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ABSTRACT: BACKGROUND: Retropubic radical prostatectomy with intentional wide resection (RRP-WR), which enables clear location of the prostate apex and the performance of posterolateral wider resection to remove extraprostatic extension, was introduced to our institutions. The aim of this study is to assess the feasibility and the efficacy of RRP-WR as a surgical intervention for locally confined prostate cancer. METHODS: A total of 90 Japanese patients with pathologically proven and clinically locally confined hormone-naive prostate cancer were treated through RRP-WR, and the surgical morbidity was assessed. The patients were observed without immediate treatment until biochemical recurrence (BCR). RESULTS: The surgical morbidities were comparable to conventional procedures. No positive surgical margin (pSM) was pathologically identified in pT2 cases from prostatectomy specimens. It was identified in only 14.3% of pT3a cases, 36.4% of pT3b cases and 100% of pT4 cases. No apical pSM was found except for one of the pT4 cases in the levator ani muscle. PSA was at an undetectable level in 80.0% of all cases, 90.0% of pT2 cases, and 67.5% of pT3 and pT4 cases after surgery. The BCR-free survival rate in all cases was 82.4% and that of high-risk cases without pSM was 76.9% at a median follow-up of 19.3 months (3.3 to 59.2). CONCLUSIONS: RRP-WR is feasible and effective in removing organ-confined prostate cancer as well as extraprostatic extension without pSM. Thus, it is worthwhile to evaluate if this procedure improves the clinical outcome of locally confined prostate cancer including high-risk conditions treated by surgical intervention.
World Journal of Surgical Oncology 11/2012; 10(1):249. · 1.12 Impact Factor
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ABSTRACT: A 69-year-old man was admitted for the treatment of muscle-invasive bladder carcinoma. Total cystectomy was performed and an ileal neobladder was constructed by a modification of Studer's method. However, a week later, a subcutaneous abscess occurred withwound dehiscence. Open drainage and wound debridement was carried out. Three weeks later, a neoblader-cutaneous fistula was seen on cystography. We managed it conservatively by means of wound debridement and washing with physiological saline. The fistula was closed on the 95th day after operation. The patient can now pass urine by himself.
Hinyokika kiyo. Acta urologica Japonica 11/2010; 56(11):651-4.
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ABSTRACT: A 44-year-old woman was admitted with acute hepatic dysfunction. Screening computed tomography showed an enhancing mass of about 9 cm in the right renal upper pole. An open right nephrectomy was performed for the pre-operative diagnosis of renal cell carcinoma. Pathological examination revealed a perivascular epithelioid cell tumor (PEComa). PEComa is a rare tumor, which includes angiomyolipoma and lymphangiomyomatosis. It is sometimes associated with aggressive clinical behavior such as local recurrence and metastasis. She had no evidence of recurrence at 34 months follow up.
Hinyokika kiyo. Acta urologica Japonica 03/2010; 56(3):151-3.
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ABSTRACT: A 70-year-old man complaining of fever and chills was admitted to our hospital. A computerized tomography scan revealed a bladder tumor (cT3bN0M0), and urinary cytology demonstrated neuroendocrine carcinoma. Prostate specific antigen (PSA) was 4.089 ng/ml and human cytokeratin 19 fragment (CYFRA 21-1) was 3.8 ng/ml. He underwent transurethral resection of bladder tumor and needle biopsy of the prostate. Pathological examination demonstrated small cell carcinoma in the bladder tumor specimen and well differentiated adenocarcinoma (cT1c) with a Gleason score of 34 in the prostatic specimen. He underwent cystoprostatectomy with bilateral cutaneous ureterostomy. He did not receive adjuvant chemotherapy because of the poor postoperative systemic condition and he died of acute myocardial infarction 5 months later.
Hinyokika kiyo. Acta urologica Japonica 03/2010; 56(3):173-5.
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ABSTRACT: We report our experience of toxic shock syndrome (TSS) in a 54-year-old male patient after high orchiectomy for testicular cancer. Four days after the surgery, he began to have diarrhea, high fever, and diffuse erythroderma followed by severe hypotension. There were no signs of postsurgical wound infection, so serious drug eruption was suspected. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the culture of the drain and result of skin biopsy, leading to the diagnosis of TSS. Following treatment with intravenous fluids, antibiotics, human immunoglobulin and corticosteroids, the symptoms went into remission. TSS progresses rapidly and becomes life-threatening if treatment is delayed. Therefore, when TSS is suspected in postsurgical patients who experience fever of 39 degrees C or higher, dermal erythema, shock, treatment should be started promptly.
Hinyokika kiyo. Acta urologica Japonica 03/2010; 56(3):177-9.
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ABSTRACT: A 65-year old woman underwent retroperitoneoscopic nephrectomy, for left renal mass which was suspected to be renal cell carcinoma. On the 2nd postoperation day, she suddenly complained of dyspnea and chest pain. Enhanced computed tomography revealed a defect of peripheral pulmonary artery, and ventilation-perfusion lung scanning showed large defect of the uptake in bilateral lung fields. Based on the arterial blood gas and imagings, she was diagnosed with a PTE (pulmonary thromboembolism). Thrombolytic therapy and anti-coagulant therapy were started. Thereafter, she recovered from hypoxia. However, these therapies gave rise to postoperative hemorrhage resulting in a massive retroperitoneal hematoma.
Hinyokika kiyo. Acta urologica Japonica 01/2010; 56(1):17-20.
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ABSTRACT: We report a case of prostate cancer and left ectopic ureter opening to seminal vesicle with left renal agenesis. A 62-year-old man was admitted to our hospital for treatment of prostate cancer with cyst formation. On the rectal examination, a cystic tumor was palpable on the left side of prostate. The left kidney was not detected by intravenous pyelography and ultrasonography. Magnetic resonance imaging revealed a retrovesical cystic lesion in the left side. Total prostatectomy and left ureterectomy were performed under the diagnosis of clinical T1cN0M0 prostate cancer and left ectopic ureter opening to seminal vesicle with left renal agenesis. The pathological findings showed well differentiated adenocarcinoma, Gleason score 3 + 3, and left ectopic ureter entering into the seminal vesicle and left renal agenesis. The patient was well 39 months after the total prostatectomy and left ureterectomy without evidence of recurrence. There have been no cases of the association of this urogenital anomaly, such as ectopic ureter opening to seminal vesicle with renal agenesis and prostate cancer and the combined management of both. Our case seems to be first case in the Japanese literature.
Hinyokika kiyo. Acta urologica Japonica 02/2009; 55(1):47-50.
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ABSTRACT: We report a case of renal cell carcinoma with bilateral adrenal metastases. A 57-year-old man was admitted to our hospital for a left renal mass. Computerized tomography and magnetic resonance imaging revealed a 4.5 cm left renal tumor and bilateral adrenal masses (3.0 cm on the right side and 2.0 cm on the left). A left nephrectomy and bilateral adrenalectomies were performed. The pathological findings showed clear cell carcinoma, G2 of left kidney metastasizing to both adrenal glands. The patient was administered supplementary hydrocortisone and was well 8 months after the nephrectomy and adrenalectomies without evidence of recurrence. Bilateral adrenal metastases from renal cell carcinoma are relatively rare. Our case seems to be the thirteenth case in the Japanese literature.
Hinyokika kiyo. Acta urologica Japonica 04/2008; 54(3):225-8.
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ABSTRACT: We examined the usefulness of the volume-adjusted prostate-specific antigen (PSA) parameters for prediction of T1c prostate cancer on 210 patients who had abnormal PSA levels but no abnormal findings in digital transrectal examination (DRE) or transrectal ultrasonography (TRUS). PSA, prostate volume (PV), transition zone volume (TZV), PSAD (PSA/PV) and PSATZD (PSA/TZV) were assessed with the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Simple and stepwise logistic regression models were used to calculate the odds ratios of these parameters. Fifty-three (25.2%) of all 210 patients and 31 (19.9%) of 156 patients with intermediate PSA levels had biopsy-proved prostate cancer. The ROC curves of all patients revealed that PSA, PV, TZV, PSAD and PSATZD had significant predictive values, while AUCs of PV, PSAD and PSATZD had significant predictive values as compared to that of PSA. In the patients with intermediate PSA levels, the ROC curves revealed that PV, TZV, PSAD and PSATZD had significant predictive values, but there were no significant differences in AUCs among these parameters. The stepwise logistic regression analysis showed that PV and PSATZD were significant predictive parameters in all patients and that PSATZD was the only significant predictive parameter in the patients with intermediate PSA levels. In conclusion, not only PSAD and PSATZD but also PV and TZV had significant predictive values in discriminating prostate cancer. However, the multivariate analysis showed that PSATZD had the strongest predictive value in all patients and in those with intermediate PSA levels.
Hinyokika kiyo. Acta urologica Japonica 08/2007; 53(7):459-65.
