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A 60-year-old man visited our hospital to treat a large cystic mass in the pelvis which had been found by abdominal ultrasonography in December 201X. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a multilocular cyst with a maximum diameter of about 10 cm. CT-guided drainage and sclerotherapy with minocycline reduced the size of tumor by 40%, but symptoms such as difficulty of defecation and urinary frequency appeared a year and a half later due to re-enlargement of the cysts. Laparoscopic resection of the multilocular cysts was performed, and all cysts were removed almost completely using transrectal ultrasonography. The multilocular cyst was positive for NKX3.1 by immunohistochemical staining, and was diagnosed as a giant multilocular prostatic cystadenoma. After surgery, the symptoms such as difficulty of defecation and urinary frequency were relieved promptly. One year after the surgery, the patient was free from recurrence of the disease.

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OBJECTIVE: We aimed to examine the clinical significance of an antimicrobial administration protocol, in which postoperative prophylaxis was proactively discontinued. METHODS: We included 81 adult urethroplasties performed at our institution in the study. Preoperative bacteriuria was treated using an appropriate antimicrobial agent 2-5 days before surgery. All patients were treated with intravenous antimicrobial agents until postoperative day 2, and thereafter without prophylaxis. Antibiotics were resumed from the day before the urethrogram for urethral catheter removal, 2-3 weeks postoperatively. The relationships between pre- and postoperative positive urine culture and postoperative infectious complications, along with factors influencing surgical success rate were examined retrospectively. RESULTS: Of the 81 patients, 60 underwent anastomotic repair and 21 underwent substitution repair. Positive preoperative urine cultures were more frequent in patients having suprapubic cystostomy tube than in those without (P < 0.0001), but such a difference was not noted postoperatively between the two groups, and approximately half of the patients had a positive urine culture postoperatively. Wound infections and symptomatic urinary tract infections rates were 3.7% and 2.5%, respectively, similar to previous studies with longer prophylaxis, and no significant correlation was noted with pre- and postoperative positive urine culture, treated by this antibiotic protocol. The overall clinical and objective success rates were 96.3% and 79.0%, respectively, and no significant impact of pre- or postoperative positive urine culture was noted. The only significant parameter for objective success was patient age. CONCLUSION: Perioperative management of urethroplasty is feasible using the antimicrobial protocol described in this study.

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ABSTRACT: This study aimed to evaluate the clinical use of choline-PET/CT for discriminating viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and evaluating the response of bone metastasis to treatment in metastatic castration-resistant prostate cancer (mCRPC) patients. Thirty patients with mCRPC underwent a total of 56 11C-choline-PET/CT scans for restaging, because 4 patients received 1 scan and 26 had 2 scans. Using 2 (pre- and post-treatment) 11C-choline-PET/CT examinations per patient, treatment response was assessed according to European Organization for Research and Treatment of Cancer (EORTC) criteria in 20 situations, in which only bony metastases were observed on 11C-choline-PET/CT scans. Viable bone metastases and osteoblastic change induced by the treatment effect were identified in 53 (94.6%) and 29 (51.8%) of 56 11C-choline-PET/CT scans, respectively. In 27 cases (48.2%), 11C-choline-PET/CT scans could discriminate the 2 entities. The mean SUVmax of the metastatic bony lesions was 5.82 ±â€Š3.21, 5.95 ±â€Š3.96, 6.73 ±â€Š5.04, and 7.91 ±â€Š3.25 for the osteoblastic, osteolytic, mixed, and invisible types, respectively. Of the 20 situations analyzed, CMR, PMR, SMD, and PMD, as determined by the EORTC, were seen in 1, 2, 3, and 14 cases, respectively. Of the 13 patients with increasing PSA trend, all 13 showed PMD. Of the 2 patients with PSA response of <50%, both 2 showed SMD. Of the 5 patients with PSA response of ≥50%, 1 showed CMR, 2 showed PMR, 1 showed SMD, and 1 showed PMD. Choline-PET/CT is very useful to discriminate viable progressive osteoblastic bone metastasis from osteoblastic change, and assess treatment response of bone metastases in mCRPC.

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We here report 2 cases of castration-resistant prostate cancer (CRPC) observed two times on 11C-choline positron emission tomography computed tomography (PET/CT), which was useful to discriminate viable progressive osteoblastic bone metastasis from benign osteoblastic change induced by the treatment effect and to determine the viability of bone metastases, regardless of whether sclerosis was present or not. Because one case demonstrated disappearance of abnormal 11C-choline uptake of osteoblastic metastatic lesions after abiraterone therapy and no new lesions at other sites, suggesting nonviable bone metastases, we can assume a complete metabolic response. Because the other case demonstrated a decrease in the existing, abnormal 11C-choline uptake of osteoblastic metastatic lesions, but multiple new appearances of osteoblastic and nonosteoblastic lesions with abnormal 11C-choline uptake after radium-223 therapy suggesting multiple viable bone metastases, we can assume progressive metabolic disease. 11C-choline PET/CT could help in assessing the treatment response of bone metastases in patients with metastatic CRPC.

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SQUAMOUS CELL CARCINOMA, prostate carcinoma, The patient was a 67-year-old man who visited our hospital with urge incontinence. His serum prostatic specific antigen level was normal (1.191 ng/mL). Digital rectal examination and magnetic resonance imaging suggested common prostatic carcinoma. A transperineal needle biopsy was performed, and the histological diagnosis was squamous cell carcinoma (SCC). The serum SCC-antigen level was normal, and the patient underwent a radical prostatectomy. Computed tomography 15 months later revealed multiple metastases in the lymph nodes. The patient underwent systemic chemotherapy using fluorouracil (5-FU) and cisplatin (CDDP). After 3 courses of chemotherapy, the multiple lymph node metastases could not be detected.

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A man in his 50s was referred to our hospital after recurrent severe urinary tract infection. He had undergone anoplasty for anorectal malformation during early infancy. He noticed urinary leakage from the anus for a long time. Under diagnosis of congenital rectourethral fistula, we performed fistula closure. The fistula was transsected via transperineal incision and each stump was closed. A gracilis muscle flap approximately 30 cm long was harvested from the left thigh, brought into the deepest part between the separated rectum and urethra through a subcutaneous tunnel and fixed there. The urinary leakage from the anus disappeared, and the infection resolved. Application of gracilis muscle flap for congenital diseases is rare, but was useful in the present case.

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A 47-year-old woman came to our hospital with left lower abdominal pain in April 2013. An abdominal computed tomographic (CT) examination revealed left hydronephrosis secondary to a 7 cm retroperitoneal cyst near the left common iliac artery and ureter. Serum tumor markers including CEA, CA19-9, and CA125 were negative. Although CT guided needle aspiration of the cyst successfully relieved severe left flank pain, the cyst again increased in size, causing left hydronephrosis, though examinations for fluid tumor markers and cytology were negative. Two months later, the patient underwent open fenestration. The final pathological results demonstrated a mesothelial cyst without malignant findings. Six months after the operation, the patient was doing well without recurrence of symptoms.

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A 37-year-old woman with an incidentally found abdominal mass was referred to our hospital. A fixed, non-tender mass was palpated in the right upper quadrum of her abdomen. There was no elevation of tumor markers. Computed tomography revealed a mass extending from the hepatic vein level to renal hilar level. The tumor completely obstructed the inferior vena cava (IVC). T1-weighted magnetic resonance imaging (MRI) showed that the mass was isointense with muscles. T2-weighted MRI image with contrast medium demonstrated collateral circulation. Upon diagnosis of the IVC tumor, we removed the right kidney and the tumor en bloc without reconstructing IVC. The tumor diameter was 11.6 × 5.5 × 4.7 cm. Pathological examination established a diagnosis of IVC leiomyosarcoma. She is alive without sign of recurrence after operation for seven months. There were 143 reports of IVC leiomyosarcoma in Japan. In 31% of them, IVC was not reconstructed.

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A 23-year-old man and a 62-year-old man suffering from cystinuria underwent extracorporeal shock wave lithotripsy (ESWL) for right renal stone and left ureteral stone, respectively. They had double-J stents placed before ESWL, but since attempts to retrieve the stents were unsuccessful due to encrustation, they were referred to our clinic. Multimodal endourologic and open approaches including ESWL, transurethral ureterolithotripsy, and pyelolithotomy were required to render them stent- and stone-free. The guidelines do not recommend routine stenting before ESWL ; therefore, the indication and duration of indwelling stents should be minimized. Multimodal options including not only ESWL and endoscopic surgery but also open surgery, should be attempted for the management of encrusted stents. Close monitoring and follow up are important to the prevent complications of ureteral stents.

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Patients administered anti-cholinergic agents, as first-line therapy for an overactive bladder (OAB) are often unable to continue medical treatment because of dry mouth. We assessed oral health in patients with OAB using the General Oral Health Assessment Index (GOHAI), an oral health-related quality of life questionnaire. We investigated 75 patients with OAB who were receiving continuous administration of anti-cholinergic agents. The OAB symptom score, as well as GOHAI and our original dry mouse score were determined by self-administered questionnaires. The mean age of the subjects was 70.9±10.2 years, the median period of anti-cholinergic agent use was 20 (1-116) months and the mean OAB symptom score was 6.3±3.1. The GOHAI score for all patients was 51.9±8.4 and not significantly different from the national normal value (p＝0.22). On the other hand, the score in patients with a severely dry mouth was 49.2±8.6, which was worse than the national normal value (p＝0.04). The psychosocial functioning score in patients with a severely dry mouth was significantly lower than in those with a slightly dry mouth (p＝0.02). Our results indicate that dry mouth in patients with OAB is significantly associated with worsening of oral health. GOHAI is useful as a screening test to assess the quality of life in patients with OAB.

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