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Ureteral metastasis from prostate cancer is rare. The present case report describes an 83-year-old patient with distant metastasis of prostate cancer to the right ureter that caused hydronephrosis. Upon initial examination at our hospital, he presented with a high prostate-specific antigen (PSA) level of 10.0 ng/ml. He was diagnosed with prostate adenocarcinoma, with Gleason score of 10 (5＋5) and clinical staging of cT2aN0M0. Intensity-modulated radiation therapy (IMRT) was performed after 1 year and 7 months of androgen depriation therapy. At 1 year and 4 months after IMRT, PSA increased to 3.068 ng/ml. Computed tomography scan revealed right hydronephrosis and thickening of the right ureter. We could not identify obvious malignant cells on ureteroscopic biopsy, and right nephroureterectomy was performed. Pathological examination revealed ureteral metastasis of prostate cancer. Six months after nephroureterectomy, PSA increased to 3.037 ng/ml. He was diagnosed with castration-resistant prostate cancer and has been treated with enzalutamide.

We evaluated the safety of laparoscopic radical cystectomy (LRC) during initial phases and its learning curve in a Japanese multicenter cohort by studying 436 patients who underwent LRC with no robot assistance at 10 institutions in Japan. We divided the patients into three groups according to cumulative surgical volume at each institution (first 10 cases, 11-30 cases, after 31 cases in each institution), and compared perioperative and pathologic variables among the three groups. The first, second, and third groups included 100, 166, 170 patients, respectively. The preoperative variables were similar in the three groups except for the rate of neoadjuvant chemotherapy. The methods of LRC procedure, such as urinary diversion, the extent of lymph node dissection, and concomitant urethrectomy or nephroureterectomy, were similar in the three groups. Mean operative time was 629, 562 and 531 minutes, respectively, and mean blood loss was 755, 650 and 435 ml, respectively. Both values decreased over time with the institution's experience. There was no significant difference among the three groups in the rate of positive surgical margin, the number of retrieved lymph nodes, and the rate of intra- and postoperative complications. LRC was safely performed during initial phases with an acceptable complication rate and without compromising oncological results, although operative time was longer and blood loss increased.

Peritoneal metastasis of prostate cancer is extremely rare, with only a few cases reported. A 78-yearold male patient was introduced to our hospital presenting with a prostate-specific antigen (PSA) level of 94.0 ng/ml at examination. He was diagnosed with poorly differentiated adenocarcinoma of the prostate, with a Gleasonscore of 9 (5＋4) at cT3bN0M0. Intensity-modulated radiation therapy was performed after 6 months of combined-androgen blockade (CAB) therapy. Twenty-one months later, several lymph node metastases were observed. With the resumptionof CAB therapy, PSA levels dropped and the multiple lymph node metastasis disappeared ; however, peritoneal metastasis was observed after 43 months. We performed a laparoscopic biopsy and our diagnosis after pathological evaluation was metastasis of the prostate cancer. He was treated with Enzalutamide.

Bladder tamponade is thought to be caused mainly by bladder cancer or radiation cystitis. However, in women, it may often be caused by cystitis in clinical settings. This has not been noted in previous reports of bladder tamponade in Japan. Thus, we retrospectively analyzed the clinical features of 83 male and 41 female patients with bladder tamponade. Seventy-four patients were treated at Nishi-Kobe Medical Center between April 2005 and March 2015, and 50 were treated at Shizuoka City Shizuoka Hospital between November 2008 and March 2015. The patients'median age was 80 years. The cause of bladder tamponade was urological malignancies in 33 of the 83 male patients (40%), benign prostatic hyperplasia in 20 of the 83 male patients (24%), and cystitis in 33 of the 41 female patients (80%). Compared with the men, the women with bladder tamponade were significantly older and the proportion of patients with cerebrovascular disease, diabetes, and dementia was higher. In addition, more women were nursing home residents, with a higher rate of voiding with diapers and antithrombotic use than men. Causative strains of cystitis were diverse, and some were antibiotic resistant. Most of the cases of bladder tamponade in the women occurred in the elderly and were caused by cystitis. In an aging society, increases in the incidences of chronic, complicated cystitis due to impaired independent micturition, dysuria, and systemic diseases such as diabetes, and increased use of antithrombotic drugs may contribute to bladder tamponade in women.

A 73-year-old male patient with a 16-year history of ulcerative colitis presented to our hospital with a history of pneumaturia and fever. Cystoscopy and a computed tomography scan showed sigmoidovesical fistula. Colonoscopy showed a necrotic tumor along with sigmoidovesical fistula. A biopsy was not sufficient to make a definitive diagnosis of the tumor. Total colectomy with ileostomy and partial cystectomy were performed. A pathological examination showed diffuse large B-cell lymphoma of the sigmoid colon. On postoperative day 35, delayed dehiscence of the bladder wall was detected and a biopsy of the bladder wall showed lymphoma. Standard systemic chemotherapy (R-THP-COP) was administered and the defect of the bladder was closed. Three years and 2 months postoperatively, the patient has no local recurrence or distant metastasis.

A 59-year-old man who had undergone hemodialysis for 13 years was diagnosed with left renal cell carcinoma (RCC),cT1aN0M0,in 2010. He had a laparoscopic left nephrectomy,and the pathological diagnosis at that time was clear cell carcinoma,pT1a (multifocal). At 1 year after surgery,he was diagnosed with a left renal hilar lymph node metastasis and a new right RCC,cT1aN0M0. Consequently,he underwent a right nephrectomy and retroperitoneal lymph node dissection in 2012. Pathologic diagnosis by the current classification of the right renal tumor was acquired cystic disease-associated renal cell carcinoma (ACD-associated RCC),and that of the left hilar lymph node was metastatic RCC with sarcomatoid change. According to the revised classification the pathological diagnosis of the left renal tumor was ACD-associated RCC. There has been no evidence of recurrence or metastasis for 3 years after the second operation. The specific classification of dialysis-related renal tumors and their characteristics should be standard knowledge for urologists.

We assessed the effect of subcuticular buried sutures with subcutaneous closed suction drain to prevent surgical site infection (SSI) in patients undergoing total cystectomy with urinary diversion using the intestine. We reviewed the clinical charts of 43 consecutive patients who underwent total cystectomy with urinary diversion using the intestine from February 2006 to March 2011 at Nishi-Kobe Medical Center. All patients received intravenous prophylactic antibiotics before and throughout surgery as well as for three days after surgery. Skin closure was performed with interrupted vertical mattress sutures with 2-0 nylon on the first 22 patients (mattress group), and with interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous closed suction drain on the remaining 21 patients (subcuticular buried suture with subcutaneous drain; SBD group). SSI occurred in 7 (31.8%) patients in the mattress group, but did not affect any patient in the SBD group. We compared risk factors for SSI between the groups, and found that the method of skin closure was significant risk factor for SSI (P = 0.005). We concluded that interrupted subcuticular buried sutures with 4-0 absorbable monofilament with subcutaneous suction drain is effective for prevention of SSI in total cystectomy with urinary diversion using the intestine.

We retrospectively reviewed the records of 11 patients with small cell carcinoma of the bladder, who were diagnosed at Kyoto University Hospital between June 1995 and November 2010. The median age was 79 years. Two patients had stage I disease, 4 had stage II disease, 2 had stage III disease, and 3 had stage IV disease. All 3 patients with stage IV disease had metastatic disease. They had very poor prognosis with a median survival of only 9.1 months (range 3.2-13.0 months). Of 8 patients without metastatic disease, 3 patients who had been treated with neoadjuvant chemotherapy followed by cystectomy had longterm survival. The median survival of these 3 patients was 85.5 months (range 38.0-102.8 months), and all of them are still alive without cancer. The median survival of the other 5 patients was 12.6 months (range 9. 9-33. 8 months). There were significant differences in survival between patients with neoadjuvant chemotherapy followed by cystectomy and with other treatments (p＝0.024). In conclusion, these results suggested that neoadjuvant chemotherapy followed by cystectomy could cure patients with small cell carcinoma of the bladder without metastatic disease.

We prospectively investigated the safety and efficacy of sunitinib using a modified regimen (2 weeks on/1 week off) in 24 patients (22 males, 2 females ; age range 39-86 years, median 64 years) with metastatic renal cell carcinoma (RCC). During the observation period (3-62 weeks, median 21 weeks), thrombocytopenia was seen in 13 (54.2%), leukopenia in 11 (45.8%), hand-foot syndrome in 5 (20.8%), hypertension in 4 (16.7%), and hypothyroidism in 3 (12.5%) patients, while grade 3 or higher adverse events were found in 4 (16.7%), 1 (4.2%), 1 (4.2%), 2 (8.3%), and 0 patients, respectively. Of the 21 patients evaluable for response, 5 (23. 8%) showed partial response, 8 (38.1%) stable disease, and 8 (38.1%) progressive disease. This new modified regimen may lead to a reduction in adverse events for treatment of patients with metastatic RCC as a substitute for the standard dosing regimen of sunitinib.

A 77-year-old man was diagnosed with urachal cyst, but had not been followed-up because of his severe dementia. He visited our department complaining of mucinuria. Ultrasonography showed a tumor with heterogeneous contents above the bladder. Mucinousfluid was found by cystoscopic examination. After the fluid was removed, a non-papillary tumor with mucin secretion was identified at the dome of the bladder. Computed tomography revealed that the peritoneal cavity was filled with a mucinous tumor. Peritonitis was suspected because of the existence of free air and abdominal rebound tenderness, and emergent surgery was performed. Bowel perforation was not found. Tumors could not be removed and the tissue biopsy was performed. It was pathologically diagnosed as pseudomyxoma peritonei arising from urachal carcinoma.

We performed transobturator sling (TOS) surgery for iatrogenic stress urinary incontinence (SUI) in 7 men. Assessment with the International Consultation Society Incontinence Questionnaire Short Form revealed that complete continence, significant improvement, and no change of incontinent status were observed in two, three, and two patients, respectively, at one year after surgery. Of the three patients with significant improvement, two patients obtained a pad-free status. Both of the two patients without improvement had a past history of salvage radiation therapy for biochemical recurrence after radical prostatectomy before TOS surgery. The severity of SUI seems not to be associated with the outcome of TOS surgery. TOS surgery can be one of the surgical options for iatrogenic male SUI.

Fifty-three patients with biochemical relapse (BCR) after receiving external beam radiotherapy (EBRT) against locally advanced prostate cancer (stage III : International Union Against Cancer [UICC] 6th edition) between September 1997 and January 2006 at our institution, who were treated with salvage hormonal therapy (HTx), were followed for a mean period of 75.5 months. There was progression to castrationresistant prostate cancer (CRPC) during the follow-up period in 17 patients (32.0%). The median time to CRPC after initial HTx was 17 months. Univariate analysis revealed that time to BCR after EBRT was significantly associated with progression to CRPC (p＝0.022), while PSA-doubling time just before salvage HTx was marginally associated with irradiation dose (p＝0. 088, p＝0.128 respectively). Multivariate analysis showed that time to BCR after EBRT was the only significant predictor of progression to CRPC (p＝ 0.035, Hazard ratio ; 0.252, 95% confidence interval ; 0.070-0.905) conclusion, time to BCR after EBRT might be a good predictor for the efficiency of salvage HTx after EBRT against locally advanced prostate cancer.

The D'Amico risk group classification was originally developed to estimate the risk of biochemical recurrence following treatment for localized prostate cancer. We validated the ability of the risk group to predict biochemical recurrence after radical prostatectomy for patients with high-risk prostate cancer. We retrospectively reviewed the medical records of 208 patients who underwent radical prostatectomy, excluding patients with neoadjuvant hormonal therapy, with adjuvant hormonal therapy or radiotherapy, and patients without significant clinical data at our institution between 1997 and 2005. Using the D'Amico risk criteria, 58 (28%), 100 (48%), 50 (24%) were stratified as low-, intermediate- and high-risk groups, respectively. The Kaplan-Meier analysis of biochemical progression-free survival showed that the high-risk group in the D' Amico risk criteria consisted of patients with various prognosis. Therefore, in this group, patients with two or more of three factors including clinical stage T2b or higher, preoperative PSA 10 ng/ml or greater, and biopsy Gleason score 7-10 were reclassified into the very-high-risk group, and those with only one of three factors were reclassified into the semi-high risk group. Patients in the very-high risk group had recurrence at a significantly higher rate than those in the semi-high risk group (p＝0.021). In conclusion, further classification of the D'Amico high risk group into two subgroups has a potential to identify a patient group with very high risk of PSA recurrence after prostatectomy.

A 59-year-old man was referred to our hospital with right hydronephrosis, which was diagnosed from a medical examination. On imaging studies, he had concentric thickness of the right ureteral wall, and retroperitoneal and mesenteric lymphadenopathy. Urine cytology was negative, and an ureteroscopic biopsy showed no malignancy. We performed laparoscopic biopsy of the retroperitoneal lymphadenopathy, and the histopathological diagnosis was B-cell follicular lymphoma. The patient received four cycles of RCVP (rituximab, cyclophosphamide, vincristine, prednisolone) chemotherapy and four cycles of rituximab monotherapy and then he obtained complete remission. If concentric thickness of the ureteral wall is found, physicians should be aware of the possibility of malignant lymphoma and should consider laparoscopic biopsy for diagnosis.

Assessment of renal function is important to determine the appropriate dose for cisplatin (CDDP)-based chemotherapy. Many previous CDDP-based chemotherapy trials for bladder cancer have required a creatinine-clearance (Ccr) ≧60 ml/min for entry. However, there is little evidence on renal function assessed by estimated glomerular filtration rate (eGFR) using the 4-variable Modification of Diet in Renal Disease Study Equation (MDRD), which has recently been introduced, to determine the eligibility for CDDP-based chemotherapy. To evaluate the proportion of patients with invasive urothelial carcinoma(UC) who would be ineligible ("unfit") to receive CDDP-based chemotherapy based on eGFR criteria (eGFR ＜60 ml/min/1.73 m2), and to determine the side effects of chemotherapy in these "unfit" patients, we conducted a retrospective clinical study. Our study population consisted of 61 consecutive patients who underwent 100% dose CDDP-based chemotherapy for invasive UC with 24 h-Ccr≧50 ml/min between June 2001 and July 2009. We assessed renal function using 3 equations (eGFR, Ccr according to Cockcroft-Gault formula (C-G Ccr), and Ccr examined by 24-hour urine collection (24 h-Ccr)) as well. Mean values of eGFR, C-G Ccr, and 24 h-Ccr were 58.6, 68.9, and 82.8 ml/min, respectively (P＜ 0.001). In total, 29/61(48%) patients were ineligible ("unfit") to receive chemotherapy based on eGFR criteria. However, there was no difference in the frequency of side effects between eGFR ≧60 ml/min/ 1.73 m2 and eGFR ＜60 ml/min/1.73 m2 groups. Our observations suggest that 24 h-Ccr≧50 ml/min would be a reasonable cutoff for CDDP-based chemotherapy even when eGFR ＜60 ml/min/1.73 m2.

A 64-year-old man was referred to our hospital for the treatment of left renal cell carcinoma associated with a tumor located on the back of the inferior vena cava. At first the tumor located on the back of the inferior vena cava was suspected to be lymphnode metastasis of renal cell carcinoma. A more detailed examination at our hospital revealed elevation of vanillylmandelic acid in urine and (131)Imetaiodobenzylguanidine uptake in the tumor. We diagnosed the tumor as paraganglioma and operated both tumors at the same time. Histological examination revealed chromophobe renal cell carcinoma and paraganglioma. His important to discriminate paraganglioma in the renal cell carcinoma that has an atypical swelling of lymphnode.

A 78-year-old woman was referred to our hospital with chief complaint of colicky right flank pain. Computed tomography (CT) demonstrated right hydronephrosis and a wall thickening in the right ureteropelvic junction. Right nephroureterectomy was performed under a clinical diagnosis of invasive ureteral cancer. Histological examination revealed immunoglobulin light chain (AL) amyloidosis of the ureter. Although amyloid deposition seemed to be localized to the ureter alone, bone marrow biopsy revealed primary macroglobulinemia. After 23 months, no signs or symptoms suggesting the progression of amyloidosis or macroglobulinemia have been pointed out. AL amyloidosis arising secondarily to plasma cell disorder is called immunocytic amyloidosis. In general, immunocytic amyloidosis accompanies deposition of the amyloid protein to various organs of the whole body, and causes multiple clinical symptoms related to amyloid deposition. Even though the clinical manifestation indicates the localized disease like the presented case, close examination of immunocytic amyloidosis is important.

Patients with autosomal dominant polycystic kidney disease (ADPKD) often suffer from abdominal symptoms. Although laparoscopic nephrectomy has been reported as a minimally invasive therapy, it is still technically demanding due to the large size of the kidneys. Transarterial embolization (TAE) is one of the alternatives, but there are only limited reports on its application in ADPKD. We describe a case in which bilateral nephrectomy was performed as a second-line treatment after TAE. One kidney was removed because a small feeding arterial branch was not completely embolized. The other kidney was removed due to infection. Retroperitoneoscopic nephrectomy was a good choice as a second-line modality in the case without infection because the volume of the kidney was reduced even with incomplete TAE, and adhesion after TAE was minimal. TAE is an effective choice in ADPKD patients without infection as a first-line treatment even when complete embolization is difficult, since nephrectomy after TAE is technically easier than removal of a fresh ADPKD kidney.