Search

Objectives To examine the effectiveness of intravesical irrigation with physiological saline solution or distilled water for the prevention of bladder recurrence in patients undergoing laparoscopic nephroureterectomy for upper urinary tract urothelial carcinoma. Methods This retrospective study involved 109 upper urinary tract urothelial carcinoma patients who underwent laparoscopic nephroureterectomy, and were evaluated at Chiba University Hospital and Yokohama Rosai Hospital between 2001 and 2018. We investigated the outcomes and analyzed various clinical factors including with or without intravesical irrigation related to bladder carcinoma recurrence after surgery. Physiological saline solution or distilled water was used for irrigation, which was carried out only during surgery. Results The median follow-up period after surgery was 26.1 months. Bladder recurrence was confirmed within 2 years for 45 of the 109 patients in the present study. Irrigation was carried out for 48 cases (distilled water, 26 patients; physiological saline solution, 22 patients). Tumor grade (G1-2 vs G3; P = 0.05) and intravesical irrigation (yes vs no; P = 0.0058) were related to bladder recurrence on univariate analyses. On multivariate analyses, intravesical irrigation was the independent factor involved in the prevention of bladder recurrence (P = 0.0051). Comparison between the irrigation and non-irrigation groups showed that bladder recurrence rates were significantly lower in the irrigation group (irrigation group vs non-irrigation group: 25.0% vs 52.5%, P = 0.0066). There was no significant difference in the recurrence rate between the two solutions used for irrigation. Conclusions Intravesical irrigation during surgery of upper urinary tract urothelial carcinoma might decrease postoperative bladder recurrence rates.

(Objectives) To evaluate the safety and oncologic efficacy of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, we retrospectively reviewed the clinical outcome and long-term cancer control of patients who underwent LRN in comparison to open radical nephrectomy (ORN). (Patients and methods) The clinical records of 79 patients with RCC >7 cm, who underwent radical nephrectomy (37 LRN; 42 ORN) between 1993 and 2014, were reviewed. (Results) The 2 groups (LRN and ORN) were comparable regarding age, body mass index and mean tumor size (86.5 mm vs. 94.6 mm).The operative time was significantly longer in the LRN group than ORN group (204 min vs. 168 min; p

Because of the recent increase of prostate specific antigen (PSA)-screening, potential risks of overdiagnosis and overtreatment are more easily pointed out for low-risk prostate cancer. Active surveillance is one of the therapeutic options for the management of patients with low-risk prostate cancer. Concerning the indication of active surveillance, candidates for it have been selected based on several clinical factors including clinical stage(T), PSA level, Gleason score, and the number of positive cores on prostatic biopsy, but the selection criteria have not yet been uniformly established. As for the observation method, PSA doubling time and results from repeated biopsies have been utilized to select a high-risk case for whom intervention by curative therapy will be recommended. However, there are still controversies concerned with which is the most appropriate method of follow-up during active surveillance. In addition, the psychological impact of active surveillance on both the patient and the health care staff needs to be taken into account. Since the efficacy and safety of active surveillance were demonstrated by the results of several clinical studies, it is regarded as one of the superior and acceptable therapeutic options for patients with low-risk prostate cancer. It is expected that both the patient and health care staff would choose active surveillance as a reliable option when the appropriate selection criteria and the suitable follow-up method are determined and established.

A 40-year-old man visited our hospital in August, 2007 with the complaint of gait disturbance. Six years ago he had had right high orchiectomy for treatment of stage I seminoma at another hospital. The magnetic resonance imaging (MRI) examination showed a small tumor and compression fracture in the eighth thoracic vertebrae. Emergency spinal decompression with bone biopsy was done. The pathological diagnosis of the bone was metastasis of seminoma. He was treated with 3 courses of BEP (bleomycin, etoposide and cisplatin) therapy and external beam radiotherapy (36 Gy) was performed. His symptom of gait disturbance disappeared gradually, and was evaluated to be in complete remission. He has been alive with no evidence of recurrence for 3 years.