Retroperitoneoscopic treatment of ureteral invagination caused by a long fibroepithelial polyp protruding into the bladder: report of a case.

We describe how we performed retroperitoneoscopic surgery for a 15.5-cm fibroepithelial polyp, which originated in the lowest portion of the right upper ureter, protruded intermittently into the bladder, and caused ureteral invagination. To our knowledge, this is the first report of the retroperitoneoscopic management of ureteral invagination caused by a long fibroepithelial polyp.

Inguinal hernia after radical perineal prostatectomy: comparison with the retropubic approach.

OBJECTIVES: To clarify the characteristics of inguinal hernia (IH) after radical perineal prostatectomy (RPP) compared with that after radical retropubic prostatectomy (RRP). METHODS: We retrospectively reviewed 285 and 311 men who underwent RPP and RRP, respectively, for clinically localized prostate cancer between August 2000 and June 2006, using medical records and a telephone survey. RESULTS: The incidence of postoperative IH after RPP was 1.8% (5 of 285) with a median follow-up time of 43 months; that after RRP was 10.3% (32 of 311) with a median follow-up of 36 months (P <0.0001). The cumulative IH-free rate was significantly higher after RPP than after RRP (P <0.0001, log-rank test). Three of the five RPP patients (60%) developed IH more than 24 months after surgery, whereas 25 of 32 (78%) of the RRP group did so within 24 months (P = 0.0742). The incidence rate of post-RPP IH did not differ between the standard (4 of 194 = 2.1%) and modified (1 of 91 = 1.1%) RPP procedures, where the endopelvic fascia was left intact and opened, respectively (P = 0.5638). CONCLUSIONS: The incidence of IH after RPP appears to be sporadic and about the same as that (2.0-2.4%) reported previously in men with prostate cancer treated nonsurgically. Although some kinds of procedures during RRP are speculated to affect the internal inguinal ring, prostatectomy with or without opening of the endopelvic fascia seems to be less implicated in the development of IH after RRP because it was not a significant variable in IH development after different techniques had been used in RPP.

Prevalence of renal cell carcinoma: a nation-wide survey in Japan, 2002.

OBJECTIVE: To investigate the incidence of renal cell carcinoma, classified by sex, age group and region in Japan, following a 5-year interval after a previous survey performed in 1997. METHODS: The survey was conducted between the beginning of January 2002 and the end of December 2002. A total of 1288 institutions in all 47 prefectures throughout Japan were requested to register cases. RESULTS: There were 7405 persons with renal cell carcinoma, consisting of 5063 males and 2342 females. Crude incidence rates were 8.2 and 3.6 per 100 000 population for men and women, respectively. Incidence rates in the Hokkaido region were highest followed by the Shikoku region. CONCLUSIONS: Despite incidence of renal cell carcinoma increasing to 7405 from the 6358 persons in 1997, statistical data reported by the Ministry of Health, Labor and Welfare indicate that rising age-adjusted death rate for this tumor reached a ceiling in the past decade. Early detection may have contributed to this current trend; however, further epidemiological research is required to fully elucidate this.

Primary amelanotic malignant melanoma of the female urethra.

The case is reported of amelanotic malignant melanoma of the female urethra mimicking urethral caruncle. A 75-year-old woman complained of a mass of the external meatus. Urethral carunclectomy was performed, but histological diagnosis was amelanotic malignant melanoma. Finally, she underwent en block resection of urethra including bladder neck, uterus, adnexa, vagina, and vulva. As urinary diversion, she underwent a continent cathererizable stoma with an appendicovesicostomy, according to the method described by Mitrofanoff, and Y-V graft for reconstruction of the vulva.

Three-dimensional navigator for retroperitoneal laparoscopic nephrectomy using multidetector row computerized tomography.

PURPOSE: We evaluated the efficacy of a 3-dimensional (D) navigator for retroperitoneal laparoscopic nephrectomy. MATERIALS AND METHODS: A total of 21 patients with malignant localized renal (16) or ureteral (5) neoplasms underwent multi-detector row computerized tomography. The 3-D navigator was created using volume rendering technique. These findings were compared with videos obtained during laparoscopy. RESULTS: The 3-D navigator depicted all renal arteries (100% sensitivity) and 24 of the 25 renal veins (96% sensitivity). Hilar anatomy, including the tumor, major vessels and adrenal gland, and their relationships were visualized as in laparoscopic views. CONCLUSIONS: The 3-D navigator has a potentially important role in retroperitoneal laparoscopic nephrectomy. It is able to guide surgeons and aid in avoiding operative risks and possible complications.

Localization and expression of tissue inhibitor of metalloproteinase-1 in human urothelial cancer.

PURPOSE: We evaluated the role of tissue inhibitor of metalloproteinase-1 (TIMP-1) in the invasion and metastasis of human urothelial cancer. MATERIALS AND METHODS: The expression level of TIMP-1 messenger (m)RNA was determined in 33 urothelial carcinomas, including upper urothelial cancer in 15 cases and bladder cancer in 18, by Northern blot analysis. Localization of TIMP-1 mRNA was analyzed by in situ hybridization. These data were compared with clinicopathological features. We also determined the growth activity of tumor cells using immunohistochemical staining for Ki-67 and compared it with the expression levels of TIMP-1 mRNA. These data were also compared with clinicopathological features. RESULTS: The expression level of TIMP-1 mRNA significantly correlated with pathological stage and histological differentiation. In situ hybridization showed that TIMP-1 mRNA was expressed in the cytoplasm of urothelial cancer cells. The Ki-67 labeling index significantly correlated with the expression level of TIMP-1 mRNA in urothelial cancer. Patients with high expression of TIMP-1 mRNA had a poorer prognosis than those with low expression. CONCLUSIONS: TIMP-1 mRNA is expressed in the cytoplasm of cancer cells and high expression indicates more malignant potential in cases of urothelial cancer.