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Yusuke Shiraishi,
Nozomi Hayakawa,
Taro Wakamatsu,
Kazuhiko Yoshida,
Masaaki Yanishi,
Eri Tomita,
Yuuki Miyauchi,
Hiroki Shirakawa,
Tomokazu Shimizu,
Hideki Ishida,
Kazunari Tanabe
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ABSTRACT: Renal allograft rupture (RAR) is a rare but serious complication of renal transplantation. The most common cause of RAR is acute rejection but other causes have increased in frequency with advances in immunosuppressive therapy. We report a patient with RAR attributed to coughing while asleep. A 53-year-old male received a living-donor renal transplantation for end-stage renal failure due to diabetic nephropathy. The clinical course was satisfactory, and he was discharged on the 12th postoperative day with a serum creatinine level of 1.24 mg/dl. On the 24th morning, he felt sudden swelling and pain over the incision area soon after a big cough. Ultrasound and computed tomography revealed a perinephric hematoma. Emergency surgical exploration showed complete laceration of the abdominal fascia and 4-cm rupture at the anterolateral aspect of the kidney. High intra-abdominal pressure when coughing had torn the fascia, and the graft appeared to have ruptured under the fascial tension. Bleeding was controlled with a polyglactin 910 2/0 mattress parenchymal suture enforced with application of a fibrin tissue-adhesive collagen fleece. Twelve months after the repair, the patient's renal function was stable with a serum creatinine level of 1.3 mg/dl.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 05/2011; 102(3):595-9.
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Yusuke Shiraishi,
Hiroyuki Nishiyama,
Kazutoshi Okubo,
Ryo Iguchi,
Takahiro Inoue,
Jun Watanabe,
Tomomi Kamba,
Koji Yoshimura,
Akihiro Kanematsu,
Takahiro Nakayama,
Hiroshi Hatayama,
Osamu Ogawa
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ABSTRACT: A Leydig cell tumor is a rare disease entity occurring in the testis. Occasionally it is considered to be related to male infertility. We report a case study of a Leydig cell tumor in a single testis presenting as male infertility. A 38-year-old male was referred to our hospital because of a tumor in his right testis. He had undergone left orchiectomy at one year old because of a testicular tumor. During an examination related to the infertility, ultrasound revealed a 1 cm tumor. Tumor markers were all within normal ranges.Hormonal examination showed that luteinizing hormone (LH) 30.3 mIU/ml (1.5-12.4) and follicle stimulating hormone (FSH) 11.9 mIU/ml (1.7-8.6) were higher than normal limits, but total testosterone(total T) and estradiol (E2) were within normal ranges. Tumor enucleation was first performed, and then testicular sperm extraction (TESE) was carried out from a macroscopically normal site of the testis.Histopathological diagnosis was a benign Leydig cell tumor surrounded by Leydig cell hyperplasia. For 12 months after the operation there has been no recurrence. Although high LH and FSH persisted, total T and E2 were within normal ranges.
Hinyokika kiyo. Acta urologica Japonica 12/2009; 55(12):777-81.
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Yusuke Shiraishi,
Koji Yoshimura,
Takahiro Inoue,
Kazutoshi Okubo,
Jun Watanabe,
Tomomi Kamba,
Akihiro Kanematsu,
Eijiro Nakamura,
Hiroyuki Nishiyama,
Toshiyuki Kamoto,
Osamu Ogawa
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ABSTRACT: We performed holmium laser enucleation of the prostate (HoLEP) on 98 patients between February 2005 and February 2007. Seventy five patients with the mean age of 68.9 (ranging 55-84) were assessed preoperatively and followed up at 1, 3 and 12 months postoperatively. Before and after HoLEP, International Prostate Symptom Score (IPSS), quality of life (QOL) index, maximum flow rate (Qmax) and post-void residual (PVR) urine were all improved significantly (P < 0.001). When urinary incontinence was strictly defined as International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores > or = 1, incontinence was observed in 71% of patients preoperatively. ICIQ-SF scores were increased from 5.2 preoperatively to 8.0 at 1 month postoperatively, but improved thereafter and had decreased significantly to 2.5 (p < 0.05 compared with baseline) at 12 months. Univariate and multivariate logistic regression analysis revealed date of operation and operation time were significantly (P < 0.05) correlated with postoperative stress urinary incontinence (SUI) at 1 month and enucleated volume was of borderline significance (p = 0.052) at 12 months. In terms of sexual function, mean IIEF5 scores were not significantly changed, but we could classify the scores into five types of response-unchanging (64%), improving (13%), worsening (11%), transient worsening (9%) and unclassified (2%). HoLEP is an effective treatment for BPH. Urinary incontinence improved by 1 year. HoLEP does not appear to affect sexual function, but various clinical courses were observed.
Hinyokika kiyo. Acta urologica Japonica 09/2009; 55(9):539-43.
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ABSTRACT: We present a case of liver metastasis of renal cell carcinoma (RCC) presenting as an intraductal tumor thrombus of the common bile duct. A 62-year-old man was admitted with jaundice. He had undergone right nephrectomy for RCC 8 years previously, and had been administered interferon alfa for lung, bone, and liver metastases for these 3 years. Abdominal enhanced computerized tomography (CT) disclosed the progression of liver metastasis to the common bile duct and the dilated bilateral bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a smooth filling defect in an upper portion of the common bile duct, suggesting an intraductal RCC tumor thrombus of the common bile duct. He died 4 months later despite the percutaneous biliary drainage. Liver metastasis of RCC proceeding to the common bile duct is extremely rare, and this is the 8th case. We should be aware of the fact that metastatic intraductal tumor thrombus of the common bile duct can cause obstructive jaundice.
Hinyokika kiyo. Acta urologica Japonica 03/2009; 55(2):99-102.
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ABSTRACT: A 71-year-old man was admitted with a swelling of the left scrotum where Galium scintigraphy was positive. He had a history of malignant lymphoma of the right testis and had undergone an orchitectomy, with adjuvant CHOP (cyclophosphamide, doxorubicin, vincristine, predonisolone) chemotherapy and radiotherapy to the post-orchitectomy site and opposite testis. An open biopsy of his scrotum and left testis revealed relapse of the malignant lymphoma in the left scrotal skin.
Hinyokika kiyo. Acta urologica Japonica 11/2008; 54(10):685-7.
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ABSTRACT: The efficacy of an all-in-one clinical pathway for retropubic radical prostatectomy (RRP) was assessed. A total of 60 patients were enrolled, including 33 before the introduction of the pathway (mean age 67.3) and 27 after the introduction (mean age 66.4). The introduction of the pathway significantly improved recovery after the surgery, such as time of ambulant (mean postoperative day 1.5 vs 1.1), food intake (1.3 vs 1.0) and duration of intravenous fluid administration (3.1 vs 2.5). The mean postoperative hospital stay was shortened by 2.1 days (p = 0.06). Medical fees decreased by yen 94170 (p < 0.05). The variance related to the removal of a urethral catheter was observed in seven cases. The catheters were indwelled 3-7 days longer. According to the questionnaire survey, 80% of nurses had good impression on the path because the introduction of the path resulted in improving patient assessment, volume of nurse records, simplicity of the overall description and handling nurse records. The RRP clinical pathway is useful to achieve early recovery, short hospital stay and cost reduction.
Hinyokika kiyo. Acta urologica Japonica 01/2007; 53(1):1-8.
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ABSTRACT: Between October 2004 and August 2005, 43 patients with the mean age of 70.9 (ranging 57-83) years, who had lower urinary tract symptoms underwent holmium laser enucleation of the prostate (HoLEP) at our hospital. The mean operative time, change in hemoglobin and resected tissue weight were 193 (83-390) minutes, -2.1 (-5.3 -/+ 1.3) g/dl and 40.2 (6.3-90.9) g, respectively. The mean postoperative urethral catheter time and postoperative hospital stay were 1.7 and 5.5 days, respectively. Minor prostatic capsular perforation and bladder mucosal injuries in 18 cases without need of additional interventions or treatments. Blood transfusion for preoperative anemia was needed in one case. Postoperatively, high fever occurred in 6 cases including sepsis in one case, while recatheterization was needed in 2 cases because of urination difficulty. After discharge, meatal stenosis was found in 7 cases, urethral stenosis in 3 cases including 2 cases with preoperative urethral stenosis. Scrotal abscess developed after acute epididymitis in one case. Transient urinary incontinence reported in 12 cases, which requires medication or more than 1 pad per day. HoLEP improved international prostate symptom score, quality of life score, peak urinary flow rates and postvoiding residual urine volumes immediately and significantly. HoLEP is a feasible and effective procedure to relieve lower urinary tract symptoms, although technical and instrumental advances are required to reduce the operative time and complications.
Hinyokika kiyo. Acta urologica Japonica 10/2006; 52(9):681-5; discussion 685.
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ABSTRACT: We reviewed 18 patients with transitional cell carcinoma of the renal pelvis and ureter undergoing nephron-sparing surgery between April 1990 and Febrary 2003. The mean age of the patients, 17 males and one female, was 69 years (range 33-88 years). The tumor site was the renal pelvis in 2, ureter in 13 and ureteral orfice in 2. Six of them were imperative cases and 12 were elective. Eight patients underwent endourological treatment and 10 patients open surgery including partial ureterectomy performed on 8 patient. The follow up period was 3 to 104 months (mean 37 months). Among those defined as imperative, the histopathological stage was pT1 in one, pT2 in one, pT3 in 3 and one in pT4. Among the elective cases, the histopathological stage was pTa in 7, pT1 in 2, pT2 in one, pT3 in 2 patients. Of the three defired as elective with tumors cT2 or higher, two died of disease. The 5-year survival rate was 50% and 68% in the imperative and elective cases, respectively. In the patients with tumors pT2 or higher and/or grade 3, the prognosis was poor which suggests the need for intensive therapy including lymph node dissection and/or adjuvant chemotherapy. It is necessary to consider the possibility of selecting nephron-sparing surgery for locally advanced tumors.
Hinyokika kiyo. Acta urologica Japonica 05/2006; 52(4):249-53.
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ABSTRACT: A 71-year-old woman with pan-peritonitis was transferred to our hospital. Imaging studies showed the extravasation of contrast medium from the bladder to the intraperitoneal cavity, the right non-visualizing kidney and the left hydronephrosis. Cystoscopy revealed bladder stones and a fistula at the posterior wall of the bladder. A histological examination of specimen around the fistula revealed squamous cell carcinoma(SCC) with stromal invasion. Symptoms of peritonitis subsided following the placement of bilateral ureteral catheters and a urethral catheter. Because a laparotomy revealed peritonitis-carcinomatosa, she underwent bilateral ureterocutaneostomies, the removal of the bladder stones and the primary closure of the fistula. She died on the 42nd day after surgery.
Hinyokika kiyo. Acta urologica Japonica 03/2006; 52(2):139-41.
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ABSTRACT: Between April 2002 and March 2004, 21 patients with clinical T1-T3a renal cell carcinoma underwent laparoscopic radical nephrectomy at the Kobe City General Hospital. A transperitoneal approach was chosen in 9 patients with clinical T2 stage, tumors more than 5 cm in diameter at the upper pole of the kidney, and posteriorly protruded tumors at the middle portion. Otherwise, a retroperitoneal approach was chosen in 12 patients. The mean (range) operative time for the transperitonal and retroperitoneal approaches was 355 (290-410) min and 342 (275-490) min, respectively. There were no major intraoperative complications. Postoperatively, one patient underwent emergency operation due to the perforation of duodenal ulcer. In the mean follow-up of 15.9 months, lung metastasis was seen in one patient under adjuvant immunotherapy. Significant differences between transperitoneal and retroperitoneal approaches were seen in mean time to renal artery clipping (170 versus 85 min, p < 0.01), mean blood loss (548 versus 281 ml, p < 0.05) and concurrent adrenalectomy (66.7 versus 16.7%, p < 0.05). Laparoscopic radical nephrectomy is a safe and feasible procedure when suitable approaches are chosen depending on tumor size and location.
Hinyokika kiyo. Acta urologica Japonica 07/2005; 51(6):369-72.
