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Background Prolonged laparoscopic nephroureterectomy (LNU) for upper tract urothelial cancer (UTUC) can increase the frequency of intravesical recurrence after surgery. Therefore, it is important for urological surgeons to have knowledge on preoperative risk factors for prolonged LNU. However, few studies have investigated the risk factors for prolonged LNU. We hypothesized that the quantity of perirenal fat affects the pneumoretroperitoneum time (PRT) of retroperitoneal LNU (rLNU). This study aimed to investigate the preoperative risk factors for prolonged PRT during rLNU. Methods We reviewed the data of 115 patients who underwent rLNU for UTUC between 2013 and 2021. The perirenal fat thickness (PFT) observed on preoperative computed tomography (CT) images was used to evaluate the perinephric fat quantity. Preoperative risk factors for PRT during rLNU were analyzed using logistic regression models. The cutoff value for PRT was determined based on the median time.The cutoff values for fat-related factors influencing PRT were defined according to receiver operating characteristic curve analysis. Results The median PRT for rLNU was 182 min (interquartile range, 155–230 min). The cutoff values of posterior, lateral, and anterior PFTs were 15 mm, 24 mm, and 6 mm, respectively. Multivariate analysis revealed that a posterior PFT ≥ 15 mm (odds ratio [OR], 2.72; 95% confidence interval, 1.04–7.08; p  = 0.0410) was an independent risk factor for prolonged PRT. Conclusions Thick posterior PFT is a preoperative risk factor for prolonged PRT during rLNU. For patients with UTUC and thick posterior PFT, surgeons should develop optimal surgical strategies, including the selecting an expert surgeon as a primary surgeon and the selecting transperitoneal approach to surgery or open surgery.

Introduction We encountered a case of acute obstructive pyelonephritis caused by bleeding from a renal pelvis cancer that was successfully treated by laparoscopic nephrectomy. Case presentation An 88‐year‐old woman with fever of 40.2°C and right back pain associated with hematuria due to a right renal pelvic tumor. Computed tomography showed a blood clot filling the right renal pelvis and ureter. She was diagnosed with severe obstructive pyelonephritis due to undrainable blood clots. Nephrectomy was performed to control the infection. Although the perirenal area was easy bleeding, nephrectomy was completed and the patient's condition improved. Conclusion Renal pelvis carcinomas with hemorrhage requiring blood transfusion should be treated with radical nephroureterectomy as early as possible.

Background To investigate the impact of Perirenal fat stranding (PRFS) on progression after radical nephroureterectomy (RNU) for renal pelvic urothelial carcinoma (RPUC) without hydronephrosis and to reveal the pathological findings of PRFS. Methods Clinicopathological data, including computed tomography (CT) findings of the ipsilateral PRFS, were collected from the medical records of 56 patients treated with RNU for RPUC without hydronephrosis between 2011 and 2021 at our institution. PRFS on CT was classified as either low or high PRFS. The impact of PRFS on progression-free survival (PFS) after RNU was analyzed using the Kaplan–Meier method and log-rank test. In addition, specimens including sufficient perirenal fat from patients with low and with high PRFS were pathologically analyzed. Immunohistochemical analysis of CD68, CD163, CD3, and CD20 was also performed. Results Of the 56 patients, 31(55.4%) and 25 (44.6%) patients were classified as having low and high PRFS, respectively. Within a median follow-up of 40.6 months postoperatively, 11 (19.6%) patients showed disease progression. The Kaplan–Meier method and log-rank test revealed that patients with high PRFS had significantly lower PFS rates than those with low PRFS (3-year PFS 69.8% vs 93.3%; p = 0.0393). Pathological analysis revealed that high PRFS specimens (n = 3 patients) contained more fibrous strictures in perirenal fat than low PRFS specimens (n = 3 patients). In addition, M2 macrophages (CD163 +) infiltrating fibrous tissue in perirenal area were observed in all patients with high PRFS group. Conclusions PRFS of RPUC without hydronephrosis consists of collagenous fibers with M2 macrophages. The presence of ipsilateral high PRFS might be a preoperative risk factor for progression after RNU for RPUC patients without hydronephrosis. Prospective studies with large cohorts are required in the future.

Background The presence of collateral vessels (CVs) on contrast-enhanced computed tomography is a poor prognostic factor in renal cell carcinoma (RCC), but its value in small RCC (sRCC; < 4 cm) remains unknown. In this study, we investigated whether presence of CVs is a predictor of high potential for metastasis in sRCC. Methods We retrospectively reviewed clinical and imaging data of patients with pathologically confirmed sRCC evaluated at our institution between 2011 and 2021. All sRCCs were pathologically diagnosed by biopsy, metastasectomy, partial nephrectomy, or radical nephrectomy. CVs were defined as blood vessels of any diameter connecting the tumor with the surrounding perirenal tissues on contrast-enhanced computed tomography. The rate of metastasis-free survival (MFS), defined as the time from pathological diagnosis to confirmed metastasis, was compared among patients without CVs, those with one CV, and those with two or more CVs. Results Of 141 patients, 4 (2.8%) had metastatic sRCC at initial diagnosis. In the 137 patients with nonmetastatic sRCC, the diagnosis was pathologically confirmed following radical surgery. The median follow-up period from pathological diagnosis was 73.9 months, and the overall 5-year MFS was 93.5%. The 5-year MFS was significantly poorer in patients with two or more CVs than in those with one CV (63.8% vs. 96.3%; p = 0.0003) and those without CVs (63.8% vs. 100%; p < 0.0001). Conclusions sRCCs with two or more CVs might have high potential for metastasis. Conversely, sRCCs without CVs might not be aggressive and be suitable for active surveillance.

Intravesical bacillus Calmette-Guerin (BCG) therapy is considered the most successful immunotherapy against solid tumors of human bladder carcinoma. To determine the actual effector cells activated by intravesical BCG therapy to inhibit the growth of bladder carcinoma, T24 human bladder tumor cells, expressing very low levels of class I MHC, were co-cultured with allogeneic peripheral blood mononuclear cells (PBMCs) with live BCG. The proliferation of T24 cells was markedly inhibited when BCG-infected dendritic cells (DCs) were added to the culture although the addition of either BCG or uninfected DCs alone did not result in any inhibition. The inhibitory effect was much stronger when the DCs were infected with live BCG rather than with heat-inactivated BCG. The live BCG-infected DCs secreted TNF-α and IL-12 within a day and this secretion continued for at least a week, while the heat-inactivated BCG-infected DCs secreted no IL-12 and little TNF-α. Such secretion of cytokines may activate innate alert cells, and indeed NKT cells expressing IL-12 receptors apparently proliferated and were activated to produce cytocidal perforin among the PBMCs when live BCG-infected DCs were externally added. Moreover, depletion of γδ T-cells from PBMCs significantly reduced the cytotoxic effect on T24 cells, while depletion of CD8β cells did not affect T24 cell growth. Furthermore, the innate effectors seem to recognize MICA/MICB molecules on T24 via NKG2D receptors. These findings suggest the involvement of innate alert cells activated by the live BCG-infected DCs to inhibit the growth of bladder carcinoma and provide a possible mechanism of intravesical BCG therapy.

We performed transurethral resection of the prostate (TUR-P) for a 66-year-old man with benign prostatic hyperplasia. Pathological examination diagnosed poorly differentiated urothelial carcinoma of the urethra with broad prostatic permeation. Random bladder biopsies showed no malignancy, but a second TUR-P revealed urothelial carcinoma in the prostate and bladder neck. Computed tomography (CT) showed lymph node metastases from para-aortic to right/left external iliac and left obturator nodes, so clinical stage T3N2M0 carcinoma of the prostatic urethra was diagnosed. Given the presence of lymph node metastases, neoadjuvant chemotherapy using cisplatin 70 mg/m 2 , ifosfamide 1.2 g/m 2 and docetaxel 70 mg/m 2 (PIT) was considered. After chemotherapy, CT showed complete response (CR) of all lymph nodes. Local control in the bladder was considered to be good, so total prostatectomy and retroperitoneal lymph node dissection was selected instead of total cystoprostatectomy. Pathological findings of surgical specimens showed no residual carcinoma in the prostatic urethra or lymph nodes, although prostatic adenocarcinoma was recognized. No recurrences or metastases have been encountered as of 3 years and 5 months since surgery.

Preoperative obstructive pyelonephritis (OP) increases the risk of febrile urinary tract infection (fUTI) after ureteroscopic lithotripsy (URSL). This study aimed to investigate the effect of a history of OP treated without drainage on post‑URSL fUTI. We retrospectively reviewed the medical records of 343 consecutive patients who underwent URSL at three institutions between January 2021 and April 2024. Risk factors for post‑URSL fUTI were analyzed, and frequencies were compared among patients with a history of OP treated without drainage, those with a history of OP treated with ureteral stent (US) placement, and those without a history of OP. Of the 343 patients, 29 (8.5%) developed post‑URSL fUTI. Multivariate logistic regression analysis revealed that a history of OP (p < 0.001) and preoperative positive urine culture (p = 0.043) were independent risk factors for post‑URSL fUTI. The incidence of post‑URSL fUTI was significantly higher in patients with OP treated with drainage than in those without a history of OP (p < 0.001). Moreover, the incidence of post‑URSL fUTI in patients with OP treated without drainage was significantly higher than that in patients treated with US placement (p = 0.030). In this study, the incidence of post‑URSL fUTI in patients with OP treated without drainage was significantly higher than that in those treated with US placement. A history of OP treated without drainage might represent the highest risk factor for post‑URSL fUTI. Therefore, calculous pyelonephritis probably should be managed with drainage to mitigate this risk.

Genes encoding the serine proteinase inhibitor B family ( SERPINB s) are mainly clustered on human chromosome 18 (18q21). Several serpins are known to affect malignant phenotypes of tumor cells, so aberrant genetic variants in this molecular family are candidates for conferring susceptibility for risk of cancer. We investigated whether eight selected non-synonymous variations within SERPINB loci at 18q21 might be associated with risk of prostate cancer in Japanese men. A case-control study involving 292 prostate-cancer patients and 384 controls revealed significant differences in regard to distribution of four missense variations in genes encoding plasminogen activator inhibitor 2 ( PAI2 ) and SERPINB10 . The most significant association was detected for the N120D polymorphism in the PAI2 gene ( P =5.0×10 −5 ); men carrying the 120-N allele (120-N/N and 120-N/D genotypes) carried a 2.4-fold increased risk of prostate cancer (95% confidence interval 1.45–4.07). Associations were also detected for three other missense polymorphisms in those two genes. Strong linkage disequilibrium in the region encompassing PAI2 and SERPINB10 extended to about 50 kbp. The results suggested that missense variations in one or both of these genes confer important risks for prostate cancer, and may be themselves tumorigenic. Although confirmative replication studies on larger cohorts are awaited, clinical examination of these variations may become useful for identifying individuals at high risk for prostate cancer.

We carried out this study to clarify whether the operative methods of laparoscopic prostatectomy established in France could become standard therapy. The purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic prostatectomy performed by a general urologist. Between June 2000 and August 2002, 30 patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy performed as previously reported by Guillonneau and colleagues. Oncological data were assessed by pathological examination and by postoperative prostate-specific antigen (PSA) levels. All prostatectomy specimens were processed according to the Stanford protocol. Prostate features, including tumor weight; Gleason score; and the tumor status of the capsule, seminal vesicles, and surgical margins were studied. Complete laparoscopic removal of the prostate and seminal vesicles was achieved in all 30 patients. Operating time averaged 325.5 min (range, 165 to 880 min). The transfusion rate for the patients in the series was 50%, using own-blood transfusion (800-1200 ml). No patient required an allogenic blood transfusion. Only 2 of the 30 patients had a positive surgical margin that involved the urethra. There were three complications: bladder injury, rectal injury, and ileus associated with a drainage tube. No vascular, nervous system, or urethral complications were found. These preliminary results demonstrated that radical prostatectomy can be performed laparoscopically by general urologists. Laparoscopy offered better luminosity and magnification than conventional procedures, permitting precise dissection. Thus, laparoscopic prostatectomy could be a standard operation for patients with clinically organ-confirmed prostate cancer.