appearing after radical nephrectomy for renal cell carcinoma].

We report 3 patients with pulmonary hamartoma, all of whom had undergone nephrectomy for renal cell carcinoma. A lung tumor was detected 2 to 9-months following nephrectomy. Preoperative diagnosis was pulmonary metastasis from renal cell carcinoma and pulmonary tumor resection was performed in each case. There was a 9- to 12-month interval between the detection and resection of the lung tumor. The histological diagnosis of the lung tumor in all three patient was pulmonary hamartoma. Following the resection of the lung tumor, recurrence was not noted in any of the patients.

[A case of primary choriocarcinoma of the bladder].

A 75-year-old man visited our hospital presenting with gross hematuria. Cystoscopy revealed a bladder tumor with coagulated blood and necrotic tissue at the dome. We resected the bladder tumor transurethrally. Pathologically, the tumor was shown to be a transitional cell carcinoma with choriocarcinomatous differentiation, G3, > or = pT2. Immunohistochemical staining showed human chorionic gonadotropin (HCG)-positive tumor cells. Just after surgery, the serum HCG-beta concentration was less than 0.1 ng/ml. Total cystectomy and an ileal conduit operation were performed. The histological classification was TCC, G3, pTis. In later blood chemistry tests, HCG-beta elevation was observed. Pulmonary metastases appeared on a chest X-ray, and combination chemotherapy with cisplatin and etoposide was administered. Although the serum HCG-beta decreased with one course of chemotherapy, it increased immediately thereafter. The patient died of the disease about 8 months after the total cystectomy. Autopsy revealed multiple metastases in the lungs, liver, kidneys, stomach, pancreas, thyroid gland, adrenal glands, heart, jejunum, and vertebral body (Th10). Lymph node metastases in the pulmonary hilum, mediastinum, and right submaxillary gland were also found.

[Squamous cell carcinoma of the ureter arising seventeen years after total cystectomy for squamous cell carcinoma of the bladder: a case report].

We report a case of squamous cell carcinoma of the ureter. A 62-year-old woman had undergone total cystectomy and ileal conduit because of squamous cell carcinoma of the bladder when she was 44 years old. Seventeen years later, she complained of edema and oliguria. Antegrade pyelography and loopography revealed a left ureteral tumor. She underwent left ureterectomy and extirpation of the conduit. Pathological diagnosis was moderately differentiated squamous cell carcinoma of the ureter, pT2. The patient is alive without recurrence or metastasis in the first year after surgery.

[Results of adjuvant intravesical Bacillus Calmette-Guérin therapy for grade 3 superficial bladder cancer].

To examine the incidence of recurrence, progression and survival in patients with grade 3 superficial bladder cancer after transurethral resection (TUR) and adjuvant intravesical instillation of Bacillus Calmette-Guérin (BCG), we retrospectively studied 39 patients with grade 3 superficial bladder cancer. Nineteen patients with high-grade superficial bladder cancer (pTa, pT1) and 5 patients with grade 3 carcinoma in situ (CIS) received intravesical instillation of BCG after transurethral resection of the bladder tumor (BCG group and CIS-BCG group). The Tokyo 172 strain BCG was given for 8 weeks, as a rule, in a dose of 80 mg in 40 ml of saline instilled into the bladder. As a control, 15 patients with grade 3 superficial bladder cancer who did not receive BCG therapy after TUR were compared (non-BCG group). Of the BCG group (n=19), 4 patients (21.1%) had recurrent tumor and 3 had invasive progression after BCG therapy and died as a result of tumor progression, while in the non-BCG group (n=15), 8 cases (53.3%) developed recurrence, only one case had progression and died of cancer. In the CIS-BCG group (n=5), 3 patients (60.0%) had recurrent tumor and 2 had invasive progression. Univariate analysis (Logrank test) demonstrated that tumor size and adjuvant instillation of BCG were associated with tumor recurrence except for carcinoma in situ, but tumor progression and survival did not differ significantly. Our results suggest that BCG therapy prevents grade 3 superficial bladder cancer (pT1, pTa) recurrence.