Shingo Moriyama

Simultaneous bilateral testicular metastases from renal clear cell carcinoma: A case report and review of the literature.

Metastasis from renal cell carcinoma (RCC) to the testis is rare. This case report presented an extremely rare case of simultaneous bilateral testicular metastases from RCC in a 65-year-old man who had experienced indolent scrotal enlargement over a period of several months. Scrotal ultrasonography showed 4.0- and 2.0-cm-sized masses in the left and right testes, respectively. Contrast-enhanced computed tomography identified multiple tumors in the kidneys, the pancreas and the left adrenal gland. Left orchiectomy and pathological examination were performed and indicated testicular metastasis from clear cell RCC. The patient underwent complete surgical resection of all residual lesions. Postoperative follow-up examination without adjuvant therapy identified no recurrence over 11 months. This study also reviewed existing literature and determined that retrograde venous spread from the primary kidney tumor to the testis may be an important pathway for testicular metastasis from RCC. In conclusion, RCC can result in testicular metastases not only unilaterally, but also bilaterally, as was observed in the present case.

Randomized Crossover Comparison of the Short-Term Efficacy and Safety of Single Half-Dose Silodosin and Tamsulosin Hydrochoride in Men With Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

To compare the efficacy and safety of single half‐dose silodosin and single full‐dose tamsulosin in Japanese men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH).

IgG4-Related Prostatitis Impairs Objective Urinary Function as with Benign Prostate Hyperplasia: A Case Report Successfully Treated with Transurethral Resection.

We report a case of IgG4‐related prostatitis successfully treated with transurethral resection of the prostate (TUR‐P). A 47‐year‐old man with a history of autoimmune pancreatitis and sclerosing cholangitis presented with lower urinary tract symptoms. Because ultrasonography revealed a mildly enlarged prostate and uroflowmetry showed a severely diminished flow curve, benign prostatic hyperplasia was diagnosed. Despite the administration of α1‐blockers, the patients condition did not improve, and TUR‐P was performed in accordance with his wish.

Intensity ratio curve analysis of small renal masses on T2-weighted magnetic resonance imaging: Differentiation of fat-poor angiomyolipoma from renal cell carcinoma

To assess the diagnostic ability of a pixel intensity‐based analysis in evaluating the magnetic resonance imaging characteristics of small renal masses, especially in differentiating fat‐poor angiomyolipoma from renal cell carcinoma.

A simple technique for evacuating air bubbles with scum from the bladder dome during transurethral resection of bladder tumor

Air bubbles floating in the bladder dome during transurethral resection of a bladder tumor can interfere with the resection, causing intravesical explosion and increasing the potential risk of tumor cell reimplantation. We describe a simple and effective technique for evacuating air bubbles from the bladder dome using routine resectoscopes. First, the beak of the resectoscope is positioned near the air bubble in the bladder dome. Second, the drainage channel of the resectoscope is closed. Third, the irrigation tube is detached from the irrigation channel, and then the channel is opened. Subsequently, the air bubble with entangled scum will be retrogradely aspirated from the beak of the resectoscope to the irrigation channel. Reversing the direction of the water stream enables evacuation of the air bubble with the scum under direct vision. This simple and effective technique may assist surgeons and ensure the safety of patients during a transurethral procedure.

CLINICAL OUTCOMES OF LAPAROSCOPIC SACROCOLPOPEXY FOR PELVIC ORGAN PROLAPSE: A RETROSPECTIVE ANALYSIS OF 500 CASES FROM A SINGLE INSTITUTION

(Objectives) Laparoscopic sacrocolpopexy (LSC) is becoming a more popular alternative for pelvic organ prolapse (POP) repair in Japan in the recent years. This study aimed to evaluate the safety and efficacy of LSC. (Patients and methods) This is a retrospective study on all the LSC cases that were performed in Urogynecology center, Kameda Medical Center, Japan from January 2013 to March 2016. Medical records of all the patients were retrieved and details on operating time, estimated blood loss, perioperative complications, anatomical recurrence (postoperative POP-Q stage≥II) rate and reoperation rate were assessed.Our procedure of LSC used two pieces of polypropylene mesh placed on the vesico-vaginal and recto-vaginal space in which the dissection was extended to the level of the bladder neck and levator ani muscle. Subtotal hysterectomy was performed in almost all patients with uterus except in 39 women who chose to preserve their uterus. Additionally, multivariate analysis of risk factors for recurrence-free survival was performed using the Cox regression method. (Results) Five hundred and five patients who were diagnosed as POP (cystocele, rectocele, enterocele, uterine prolapse, vaginal vault prolapse) were included. The mean operating time and estimated blood loss were 236 min and 27.2 ml. There were 2.6% perioperative complication rate and 1.0% severe complication rate (Clavien grade≥IIIa). With a median follow-up of 12 months, anatomical recurrence rate was 8.0%, significant anatomical recurrence (stage≥III) rate was 1.2% and reoperation rate was 1.0%. Preoperative POP-Q stage IV was found as independent risk factors for anatomical recurrence. (Conclusions) The present study demonstrated a relatively low complication rate, low significant anatomical recurrence rate and low reoperation rate. Therefore, LSC is a safe and effective surgical treatment for various types of POP.

MP78-03 MRI INTENSITY RATIO CURVE ANALYSIS: A NEW OBJECTIVE METHOD FOR CHARACTERIZING SMALL RENAL MASSES

INTRODUCTION AND OBJECTIVES: Obesity is a well-known risk factor for the development of renal cell carcinoma (RCC). However, the impact of BMI-indicated visceral fat distribution on tumor aggressiveness and prognosis in RCC remains controversial. Because free fatty acids are transported from excess visceral adipose tissue directly to the liver via the portal vein, the ectopic lipid accumulation in liver could be more informative as a prognostic factor for RCC. In the present study, we examined the ectopic lipid accumulation in liver in patients with RCC and investigated its associations with clinicopathological parameters and survival. METHODS: A total of 230 patients who underwent surgery for RCC at a single institute were retrospectively reviewed. The mean CT values of liver regions of S3 and S6 and S8 were estimated in the preoperative planar CT images, and a fatty liver was defined as one with a mean CT value< 50 Hounsfield units. The visceral fat area (VFA) was also estimated in the preoperative planar CT images at the umbilical level, and the visceral obesity was defined as VFA 100 cm. Kaplan-Meier curves were generated to determine overall survival (OS) rates and cancer specific survival (CSS) rates for patients, and the log rank test was used to compare the survival rates of patients with and without fatty liver. Cox proportional hazard models were used to identify the independent predictors of OS and CSS. RESULTS: Visceral fat area was not associated with any pathological parameters or survival. The mean liver CT values of patients with high-grade tumors (G3), patients with T3-4 tumors, and patients with visceral obesity were significantly lower than those of patients with low-grade tumors (G1-2), patients with T1-2 tumors, and patients without visceral obesity (p 1⁄4 0.0116, p 1⁄4 0.0336, p < 0.0001, respectively). Overall patients with fatty liver had significantly shorter OS and CSS than those without fatty liver (p 1⁄4 0.0095, p 1⁄4 0.0145). In patients without visceral obesity, the mean liver CT values of patients with T3-4 tumors and patients with lymph node metastasis and/or distant metastasis at the time of operation were significantly lower than those of patients with T1-2 tumors and patients without any metastasis (p 1⁄4 0.0401, p 1⁄4 0.026), and presence of fatty liver was significantly associated with shorter OS and CSS (p 1⁄4 0.0009, p 1⁄4 0.0015). CONCLUSIONS: Our results suggest that ectopic lipid accumulation in liver could be a novel predictor of tumor aggressiveness and poor prognosis in renal cell carcinoma regardless of the presence or absence of visceral obesity.

MP16-18 OPTIMAL COMBINATION OF MRI-TARGETED BIOPSY AND SYSTEMATIC BIOPSY FOR MEN WITH SUSPICION OF PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Magnetic resonance imaging (MRI)-targeted prostate biopsy (MRBX) is an effective biopsy procedure for with suspicion of prostate cancer on MRI. However, some significant cancer (SC) is missed using MRBX. Use of systematic prostate biopsy (SBX) for negative areas on MRI to detect SC missed by MRBX is not established for this indication. In this study, we aimed to explore the optimal combination of SBX and MRBX in these patients. METHODS: Between 2014 and 2015 at our institution, 271 men underwent MRBX with or without SBX based on prebiopsy multiparametric 1.5T MRI. Of these, 52 were excluded from the analysis because of PSA levels>40 ng/ml, obvious clinical T3-4 disease or biopsy with an insufficient number of cores for severe comorbidity. The remaining 219 men who underwentMRBXandSBXinonesessionaccording toourbiopsyprotocolwere enrolled in this study. MRBX was performed under cognitive or MRI/transrectal ultrasound fusion. Using MRBX, four-core samples for one suspicious lesiononMRIwereperformed.TheSBXprotocolwasa transperineal18-core biopsy.SCwasdefinedasclinical stageT2borgreater,biopsyGleasonscore of 4+3orgreater, ormaximumcancer lengthof 5mmorgreater.Cancerother thanSCwasdefinedas indolent cancer (IC). SC thatwasnot detected or that wasdetectedas ICusingMRBX,but thatwasdetectedasSCusingSBXwas defined as MRBX-missed SC. The frequency of MRBX-missed SC was investigated. A SBX protocol that could sufficiently detect MRBX-missed SC with a minimum number of sampling cores was determined. RESULTS: The median PSA was 7.5 ng/ml, and one/two suspicious lesions were observed in 204/15 patients, respectively, using MRI. The detection rate of any cancer or SC using both MRBX and SBX was 76%or 61%, respectively. Frequency ofMRBX-missed SC to overall SC was 13% (21/135). MRBX results in MRBX-missed SC patients was no cancer in 8 and IC in 13. Of 21 MRBX-missed cancer, a maximum of 10, 13, 15, 17, 19, 20 and 21MRBX-missed SCwere detected using 2, 4, 6, 8, 10, 12and14SBXsamplingcores, respectively.Whenweset theSC detection rate using both MRBX and the transperineal 18-core SBX at 100%, aminimum of 6 sampling cores in SBX (in addition to MRBX) were required to detect 95% of overall SC as SC. The six SBX sampling locationswere bilateral transperineal anterior, posterior and far lateral sites. CONCLUSIONS: The combination of transperineal 6-core SBX and MRBX could be an optimal biopsy strategy that strikes a balance between SC detectability and sampling number for men with suspicion of prostate cancer on MRI.

Patterns of metastasis from the primary site to the testes indicate the potential pathway of metastasis

We have reviewed cases of testicular metastases from renal cell carcinoma and investigated the laterality of the involved testis and the kidney; this revealed 18 cases of ipsilateral metastases and 9 cases of contralateral metastases [3]. Ipsilateral metastasis is more frequent, and we extrapolated that retrograde venous spread might be a main pathway of tumorous dissemination to the testis, considering the spermatic vein shows characteristic running and acts as the main drainage route of the testis. On the other hand, as clearly demonstrated by Gat et al. [4], the testes are also drained via three other vessels—the deferential vein, scrotal vein, and cremasteric vein. We understand that the deferential vein is the most important pathway connecting the testis with pelvic organs, and it forms a venous connection in the bilateral testes through the intrapelvic veins. We presume that this intra-extrapelvic venous communication could partly affect the incidence of contralateral/bilateral testicular metastases in cases of renal cell carcinoma. Various pathways of tumorous dissemination to the testis have been discussed in the literature; however, considering laterality and drainage systems might be helpful to understand the main pathway in each organ. Further detailed investigation is still required to clarify the pathways of testicular metastasis.