Successful treatment of metastatic urothelial carcinoma arising in a transplanted renal allograft with paclitaxel, cisplatin, and gemcitabine combination therapy: a case report.

BACKGROUND: For locally advanced or metastatic urothelial carcinoma, cisplatin-based chemotherapy is the standard regimen. Nevertheless, almost all responding patients experience recurrence within the first year. When patients who have received prior cisplatin-based therapy become resistant, combination therapy with gemcitabine and paclitaxel has been reported. Few published case reports have addressed the utility of paclitaxel/cisplatin/gemcitabine combination therapy as second-line chemotherapy for advanced or metastatic urothelial carcinoma. This is the first report describing paclitaxel/cisplatin/gemcitabine combination therapy for metastatic urothelial carcinoma arising in a transplanted renal allograft and leading to a successful outcome. CASE PRESENTATION: We present a case of metastatic urothelial carcinoma of a renal allograft in a 32-year-old Japanese man with a history of kidney transplantation ten years prior. Because the patient's serum creatinine increased, hemodialysis was resumed, and the surgical allograft was removed. Multiple lung metastases were resistant to gemcitabine/cisplatin adjuvant chemotherapy, so paclitaxel/cisplatin/gemcitabine combination chemotherapy was instituted. After paclitaxel/cisplatin/gemcitabine chemotherapy, all pulmonary metastatic tumors disappeared. The patient has survived without disease progression for more than four years since treatment. CONCLUSION: Paclitaxel/cisplatin/gemcitabine combination therapy may be effective and lead to a survival advantage in patients with locally advanced or metastatic urothelial carcinoma when used as second-line chemotherapy following cisplatin-based therapy. However, further investigations may be required to confirm and evaluate the significance of this treatment.

[Information tools utilized by outpatients presenting to a female urological clinic and their temporal trend: analysis of 3,480 patients].

OBJECTIVES: Female urological diseases, including pelvic organ prolapse and urinary incontinence, are common in elderly people, but public knowledge about these diseases is limited. We analyzed information tools that patients with female urological disease utilized to acquire information about their diseases. MATERIALS AND METHODS: This study included 3,480 patients who presented to our female urological clinic between January 2005 and December 2008. We conducted a questionnaire survey on what information tools were used for information gathering. RESULTS: The newspaper was the leading information tool (39.9%), followed by referral from another clinic (17.8%), internet (15.7%), TV (14.8%), recommendation by family or friends (5.5%), books or magazines (3.2%), and informative sessions for the public (0.6%). The temporal trend in the rate of information tool use over the 4 years showed that internet use increased significantly every year (p trend = 0.041) and was the most utilized tool in 2008, along with referral from other clinics. The rate of newspaper or TV use depended on their volumes of the female urological diseases. Additionally, no change over the study period was observed for the rate of internet utilization for patients in their 40s or under; however, it increased in patients in their 50s or over, and patients in their 50s and 60s utilized the internet as often as patients in their 40s or under in 2008. CONCLUSIONS: The newspaper was the most utilized information tool for patients with female urological diseases. However, internet use for gathering disease information is increasing, and the internet may be the most important information tool in the near future.

[A case of tuberculous epididymitis after Bacillus Calmette-Guérin intravesical instillation therapy for bladder cancer].

A 65-year-old male had undergone transurethral resection of bladder tumor (TUR-Bt) four times for recurrent bladder cancer, and each histopathological examination revealed non-invasive urothelial carcinoma, pTa, G2. To prevent further recurrence, he received eight weekly intravesical instillations of Bacillus Calmette-Guérin (BCG). Four months after the BCG therapy, he underwent cystoscopy. One week after the cystoscopy, he developed a painful and swollen left scrotum. Treatment with levofloxacin for acute epididymitis reduced the scrotal pain initially, but the pain increased and 3 months later, a fistula with suppurative discharge appeared at the bottom of the scrotum. A smear of the discharge revealed Gaffky 2, and a culture showed tubercle bacillus. Incisional drainage of the abscess and anti-tuberculosis chemotherapy for 2 months to treat tuberculous epididymitis was not completely effective. We performed a left orchiectomy with resection of the infected scrotal skin. Histopathological examination showed tuberculous epididymitis consisting of a caseating granuloma with epithelioid cells and Langhans giant cells. He received anti-tuberculosis chemotherapy for 4 months postoperatively and had no sign of recurrence 1 year postoperatively.

[Primary carcinoid tumor of the kidney: a case report].

A 40-year-old male was referred to our hospital for further examination of a left kidney tumor. A left kidney tumor measuring 3 cm in diameter was incidentally found by abdominal ultrasound on physical checkup. Abdominal computed tomography and magnetic resonance imaging confirmed hypovascular tumor of the left kidney. Clinical diagnosis was left renal cell carcinoma and retroperitoneoscopic left nephrectomy was performed. However, pathological diagnosis was carcinoid tumor of the kidney. Primary carcinoid tumors of the kidney are uncommon. We present a case of primary carcioid tumor of the kidney and review the literature.

[Tension-free vaginal mesh repair for recurrence of pelvic organ prolapse after vaginal mesh procedures: a case report].

A 61-year-old woman presented with the chief complaint of a vaginal bulge for 2 years. She had undergone two operations for pelvic organ prolapse. The initial procedure was the Manchester procedure and posterior colporrhaphy, and the second was a vaginal repair with mesh for recurrent rectocele 3 years after the initial surgery. She noticed the vaginal bulge shortly after the second surgery. A gynecological examination revealed a stage III rectocele associated with a 2 cm, firm mass at the posterior vaginal wall. T2-weighted magnetic resonance imaging showed a 2 × 3 cm high-intensity mass located between the vaginal wall and rectum. The recurrent rectocele might have been caused by incomplete support from the mesh, which was not fixed in the vaginal wall, resulting in formation of a mass. The patient underwent complete mesh removal and tension-free vaginal mesh-posterior surgery for the rectocele. The excised mesh had shrunk from a 7 × 5 cm rectangle mesh preoperatively into a firm 2 × 2 × 3 cm mass. No recurrence has been seen for 18 months postoperatively.