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In March 2019, cefazolin was unavailable owing to difficulty in procuring the active ingredient. Furthermore, the supply of alternative drugs, such as cefotiam and cefmetazole, was limited. In the Department of Nephro-Urology, fosfomycin-based drugs are used as substitutes for cefazolin, which is a perioperative prophylactic antibacterial drug. Herein, we investigated the effectiveness of fosfomycin sodium and cefotiam in preventing infection after endoscopic combined intrarenal surgery as a retrospective preliminary study.A total of 200 patients who underwent endoscopic combined intrarenal surgery at our department between August 2017 and January 2021 were included. The patients were administered cefotiam (n = 95) or fosfomycin (n = 105) as perioperative antibacterial agents. There were no significant differences in the median age or surgery time between the cefotiam and fosfomycin groups. Propensity score matching was performed to match the preoperative urine bacterial counts of both groups. Sixty-eight patients were selected from each group.The median postoperative hospital stay duration was 4 days for the two groups. The median maximum postoperative temperatures were 37.5 and 37.4°C, respectively. There were no significant differences between the maximum postoperative temperatures in both groups. Furthermore, there were no differences between the groups regarding the white blood cell counts, C-reactive protein levels, and aspartate aminotransferase and alanine aminotransferase levels postoperatively, as well as in terms of postoperative fever requiring additional antibiotics.During a period of difficulty in acquiring cefazolin and cefotiam, the use of fosfomycin allowed us to continue with the procedure without increased clinical complications.

The number of patients with urothelial carcinoma (UC) is high, with a corresponding demand for detecting UC easily and non-invasively. Cystoscopy and urine cytology, with widely known diagnostic accuracies, are the gold standards for identifying UC originating from the bladder. However, cystoscopy or other tests, such as ureteroscopy or retrograde pyelography, are uncomfortable for patients. Tests for urinary biomarkers are expected to satisfy the demand for less invasive tests that will benefit patients with anxiety for invasive tests such as cystoscopy or ureteroscopy. Although several urinary biomarkers have been reported to support the diagnosis or follow-up of UC, their use in the clinic is uncommon. The UroVysion test examines urinary biomarkers using a multitarget, multicolor fluorescence in situ hybridization (FISH) assay. The test uses exfoliated cells found in urine and is a mixture of centromeric fluorescent denatured chromosome enumeration probes for chromosomes 3, 7, and 17 (labelled stratum red, spectrum green and spectrum aqua, respectively), and a locus-specific identifier probe for 9p21 (spectrum gold). It is used for the initial diagnosis of patients with hematuria or the monitoring of patients previously diagnosed with bladder cancer. Almost 20 years have passed since UroVysion was approved by the U.S. Food and Drug Administration, and so this is a well-established test. However, room exists for further research, with numerous reports on this test having been recently published. In order to update our knowledge, we herein present a brief overview of UroVysion and its features that follows the latest findings as they relate to UC.

Background Recent studies have shown that epigenetic alterations, such as those involving lysine‐specific demethylase 1 (LSD1), lead to oncogenic activation and highlight such alterations as therapeutic targets. However, studies evaluating the effect of LSD1 inhibitors on male fertility are lacking. Objectives We analyzed the potential toxicity of a new selective LSD1 inhibitor, N‐[(1S)‐3‐[3‐(trans‐2‐aminocyclopropyl)phenoxy]‐1‐(benzylcarbamoyl)propyl] benzamide (NCL1), in testes. Materials and methods Human testicular samples were immunohistochemically analyzed. Six‐week‐old male C57BL/6J mice were injected intraperitoneally with dimethyl sulfoxide vehicle (n = 15), or 1.0 (n = 15) or 3.0 (n = 15) mg/kg NCL1 biweekly. After five weeks, toxicity and gene expression were analyzed in testicular samples by ingenuity pathway analysis (IPA) using RNA sequence data and quantitative reverse transcriptase (qRT)–PCR; hormonal damage was analyzed in blood samples. NCL1 treated GC‐1, TM3, and TM4 cell lines were analyzed by cell viability, chromatin immunoprecipitation, flow cytometry, and Western blot assays. Results LSD1 was mainly expressed in human Sertoli and germ cells, with LSD1 levels significantly decreased in a progressive meiosis‐dependent manner; germ cells showed similar expression patterns in normal spermatogenesis and early/late maturation arrest. Histological examination revealed significantly increased levels of abnormal seminiferous tubules in 3.0 mg/kg NCL1–treated mice compared to control, with increased cellular detachment, sloughing, vacuolization, eosinophilic changes, and TUNEL‐positive cells. IPA and qRT–PCR revealed NCL1 treatment down‐regulated LSD1 activity. NCL1 also reduced total serum testosterone levels. Western blots of mouse testicular samples revealed NCL1 induced a marked elevation in cleaved caspases 3, 7, and 8, and connexin 43 proteins. NCL1 treatment significantly reduced GC‐1, but not TM3 and TM4, cell viability in a dose‐dependent manner. In flow cytometry analysis, NCL1 induced apoptosis in GC‐1 cells. Conclusions High‐dose NCL1 treatment targeting LSD1 caused dysfunctional spermatogenesis and induced caspase‐dependent apoptosis. This suggests the LSD1 inhibitor may cause testicular toxicity via the regulation of apoptosis.

INTRODUCTION AND OBJECTIVE:Recently, the role of the gut microbiome in inflammatory disease and carcinogenesis has become apparent. Specifically, higher gut microbiome diversity is associated with ...

Introduction Endourological intervention is a minimally invasive approach for the management of ureteral strictures. Contraindications to this approach include active infection, strictures of sizes >2 cm, and failure of endoureterotomy. This report demonstrates a case of successful dual stent placement after redo endoureterotomy. Case presentation A recurring ureteral stricture in a 69-year-old woman, who had undergone ureteroscopic lithotripsy for a right ureteral calculus 60 months earlier, was successfully managed by redo endoureterotomy. The procedure involved insertion of dual ureteral stents after endoluminal incision and balloon dilation. Ureteral stents were removed 8 weeks after the operation. No significant complications or signs of stricture were observed 42 months after endoscopic repair. Conclusion This minimally invasive and effective technique of dual ureteral stent placement following laser endoureterotomy successfully managed the recalcitrant ureteral stricture in a case with failed single stent placement following endoureterotomy.

Introduction Renal nephroblastoma, also known as Wilms' tumor, is the most common malignant renal tumor to affect children. Although rare in adults, nephroblastoma in adults is often found in its advanced stages and has a poorer prognosis than cases occurring in childhood. No report has described the efficacy of laparoscopic surgery in small diameter renal tumors in elderly patients. Case presentation Here, we report a very rare case of 71-year-old woman with asymptomatic small nephroblastoma removed by laparoscopic radical nephrectomy. Conclusion The patient refused additional treatments but shows no sign of recurrence 15 months after surgery. These findings support, therefore, that laparoscopic surgery may be effective for small nephroblastoma in elderly patients refusing other treatment modalities.

Background: Patients with metastatic urothelial carcinoma (mUC) have an uncertain prognosis. The aim of the current study was to evaluate the prognostic potential of a skeletal muscle mass reduction index measured by computed tomography (CT) for mUC patients undergoing second-line gemcitabine and docetaxel (GD) chemotherapy. Methods: We retrospectively reviewed 44 patients with mUC who received second-line GD chemotherapy between 2006 and 2015 in our hospital. Skeletal muscle area (SMA) at the third lumbar vertebra was measured using CT images obtained from medical records, and a skeletal muscle index (SMI) was calculated for each patient as: SMI = SMA / height2. Changes in SMI across timepoints (SMI inclination) were calculated as: SMI inclination = [( SMI/SMI)/duration of the interval between imaging visits]. Patients were then divided into two groups: a “steep” group (SMI inclination < -0.01) and a “gentle” group (SMI inclination ≥ -0.01). Kaplan-Meier curves and multivariate Cox proportional hazards regression models were used to evaluate the relationship between SMI inclination and overall survival (OS). Results: There were no differences in patient characteristics between the two groups with respect to median age, gender, Eastern Cooperative Oncology Group Performance Status (ECOG-PS), disease control rate or first-line treatment regimen. OS from the start of second-line GD therapy group was significantly shorter in the “steep” group relative to the “gentle” group. The multivariate analysis revealed that “steep” SMI inclination and presence of anemia were strong predictors of poor prognosis. Conclusion: Higher values of SMI inclination, indicating a faster rate of skeletal muscle mass reduction, may serve as a useful predictive marker for OS in mUC patients undergoing second-line GD chemotherapy.

INTRODUCTION AND OBJECTIVE:Reactive oxygen species (ROS) have been identified as important chemical mediators in cell growth and differentiation. The glutathione redox system is the main mechanism ...

INTRODUCTION AND OBJECTIVE:There is a need for seeking effective treatments for CRPC, because its emergence following ADT is a major clinical problem. In the present study, we investigated chemopre...

INTRODUCTION AND OBJECTIVE:Luteolin is a natural flavonoid with potent antioxidant properties. Although its antineoplastic effects have been demonstrated in several cancer types, little is known re...

Cisplatin-based systemic chemotherapy is the gold standard for the treatment of patients with metastatic urothelial carcinoma (UC), which is a chemosensitive cancer. However, long-term survival has been deemed disappointing. We describe here a case of UC with solitary pulmonary metastasis who had successfully achieved long-term disease-free survival by combination of cisplatin-based chemotherapy and pulmonary metastasectomy. From the finding of this article, we propose that adjuvant chemotherapy may be considered as a viable option after metastasectomy in low volume pulmonary metastatic UC patients. Keywords: Urothelial carcinoma, Pulmonary metastasis, Bladder, Metastasectomy

Background Development of novel agents targeting the androgen axis has led to improved overall survival in castration-resistant prostate cancer (CRPC). This study aimed to investigate the optimal timing of treatment with one such agent, abiraterone acetate (AA), in Japanese patients. Materials and methods Between July 2014 and February 2016, 106 CRPC patients were administered AA in Nagoya City University Hospital, Nagoya, Japan and in four affiliated hospitals following failure of primary combined androgen blockade (CAB). Of these, records of 69 patients treated before chemotherapy were retrospectively analyzed. Patients were divided into two AA treatment groups: (1) first- or second-line after diagnosis of CRPC, designated the Early Group, and (2) third-line onwards, designated the Deferred Group. Prostate-specific antigen (PSA) response rate, ≥ 50% PSA decline rate with treatment, progression-free survival (PFS), and overall survival (OS) were compared between the two groups. National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0 was used to classify adverse events. Results In 24 patients in the Early Group and 45 patients in the Deferred Group, no significant differences in baseline parameters were observed between groups. PSA response rate, ≥ 50% PSA decline rate and PFS (but not OS) were significantly better in the Early Group than in the Deferred Group. Serum aspartate aminotransferase/alanine aminotransferase elevations were the most common Grade 3 treatment-related toxicities, and were clinically manageable. In subgroup analyses of the Early Group, comparison of first-line AA with second-line AA after flutamide treatment showed no changes in PSA response rate, PFS, or OS. Conclusion This study suggests improved favorable outcomes of first- or second-line AA treatment in Japanese chemotherapy-naive CRPC patients after failed CAB; statistical confirmation of such improvement was evident for PFS, but not OS. In addition, early AA treatment exhibited an acceptable safety profile.

INTRODUCTION AND OBJECTIVE:Lysine-specific demethylase 1 (LSD1), the first histone demethylase to be discovered, is a novel target in prostate cancer therapy. NCL1 and NCD38, novel selective cell-a...

Urothelial carcinoma of the bladder in childhood is extremely rare. We report on a 12-year-old girl with urothelial carcinoma of the bladder who presented with gross hematuria. Immunohistochemical staining showed normal levels of cytokeratin 20 expression and decreased levels of Ki67 and p53 expression. Human papillomavirus, which can be a cause of urothelial carcinoma of the bladder, was not detected by polymerase chain reaction. We reviewed the literature focusing on diagnostic tools for urothelial carcinoma of the bladder and determined that abdominal ultrasonography, with an extremely high sensitivity of 98%, could be a useful tool for postoperative follow-up in childhood.

There is no established chemotherapy regimen in metastatic primary urethral cancer (mPUC). The efficacy of a cisplatin (CDDP)-based regimen has been reported, however, when the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) occurs, the chemotherapy regimen should be changed to another platinum compound. In this report, we describe a 66-year-old woman who was diagnosed as mPUC with, CDDP-induced SIADH. After switching her to CBDCA and careful managing her sodium balance, three courses of the chemotherapy regimen were completed.

Delayed radiation myelopathy (DRM) is a rare disorder that rapidly leads to disabilities, and the median incubation period was reported to be about 2 years (from 6 months to a few years). In this report, we describe a 61-year-old woman who presented with rapid progressive numbness and weakness in both legs 22 months after palliative radiation therapy with 39 Gy in 3 Gy fractions. She was diagnosed with DRM of the thoracic vertebrae and was treated sequentially with corticosteroids, heparin, and hyperbaric oxygen therapy. However, they were not effective, and complete paralysis of the legs occurred in 3 months.

We hypothesized that cases of uncomplicated cystitis treated in a Urology Department would display higher antimicrobial susceptibility than those reported by the hospital antibiogram. This would suggest narrow spectrum antibiotics could still be an effective treatment for uncomplicated cystitis despite this era of antimicrobial resistance. The objective of this study was thus to evaluate the rates of antimicrobial susceptibility of isolates cultured from uncomplicated cystitis cases that presented to the Urology Department of a community hospital in Japan. We evaluated the efficacy of cefaclor, a narrow spectrum antibiotic, for uncomplicated cystitis. We further compared the rates of antimicrobial susceptibility of isolates from uncomplicated cystitis cases to those reported in a hospital-wide antibiogram. A retrospective chart review was performed of patients diagnosed with uncomplicated cystitis in the Urology Department. The patients were mainly treated orally by cefaclor at 750 mg/day for seven days. Significantly greater susceptibilities to cefazolin (87.0% vs 65.7%), trimethoprim-sulfamethoxazole (89.4% vs 79.1%) and levofloxacin (84.6% vs 66.9%) were observed in a cystitis antibiogram for Escherichia coli compared with a hospital-wide antibiogram. The clinical efficacy of cefaclor for acute cystitis was also demonstrated. The greater susceptibility of Escherichia coli to antimicrobials observed in this study supports the hypothesis that antimicrobial susceptibility rates in uncomplicated cystitis cases that present to the Urology Department would be greater than those reported in the hospital antibiogram. Therefore, uncomplicated acute cystitis can be treated by narrow spectrum antibiotics such as cefaclor even in this ‘‘antimicrobial resistance era’’.

INTRODUCTION AND OBJECTIVES: There is no standard second line treatment for patients with metastatic urothelial carcinoma (mUC) after the failure of platinum based first line chemotherapy. In previous study, we reported the efficacy of gemcitabine docetaxel (GD) combination as a second line treatment strategy for patients with mUC after failure of the first line treatment with platinum based chemotherapy. However, the efficacy of GD was not sufficient to be established as a standard second line treatment. The treatment options are limited for patients who demonstrate good performance status following GC or GD therapy. This study was conducted to evaluate the effectiveness of a combination of gemcitabine and paclitaxel (GP) therapy for patients with mUC that was previously treated with two lines of chemotherapy. METHODS: Between January 2006 and May 2015, 91 patients were treated with GD as second line chemotherapy. All had received first line chemotherapy consisting of cisplatin. After the failure of the second line GD therapy, 13 patients received GP therapy as a third line treatment. This consisted of gemcitabine (1000 mg/m2) on days 1, 8, and 15 and paclitaxel (200 mg/m2) on day 1 of each 21 day cycle. All patients were evaluated for toxicity and tumor responses. In addition, quality of life (QOL) was estimated by using the Short Form Health Survey (SF36) questionnaire. We analyzed the efficacy of GP as third line chemotherapy in followup study. RESULTS: The median number of GP treatment cycles was 4 (range 2 to 8). The objective response rate was 23.1%. The overall survival in third GP group after the end of second line GD therapy was longer than in untreated group. Univariate and multivariate analyses showed that good performance status was the only prognostic factor for tumor response. Grade 3 treatment related toxicity included neutropenia (77%) and thrombocytopenia (62%), and none of the patients showed grade 4 toxicity. The QOL score after 2 cycles of GP therapy was not significantly decreased compared to the pretreatment scores. CONCLUSIONS: GP combination chemotherapy as a third line regimen is a favorable option for patients with metastatic UC. Given the safety and benefit profile including QOL observed in this study, further prospective trials are warranted to evaluate this strategic chemotherapy approach for patients with mUC.

INTRODUCTION AND OBJECTIVES: Reactive oxygen species (ROS) have been identified as important chemical mediators of cell growth and differentiation, and the glutathione redox system is the main mechanism protecting against the damage caused by ROS in human body. In previous study, we established a new castration resistant prostate cancer (CRPC) animal model. Results of cDNA microarray analysis using this model revealed that glutathione peroxidase 2 (GPX2) had higher expression in CRPC. In this study, we investigated the role of the glutathione redox system in CRPC and the therapeutic potential of the antioxidant properties of luteolin. METHODS: (i) GPX2 siRNA and negative control siRNA (NC) were used to transfect castration resistant PCai1 and PC3 cells, respectively. After transfection, we investigated the proliferation rate and ROS levels through cell counts, DCFH assay, western blotting, and flow cytometry. (ii) siRNA or NC transfected cells were subcutaneously implanted into normal and castrated nude mice. Three weeks after implantation, the mice were sacrificed, and the subcutaneous tumors were isolated. (iii) The effects of luteolin on cell proliferation and apoptosis in PCai cells and on tumor growth of the subcutaneously implanted PCai1 cells in nude mice were analyzed. RESULTS: (i) Silencing of Gpx2 caused significant growth inhibition of PCai1 and PC3 cells, and the DCFH assay revealed that intracellular ROS were significantly elevated in the siRNA treated groups. The decrease in proliferation rate in the siRNA group was attributed to cyclin B1 dependent cell cycle arrest as assessed with flowcytometry. (ii) On PCai1 implantation in nude mice, the tumor growth of PCai1 was significantly inhibited by silencing Gpx2 in the castrated nude mice. (iii) Luteolin suppressed the cell proliferation in a dose dependent manner in vitro, and inhibited tumor growth in a xenograft model via induction of apoptosis and downregulation of Gpx2. CONCLUSIONS: These results suggest that GPX2 plays an important role in cell growth in the presence of ROS in prostate cancer, and the glutathione redox system can regulate cancer cell growth in castration environment. GPX2 expression may be a therapeutic target in CRPC. Luteolin may be a potentially effective chemotherapeutic agent for CRPC via regulation of expression of GPX2 and induction of apoptosis.

Background The purpose of this study was to assess the efficacy of Bacillus Calmette-Guerin (BCG) therapy after a second transurethral resection (TUR) in new onset high-grade T1 bladder cancer. Methods From January 2008 to September 2013, 207 patients with new onset high-grade T1 bladder cancer after an initial TUR were treated at our university and at affiliated hospitals. Residual cancer rate, intravesical recurrence-free survival (RFS), and risk factors for intravesical recurrence were analyzed. Results Among a total of 207 patients, 42 patients were treated with BCG therapy following a second TUR (group 1), 23 were treated with second TUR alone (group 2), 72 were treated with BCG alone (group 3), and 70 were treated without a second TUR or BCG. The median patients’ age was 72.0 years, and the median follow-up period was 33.5 months. The second TUR revealed that 34 patients (52 %) had residual cancer. Between groups 1 and 2 and groups 1 and 3, the differences in RFS were statistically significant (p = 0.002 and 0.045, respectively). In addition, BCG therapy was the most significant factor to predict RFS after the second TUR. Among the 31 patients whose pathology of the second TUR was pT0, only 1 of 12 patients (8 %) in group 1 and 11 of 19 patients (58 %) in group 2 had a recurrence. Conclusions BCG instillation following a second TUR decreases intravesical recurrence, even if the pathology of the second TUR is pT0.

Accessory scrotum is an unusual developmental anomaly defined as additional scrotal tissue in addition to a normally developed scrotum. The accessory scrotum arises posterior to the normally located scrotum and does not contain a testis. We report a case of an 18-month-old boy with an accessory scrotum attached to a perineal lipoma. We resected both and determined histologically that they were of the same tissue as the scrotum, including the presence of androgen receptor expression. To the best of our knowledge, this is the first case to assess androgen receptor expression in an accessory scrotum using immunostaining.

Patient: Female, 77 Final Diagnosis: Neuroendocrine carcinoma of the kidney and bladder Symptoms: Right lumbar pain Medication: None Clinical Procedure: CT • needele biopsy of renal tumor • transyrethral resection of bladder tumor Specialty: Urology Objective: Rare disease Background: Neuroendocrine carcinomas (NECs) of the urological organs are observed occasionally, although simultaneous development in the kidney and blabber has not been reported. Case Report: We report a case of a metastatic NEC of the kidney and bladder in a 77-year-old woman who underwent renal biopsy and transurethral resection of the bladder tumor. Pathological examination revealed NEC in the kidney and the bladder samples. Immunohistochemical examination revealed strongly positive staining for synaptophysin, chromogranin A, and CD56, and focally positive staining for cytokeratin AE 1/3 and Cam 5.2. Fluorescence in situ hybridization confirmed the increased chromosome 3 copy number, and loss of hybridization in 3q21, 5q22–23, 10q26, and 13q14 was detected when the tumor samples were compared with normal samples. Conclusions: This is a rare case of NEC-specific genetic abnormalities in a kidney-derived tumor, and is the first report to identify kidney-derived NEC that metastasized to the bladder via the urinary tract.