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Introduction There are often opportunities to consider treatment strategies for synchronous or metachronous prostate cancer with colorectal cancer. Performing robot‐assisted radical prostatectomy for prostate cancer following previous rectal cancer surgery in cases involving anal‐preserving surgeries such as low anterior resection or intersphincteric resection can be challenging because of the possibility of adhesions. Case presentation A 74‐year‐old man who had undergone laparoscopic intersphincteric resection for rectal cancer was diagnosed with prostate cancer. The patient desired to undergo robot‐assisted radical prostatectomy. During surgery, we observed the absence of Denonvillier's fascia on the dorsal surface of the prostate, the intestinal anastomosis was distal to the vesicourethral anastomosis, and the rectum was replaced with a peristaltic sigmoid colon with minimal adhesions. Conclusion Periprostatic conditions vary depending on previous rectal surgical approaches. It is crucial to confirm the previous surgical approach for rectal cancer when performing robot‐assisted radical prostatectomy following rectal cancer surgery.

Objective: Liposarcoma (LPS) is classified into 4 subtypes. As some subtypes have a high recurrence rate, knowing the risk of recurrence before surgery is important. Here, we aimed to investigate the relationship between Hounsfield units (HU) derived from preoperative computed tomography (CT) and the prognosis of patients undergoing surgery. Materials and Methods: We included 32 patients who underwent surgery for LPS between 2014 and 2022. Preoperative plain CT images were collected, and the HU value of each LPS was measured. The association between 2 HU categories (HU < cut-off vs. ≥ cut-off) and clinical variables was assessed. The optimal cut-off value was determined using statistical methods. We used the Kaplan–Meier method to determine the differences between the 2 HU categories at 2 endpoints: recurrence-free survival (RFS) and overall survival (OS). Results: The dedifferentiated subtype showed significantly higher HU values than the other subtypes (P < .001). The optimal cut-off value for HU was 20. HU < 20 was associated with young age, low-performance status, low Charlson Comorbidity Index, and well-differentiated pathology. The Kaplan–Meier curves demonstrated that RFS and OS were significantly shorter in patients with HU ≥ 20 than in those with HU < 20 (P = .007 and .04, respectively). However, when stratified based on subtype, no significant differences were observed between dedifferentiated and other subtypes. Conclusion: HU ≥ 20 on preoperative CT was associated with poor prognosis in LPS patients. Our findings suggest that preoperative CT-derived HU values may serve as useful predictors of prognosis.

Introduction: The Flemish version of the Triage Risk Screening Tool (fTRST), derived from the Triage Risk Screening Tool for assessing risk of readmission to the emergency department, is increasingly used as a simple screening tool in oncology. This study aimed to evaluate the utility of the fTRST in the context of elective surgical treatment for urologic cancer patients. Methods: We included 886 patients who underwent major urologic cancer surgery at our institution between 2020 and 2022 and underwent preoperative screening, including fTRST. We set the fTRST cutoff at 2 and used propensity score matching and multivariate regression analysis to assess how fTRST affected two postoperative outcomes: ambulation failure and delirium. Results: Of the 886 patients, 693 (78%) had an fTRST score

Introduction Intensive treatment is typically considered for very high‐risk patients with locally advanced prostate cancer and an expected survival time of 5 years or longer. Herein, we report a case of locally advanced prostate cancer with rectal infiltration treated with laparoscopic total pelvic exenteration combined with transanal total mesorectal excision. Case presentation A 73‐year‐old man presented with a ring‐shaped mass around the rectum. He was diagnosed with prostate cancer with rectal infiltration and underwent laparoscopic total pelvic exenteration combined with transanal total mesorectal excision following neoadjuvant androgen deprivation therapy. Twenty‐two months postoperatively during ongoing androgen deprivation therapy, no biochemical recurrence was observed. Conclusion To our knowledge, this is the first report of a laparoscopic total pelvic exenteration combined with transanal total mesorectal excision for prostate cancer with rectal infiltration. We believe this surgery may be considered a new option for high‐risk prostate cancer patients with rectal infiltration.

Abstract Background This study aimed to identify patients with upper urinary tract urothelial carcinoma (UTUC) having potential Lynch syndrome (pLS) by immunohistochemistry (IHC) of DNA mismatch repair gene-related proteins (MMRPs) and Amsterdam criteria II and explore their clinical characteristics. Methods We retrospectively collected the clinical data of 150 consecutive patients with UTUC who underwent surgical resection at our institution between February 2012 and December 2020, and immunohistochemistry (IHC) of four MMRPs (MLH1, MSH2, MSH6, and PMS2) on all UTUC specimens was performed. Patients who tested positive for Amsterdam criteria (AMS) II and/or IHC screening were classified as having pLS and others as non-pLS, and their characteristics were explored. Results In this study, 5 (3%) and 6 (4%) patients were positive for AMS II and IHC screening, respectively. Two patient were positive for both AMS II and IHC screening, resulting in 9 (6%) patients with pLS. The pLS group was predominantly female (67% vs. 36%; p = 0.0093) and had more right-sided tumors (100% vs. 43%; p = 0.0009) than the non-pLS group. Of the 6 patients who were positive for IHC screening, 4 showed a combined loss of MSH2/MSH6 (n = 3) and MLH1/PMS2 (n = 1). Other two patients showed single loss of MSH6 and PSM2. Conclusions AMS II and IHC screening identified pLS in 6% of patients with UTUC. The IHC screening-positive group tends to have relatively high rate of combined loss, but some patients have single loss. AMS II may overlook patients with LS, and a universal screening may be required for patients with UTUC as well as those with colorectal and endometrial cancer.

Introduction. Treatment evidence for malignancies metastatic to the prostate in young patients is scarce. Herein, we present a case of prostatic metastasis from testicular cancer treated with induction chemotherapy followed by robot-assisted radical prostatectomy. Case Presentation. The patient is a 34-year-old male who underwent radical orchiectomy for a left testicular tumor two years ago and was diagnosed with a mixed germ cell tumor. He was followed up without adjuvant therapy, but symptoms of dysuria lead to suspicion of a prostate tumor, which was diagnosed by prostate biopsy as seminoma of the prostate. After four cycles of chemotherapy, normalization of tumor markers, and tumor shrinkage on imaging, he underwent robot-assisted radical prostatectomy. No recurrence has been observed nine months after treatment. Conclusion. In men with a history of testicular cancer presenting with lower urinary tract symptoms, it is important to consider recurrent prostate metastases.

Introduction Bladder cancer is characterized by spatial and temporal recurrence in the urinary tract. We describe a case of recurrence at a uretero‐ileal anastomosis after radical cystectomy and nephroureterectomy. It was difficult to control bleeding from the tumor, but hemostasis was achieved. Case presentation A 73‐year‐old man with a history of radical cystectomy and reconstruction of the ileal conduit and right nephroureterectomy was diagnosed with recurrence at the uretero‐ileal anastomosis site. Bleeding from the tumor could not be controlled by flexible gastrointestinal endoscopy. The patient underwent coagulation via an ileal conduit approach using a rigid scope and bipolar electrocautery, which is usually a modality for transurethral resection. Conclusion This is the first report in which a modality normally used for transurethral resection was used to control bleeding in a patient with an ileal conduit. This application is useful in cases open surgery or additional irradiation might be difficult.

Introduction Robot‐assisted surgery is spreading across surgical specialities as a less invasive alternative to conventional laparoscopic and open surgery. Case presentation In this report, robot‐assisted total laparoscopic hysterectomy and robot‐assisted nephroureterectomy were performed simultaneously for a 69‐year‐old Japanese female with giant cervical polyp and ureteral cancer. All specimens could be removed from the vagina. The operative time was 379 min, the estimated intraoperative blood loss was 29 mL, and the patient was discharged on the sixth postoperative day without complications. Conclusion We reported our experience with simultaneous robot‐assisted nephroureterectomy and robot‐assisted total laparoscopic hysterectomy. To our knowledge, this is the first report of simultaneous robot‐assisted nephroureterectomy and robot‐assisted total laparoscopic hysterectomy surgery.

Introduction We report two cases where robotic‐assisted laparoscopic radical prostatectomy and inguinal hernia repair were performed simultaneously. Case presentation In case one, hernia repair was performed by implantation of 3D Max™ mesh and closure of the peritoneum. Total console time was 156 min, of which hernia repair took 21 min. In case two, hernia repair was performed using Ventralight™ ST mesh. Total console time was 181 min, of which hernia repair took 23 min. Pelvic lymph node dissection was performed in case two but not in case one. Both patients were discharged 7 days postoperatively without severe complications or mesh infection. Conclusion It may be possible to perform robotic‐assisted laparoscopic radical prostatectomy and inguinal hernia repair simultaneously.

Introduction We present a case of simultaneous robot‐assisted radical nephroureterectomy (RANU) and robot‐assisted radical cystectomy (RARC) for muscle‐invasive bladder cancer with concomitant upper urinary tract urothelial carcinoma. Case presentation A 59‐year‐old Japanese man was diagnosed with right ureteral cancer and muscle‐invasive bladder cancer. We performed RANU and RARC simultaneously; three of the ports used for RANU were diverted to RARC. Console times for RANU and RARC were 66 and 207 minutes, respectively. Total operative time was 386 minutes. The intraoperative blood loss was estimated 255 ml. The patient was discharged on postoperative day 18 without complications. Conclusion We reported our experience with simultaneous RANU and RARC for muscle‐invasive bladder cancer with concomitant right ureteral cancer. To the best of our knowledge, this is the first report of its kind in Japan.

Abstract Background We assess whether short-term recovery of urinary incontinence following robot-assisted laparoscopic radical prostatectomy (RARP) is associated with postoperative membranous urethral length (MUL) and position of vesico-urethral anastomosis (PVUA). Methods Clinical variables including PVUA and pre-and postoperative MUL were evaluated in 251 patients who underwent RARP from August 2019 to February 2021. Continence recovery was defined as no pad or one security liner per day assessed by patient interview at least 6 months follow-up. Univariate and multivariate logistic regression analyses were used to assess variables associated with continence recovery at 3 months after the operation. Results Continence recovery rates at 3 and 6 months were 75% and 84%, respectively. Lower BMI (

Introduction Solitary fibrous tumors require complete surgical resection to avoid recurrence. Large solitary fibrous pelvic tumors are difficult to resect completely with conventional surgical methods. We herein report a case in which a joint surgical approach was required for resection due to the location and size of tumor. Case presentation A 45‐year‐old man had a large solitary fibrous tumor in the pelvis, which extended into the left obturator foramen. The patient underwent tumor resection with vesico‐prostatectomy, transanal total mesorectal excision, and opening of the foramen obturatum. The tumor was grossly resected completely. No recurrence was noted nine months after surgery. Conclusion A multidisciplinary team approach with transanal total mesorectal excision may provide complete resect of large pelvic solitary fibrous tumors.

Abstract. Background:. In patients with high-risk bladder cancer and concomitant upper urinary tract malignancies, simultaneous cystectomy and nephroureterectomy is the principle oncological procedure of choice. Nevertheless, there are still not many reports of simultaneous robot-assisted radical cystectomy (RARC) and nephroureterectomy. Therefore, the aim of this study was to evaluate outcomes and complications of simultaneous RARC and laparoscopic nephroureterectomy in our institution. Materials and methods:. This case series evaluated our initial clinical results of 3 patients who underwent simultaneous laparoscopic unilateral nephroureterectomy and RARC with the da Vinci Xi system between 2019 and 2020 at our hospital. Demographic data, preoperative parameters, and postoperative parameters were retrospectively analyzed. Results:. All 3 patients were men whose median age was 75 years (range 73–89 years). The median total operative time was 435 minutes (range 429–484 minutes), median estimated blood loss was 377 mL (range 125–410 mL), and median hospital stay was 26 days (range 21–36 days). In all 3 cases, each trocar was used in 7 ports. The postoperative complications were stratified according to the Clavien-Dindo Classification system, and a grade 3B complication developed in 1 patient: trocar site herniation of the small bowel. Conclusions:. We reported our initial experience of simultaneous laparoscopic nephroureterectomy and RARC. A large-scale prospective, randomized, controlled trial will be required to prove the feasibility and safety of simultaneous laparoscopic nephroureterectomy and RARC.

Hyperchloremic metabolic acidosis can be a problem in urinary diversion using the ileum. A 73-year-old Japanese male was hospitalized in emergency due to anorexia and malaise 3 weeks after being discharged from the hospital after getting robot-assisted radical cystoprostatectomy and intracorporeal ileal conduit urinary diversion. The blood analysis revealed metabolic acidosis, elevated chloride ions, and marked hyperglycemia: he was diagnosed with hyperchloremic metabolic acidosis and hyperglycemic hyperosmolar syndrome. We started administering insulin and large amounts of fluid replacement; besides, we inserted a large-diameter open tip catheter into the ileal conduit in hopes of inhibiting urine reabsorption in the intestinal mucosa. His general condition gradually improved, and he was discharged 10 days after his hospitalization.

Introduction We present a case of cystitis, which was considered to be an immune‐related adverse event associated with nivolumab administration. Case presentation A 47‐year‐old man suffered from sudden onset urinary symptoms after 18 cycles of nivolumab treatment for stage IV pulmonary adenocarcinoma. Urine culture and urine cytology were both negative. The symptoms were inferred to be related to nivolumab administration, and a bladder biopsy under spinal anesthesia was performed. The histopathological examination showed the evidence of allergic‐related cystitis. We planned to administer corticosteroids, but the urinary symptoms disappeared after the bladder biopsy. Nivolumab treatment was continued without recurrent bladder symptoms. Conclusion We reported a case of cystitis after treatment with nivolumab, which served as a reminder to consider the possibility of immune‐related adverse events as a potential cause for any symptoms that develop during treatment with immuno‐oncology drugs.

The barbed suture e.g. V-Loc™, are occasionally used in urological surgery due to the practical advantage of omitting the need for surgical knots and reducing surgical time.In this report, an 83-year-old man diagnosed as having invasive bladder cancer underwent robot-assisted radical cystectomy: on the thirteenth postoperative day, he was diagnosed as having strangulated ileus of the small bowel. The small bowel was strangulated by bands formed between the stump of V-Loc™ and the fatty appendices of the sigmoid colon.This is the first report of a small bowel ileus associated with the barbed suture in the field of urology.

Urothelial carcinoma (UC) of the bladder rarely causes rectal constriction. We report a case of UC of the bladder that metastasized to the perirectal tissues and caused rectal constriction. The patient was diagnosed with metastasis of UC upon performing a biopsy of the perirectal tissues. No malignant findings were observed in the rectal mucosa. A relatively good prognosis of 26 months was obtained through multidisciplinary treatment combining surgery and chemotherapy. In cases of rectal constriction secondary to high-grade UC of the bladder, the possibility of metastasis of UC should be considered.

Bladder cancer is one of the common urologic malignant diseases.Cutaneous metastasis of bladder cancer is rare, with only a few case reports. The pattern of metastasis from bladder cancer is not well described.We report a patient with muscle-invasive bladder cancer who developed skin metastases after neoadjuvant chemotherapy and robot-assisted laparoscopic radical cystoprostatectomy. Skin metastases were confirmed histopathologically by skin biopsy.This case reminds us of the need to consider the possibility of skin metastasis in the differential diagnosis of skin symptoms in patients with malignant diseases.

Solid pseudopapillary neoplasm is a rare disease that accounts for approximately 2% of pancreatic neoplasms, and the treatment is complete resection of the tumor. We experienced a case preoperatively diagnosed as a left renal tumor with pancreatic invasion and histologically diagnosed with solid pseudopapillary neoplasm of the pancreas. The purpose of this case report is to illustrate the importance of differentiating solid pseudopapillary neoplasm in patients who present a left renal tumor with pancreatic invasion.

Robot-assisted radical cystectomy with or without intracorporeal urinary diversion has recently been explored as a viable surgical option for multiple, recurrent and muscle invasive bladder cancer.In this report, an 84-year-old female diagnosed as having invasive bladder cancer underwent robot-assisted radical cystectomy with intracorporeal cutaneous ureterostomy: in the third postoperative day, computed tomography of the abdomen was suggestive of incarcerated hernia through the abdominal wall defect created by the left ureterostomy.Subsequently, the parastomal hernia was repaired laparoscopically.To the best of our knowledge, this is the first report of a symptomatic parastomal hernia related to the cutaneous ureterostomy.

RS3PE syndrome is a rare condition that occurs in elderly individuals which can present alone or in association with various rheumatic or malignant diseases.We present a case of a 77-year-old man who was diagnosed with adenocarcinoma of the prostate and initially under active surveillance. 2 months after the diagnosis, he presented with arthralgia in both shoulders and knees, pitting edema of the both hands and feet.The patient underwent radical prostatectomy since the link between prostatic carcinoma and RS3PE was suspected. After 7 months from operation, the patient has no symptoms or signs of RS3PE.

Objective: Postoperative paralytic ileus is a major adverse event of radical cystectomy, causing prolonged hospitalization. The controlling nutritional status score, consisting of serum albumin, total lymphocyte count, and total cholesterol, indicates the nutritional status and may evaluate gastrointestinal status. This study aimed to clarify the association between the controlling nutritional status score and the development of postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder. Materials and Methods: We retrospectively analyzed the clinical features of patients who underwent open radical cystectomy or robotic assisted laparoscopic radical cystectomy with ileal conduit or ileal neobladder for bladder cancer between April 2011 and May 2021. The association between clinical variables, including the controlling nutritional status score and the development of postoperative paralytic ileus, was examined. Results: Out of 133 patients, 34 (26%) developed postoperative paralytic ileus. The patients who developed postoperative paralytic ileus were likely to have a higher controlling nutritional status score (P=.055) compared to those who did not develop postoperative paralytic ileus. Multivariate analysis revealed that a preoperative controlling nutritional status score of ≥1 (odds ratio: 2.90, 95% CI: 1.08-7.80, P=.034) and longer operating time (odds ratio: 3.02, 95% CI: 1.13-8.11, P=.027) were significant independent factors for postoperative paralytic ileus development. Conclusion: A high controlling nutritional status score and long operating time may be risk factors for developing postoperative paralytic ileus in patients who underwent radical cystectomy with ileal conduit or ileal neobladder for bladder cancer. Preoperative controlling nutritional status may be able to predict postoperative paralytic ileus development. [ABSTRACT FROM AUTHOR]