Renal preservation by pure laparoscopic partial ureterectomy for contralateral ureteral metastasis 7 years after nephrectomy for renal cell carcinoma: A case report.

Contralateral ureteral metastasis after renal cell carcinoma (RCC) nephrectomy is uncommon. In such cases, a mass in the contralateral ureter needs to be differentiated from the primary ureteral tumor. If high grade primary ureteral tumor is found and total nephroureterectomy is performed, dialysis is introduced. In cases of metastasis of RCC, the kidney may be preserved by local treatment by partial ureterectomy. We report a case of contralateral ureteral metastasis after nephrectomy for right RCC. We underwent an originative method of pure laparoscopic partial ureterectomy and ureteral end-to-end anastomosis.

Pure laparoscopic total ureterectomy for urothelial carcinoma that occurred in the ureteral stump after nephrectomy: A case report.

Primary carcinoma of the ureteral stump following a radical nephrectomy is rare, and it is even rarer that the cause of the nephrectomy is renal cell carcinoma (RCC). Treatment by complete ureterectomy with a bladder cuff is considered as the standard treatment. We report a case of a 70-year-old female with urothelial carcinoma with glandular differentiation that occurred in the ureteral stump after nephrectomy for left RCC. We performed a novel technique of pure laparoscopic resection of the ureteral stump with a bladder cuff.

Hand-assisted laparoscopic ileal ureter substitution for ureteral obstruction after right ureteral rupture: A case report.

Iatrogenic ureteral rupture is a serious complication. In the past, ileal ureter substitution was performed with open, laparoscopic, and robot-assisted procedure; however, there are problems with operation invasiveness and difficulty. We present a 72-year-old female whose ureter was completely injured at the ureteropelvic junction and torn longitudinally in full length at the time of transurethral lithotripsy. Although initially she had nephrostomy, we were able to internalize with hand-assisted laparoscopic ileal ureter substitution for obstruction over the full length of the ureter.

Retroperitoneoscopic partial adrenalectomy for metachronous renal cell carcinoma metastasis to solitary adrenal gland.

Metastasectomy is a widely accepted treatment for renal cell carcinoma (RCC) metastasis, and is regarded as the most effective strategy for increasing the rate of cancer-specific survival. However, since bilateral synchronous or metachronous adrenal metastasis of RCC is extremely rare, a standard approach has yet to be established. Partial adrenalectomy may avoid lifelong hormonal supplementation and reduce the risk of Addisonian crisis. A 71-year-old man had a previous history of left nephrectomy and ipsilateral adrenalectomy for metachronous adrenal metastasis. Metachronous contralateral adrenal metastasis was detected 2 years after ipsilateral adrenalectomy, and he underwent retroperitoneoscopic partial adrenalectomy using a vessel sealing device. Although corticosteroid replacement therapy was not prophylactically performed, the patient did not exhibit any symptoms of hypocorticism. Nine months after the surgery, the patient remains well without steroid supplementation, and neither local recurrence nor metastasis has been detected. To the best of our knowledge, this is the first case report of laparoscopic partial adrenalectomy for RCC metastasis. The vessel sealing device was highly effective and suitable for laparoscopic partial adrenalectomy.

Remarkable response to abiraterone acetate in castration-resistant prostate cancer patient with aggressive liver metastasis.

INTRODUCTION: The number of treatment options for metastatic castration-resistant prostate cancer has increased in recent years. Abiraterone, which selectively inhibits CYP17 in the androgen synthesis pathway, is widely used. Liver metastasis is one of the worst prognostic factors in metastatic castration-resistant prostate cancer. Only a few case reports have shown abiraterone successfully treated the liver metastasis of metastatic castration-resistant prostate cancer. CASE PRESENTATION: A 62-year-old man with prostate-specific antigen of 16.69 ng/mL was diagnosed with Gleason 8 (3 + 5) poorly differentiated prostate adenocarcinoma. Androgen deprivation therapy and sequential anti-androgen replacement were performed; however, the disease advanced to castration-resistant prostate cancer with liver metastasis. Prior to docetaxel, abiraterone achieved marked improvements in liver metastasis and prostate-specific antigen. CONCLUSION: Metastatic castration-resistant prostate cancer patients with visceral metastasis were excluded from COU-AA-302, which is phase III trial on abiraterone prior to docetaxel. Although docetaxel is the recommended treatment for the visceral metastasis of castration-resistant prostate cancer according to the European Association of Urology guidelines, abiraterone also has potential as a treatment option.

Laparoscopic management for a psoas abscess caused by migrated urolithiasis.

INTRODUCTION: To describe laparoscopic surgery for psoas abscess caused by migrated urolithiasis. CASE PRESENTATION: A 64-year-old female had renal stones in the right kidney for 5 years. She developed right back pain. Her body temperature was 37.4°C, and right costovertebral angle tenderness was detected. In blood examination, her C-reactive protein level was elevated. Computed tomography revealed that one stone had migrated into the right psoas muscle and caused psoas abscess. Another stone was detected in the renal parenchyma. Percutaneous drainage and antibiotic treatment were performed until her symptoms and inflammation improved. However, psoas abscess recurred after removal of the drainage tube. The migrated stone was laparoscopically removed after fenestration of psoas abscess, and laparoscopic nephrolithotomy was simultaneously performed for the other stone. CONCLUSION: To the best of our knowledge, this is the first case report of psoas abscess caused by migrated urolithiasis that was managed by minimally invasive surgery.

Retrocaval Ureter Manifested after Ureteral Reimplantation for Ipsilateral Vesicoureteral Reflux: A Case Report.

We report a female patient diagnosed with retrocaval ureter (RCU) after ureteral reimplantation for vesicoureteral reflux (VUR). She was diagnosed as right grade IV VUR with breakthrough urinary tract infections, and underwent ureteral reimplantation with Cohen cross-trigonal technique. Thereafter, she developed severe right hydronephrosis associated with RCU, which was presumably due to caudal traction of right ureter at ureteral reimplantation. Sheunderwent uretero-ureterostomy anterior to the inferior vena cava, and recovered well. Detailed evaluation for upper urinary tract is mandatory for high grade VUR, and Cohen technique should be avoided for VUR associated with RCU.

[CLINICAL BACKGROUND ANALYSIS ABOUT TRANSURETHRAL ELECTROCOAGULATION].

PURPOSE: Transurethral electrocoagulation (TUC) is a rare event but occurs in a constant manner with various causes or disorders and reduces patient quality of life. So far there have been no reports focusing on the details of TUC. We focused on the clinical background and related causes in cases of TUC in our institution. PATIENTS AND METHODS: We identified 76 cases (65 patients) who underwent TUC at Keio University Hospital between April 2001 and March 2011. We focused on patient background, especially with respect to the primary disease, treatment modality, use of antiplatelet or anticoagulant agent, timing of TUC, type of electrosurgical device, and the incidence of transfusion. RESULTS: The primary disease for TUC included bladder tumor (BT) in 31 cases, benign prostate hyperplasia (BPH) in 13, prostate cancer (PCa) in 13, idiopathic bladder bleeding in 4, periarteritis nodosa in 3, uterine cervical cancer in 3, and others in 9. TUC after transurethral resection (TUR) was found in 38 cases, including transurethral resection of bladder tumor (TURBT) in 26 of 31 BT cases and transurethral resection of prostate (TURP) in 12 of 13 BPH cases. After TURBT, TUC was performed before removal of a urethral catheter in 7 cases, and after removal of a urethral catheter in 19 cases. With regard to TUC associated with TURP, the average estimated prostate volume in TUC cases before removal of the urethral catheter was 66.2 ml, which was significantly larger than that in TUC cases after removal of the urethral catheter (46.1 ml, p = 0.045). TUC after the radiation therapy was observed in 21 cases, and the average time from the radiation therapy to TUC was 3.4 years (7 months-10 years). CONCLUSION: TUC was caused by multiple causes or disorders, and 75% of our TUC was associated with BT, BPH or PCa. TUC associated with TURBT frequently occurred within 1 week after TURBT but was still observed after 1 month following the operation. All TUC associated with TURP occurred within 3 weeks after operation. The average period from radiation therapy to TUC was 3.4 years (7 months-10 years) and TUC associated with radiation cystitis could occur beyond 5 years after radiation.