[A Retrospective Study on the Malignancies after Renal Transplantation].

Detection of post-transplant malignant tumors and the analysis of the associated risk factors is important for monitoring the progress after renal transplantation. In this study, we retrospectively examined the medical records of 298 patients who underwent renal transplantation at two facilities in Nagasaki Prefecture (Nagasaki University Hospital and National Hospital Organization Nagasaki Medical Center). Of the 298 patients, 45 (15.1%) patients had developed malignant tumors with 50 lesions. The most common type of malignant tumor was skin cancer (eight patients; 17.8%), followed by renal cancer (six patients; 13.3%), and pancreatic cancer and colorectal cancer, (four patients; 9.0% each). Five patients (11.1%) had multiple cancers, four of whom had skin cancer. The cumulative incidence within 10 and 20 years after renal transplantation was 6.0 and 17.9%, respectively. Univariate analysis identified age at transplantation and administration of cyclosporine and rituximab as risk factors, while multivariate analysis identified age at transplantation and administration of rituximab as independent factors. The administration of rituximab was associated with the development of malignant tumors. However, further investigation is required to establish the association with post-transplant malignant neoplasms.

Influence of prior oral ethinylestradiol use on the efficacy of enzalutamide for the treatment of castration-resistant prostate cancer in men.

OBJECTIVE: To elucidate the effect of prior use of ethinylestradiol on enzalutamide treatment for men with castration-resistant prostate cancer. METHODS: We retrospectively analyzed data from 99 consecutive patients (median age 72 years, range 50-88 years) treated with enzalutamide for castration-resistant prostate cancer between May 2014 and November 2015 after receiving several lines of hormonal therapy. RESULTS: A total of 45 patients were given ethinylestradiol before enzalutamide. The prostate-specific antigen response rate (decline in prostate-specific antigen >50% from baseline) of patients receiving ethinylestradiol and enzalutamide were 51.1% and 41.4%, respectively. Cross-resistance between ethinylestradiol and enzalutamide was clearly observed in the setting of pre-docetaxel. In multivariate analysis, the T stage and number of therapies before enzalutamide were the only significant predictors of prostate-specific antigen response to enzalutamide. However, in patients treated pre-docetaxel use, prior use of ethinylestradiol was a significant predictor of prostate-specific antigen response to enzalutamide, whereas ethinylestradiol did not affect the overall survival of these patients. CONCLUSIONS: Cross-resistance between ethinylestradiol and enzalutamide in the setting of pre-docetaxel therapy seems to be evident. Therefore, ethinylestradiol should be used prudently before enzalutamide in this setting.

[Efficacy of naftopidil in patients with overactive bladder associated with benign prostatic hyperplasia: prospective randomized controlled study to compare differences in efficacy between morning and evening medication].

A total of 100 patients with benign prostatic hyperplasia (BPH) and overactive bladder (OAB) symptoms (BPH/OAB), enrolled between June 2006 to March 2008, were randomly divided into 2 groups of morning medication (M) and evening medication (E) groups, then 50 mg of naftopidil was given once a day after breakfast or supper for 8 weeks. Data were available for efficacy analysis on 80 patients (M group ; 43, E group ; 37). Naftopidil significantly improved the overall international prostatic symptom score ; from 19.2±7.9 to 11.7±5.8 in the M group and from 19.4±6.4 to 12.3±6.8 in the E group (p<0.0001), QOL score from 4.9±0.8 to 3.2±1.4 in the M group and from 5.0±0.8 to 3.6±1.3 in the E group (p<0.0001), and OAB symptom score from 7.8±2.6 to 5.0±2.5 in the M group (p<0.0001) and from 8.6±2.9 to 5.8± 3.3 in the E group (p<0.0001). There was no significant difference in the incidence of adverse effects between the M group (6.1%) and E group (2.2%). These results suggest that naftopidil improves storage symptoms as well as voiding symptoms regardless of timing of administration.

Cavernous nerve graft reconstruction using an autologous nerve guide to restore potency.

OBJECTIVE: To present our experience of cavernous nerve graft reconstruction, using an autologous nerve vein-guide technique, to restore potency. PATIENTS AND METHODS: Prostate cancers frequently require radical resection involving one or both cavernous nerves that usually results in erectile dysfunction; nerve grafting has been used to restore erectile function, but clinical results are unsatisfactory owing to inadequate surgical techniques. In all, eight patients with prostate cancer who required radical resection involving one cavernous nerve had sural nerve grafting, with two or three sutures using the autologous vein-guide technique, in our unit between 2004 and 2005. Because of the difficulty of performing microsurgical manoeuvres deep within the pelvic cavity, the nerve anastomosis might be unsatisfactory. RESULTS: Seven of the eight patients had spontaneous erectile activity after grafting and six of these patients were able to have intercourse. CONCLUSION: Sural nerve grafting using the autologous vein-guide technique is simple, has minimal morbidity, and yields good outcomes.

Erectile dysfunction in hemodialysis patients with diabetes mellitus: association with age and hemoglobin A1c levels.

AIM: Erectile dysfunction (ED) is common in patients with diabetes mellitus (DM) as well as those undergoing hemodialysis (HD). The purpose of this study is to investigate the frequency and severity of ED in HD patients with DM and those without DM. In addition, we examined the relationship between erectile function and several risk factors, including presence of DM and hemoglobin A1c levels in HD patients. METHODS: This study involved 180 patients on HD, including 66 HD patients with DM (DM-HD) and 114 patients without DM (non-DM-HD). We evaluated erectile function using an abridged five-item version of the international index of erectile function (IIEF-5). Logistic regression analysis was used to investigate the relationship between presence of ED and several risk factors. RESULTS: The total score of IIEF-5 in DM-HD patients (9.5 +/- 4.2) was significantly lower than in non-DM-HD patients (13.5 +/- 5.7). The prevalence of severe ED was 42.4% and 18.4% in DM-HD patients and non-DM-HD patients, respectively. Age, cardiovascular disease history, and DM were identified as independent risk factors for the presence of ED. Furthermore, age and elevated hemoglobin A1c levels were identified as independent risk factors for the presence of severe ED. CONCLUSION: DM-HD patients are more likely to have ED, and particularly severe forms of ED, than non-DM-HD patients. DM and elevated hemoglobin A1c levels were associated with the presence of ED or severe ED, respectively. Aging was identified as an independent factor in both ED and severe ED.

Simultaneous two-plane x-ray imaging for endoscopic recanalization of prostatomembranous urethral disruption.

We describe a technique that uses simultaneous two-plane images to facilitate endoscopic recanalization of prostatomembranous urethral disruption. This technique is very useful for identifying the true passage and to perform endoscopic recanalization safely.