A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer

A case of spontaneous peripelvic extravasation associated with ureteral stenosis caused by retroperitoneal lymph node metastasis of the ascending colon cancer is reported. A 47-year-old woman complained of colic on right costa-vertebral angle. Excretory urograms showed right peripelvic extravasation and CT-scan showed urinoma formation around right kidney. Subsequent examination of right retrograde pyelo-ureterograms showed ureteral stenosis at sacro-iliac region. Operative findings revealed ureteral stenosis caused by retroperitoneal lymph node metastasis of ascending colon cancer, which was regarded as inoperable. There are a few reports of spontaneous peripelvic extravasation caused by a malignant tumor in Japanese literature. Twenty of them are reviewed.     

Robotically assisted radical laparoscopic prostatectomy in a patient with ectopic ureteral insertion into the prostate

Robotically assisted laparoscopic radical prostatectomy (RaLRP) has become an alternative surgical treatment option for patients with localized prostate cancer. Rare anatomic variations result in modification of established techniques. We describe the first successful completion of RaLRP for localized prostate cancer in a patient with coexisting complete left ureteral duplication and ectopic insertion of the upper pole moiety ureter into the prostatic urethra. After standard radical prostate excision and vesicourethral anastomosis, the unique anatomy in this case required additional reconstructive maneuvers including construction of a Y-type conjoined ureteral anastomosis and ureteroneocystotomy. The procedure was safely completed without open conversion. Operative time was 420 min and EBL was 200 mL. Ureteral stents were removed in six weeks and IVP showed no evidence of obstruction. When faced with a ureteral anomaly, RaLRP can be safely completed. Robotic technology is helpful in performing additional delicate reconstructive maneuvers.     

Managing the local complications of locally advanced prostate cancer

Complications of locally advanced prostate cancer are often overlooked in the overall treatment of prostate cancer, can have significant morbidity, and can provide a challenge for the treating urologist. Despite advances in early detection and treatment of prostate cancer, as many as 10% of patients present with or develop symptomatic locally advanced prostate cancer. Prostate cancer locally invading the urethra can be effectively managed with transurethral resection or ablation procedures or urethral stenting. Obstruction of one or both ureters is managed with either ureteral stenting or nephrostomy drainage. Bulky pelvic recurrence resulting in significant hematuria, rectal involvement, or severe pelvic pain can be difficult to manage, with some advocating cystoprostatectomy or pelvic exenteration to provide palliation. Surgical intervention for locally advanced prostate cancer can provide significant improvement in quality of life and should not be restricted to patients who have curable disease.     

Extracorporeal shockwave lithotripsy in patients with distal ureteral calculi does not influence the prostate specific antigen value.

BACKGROUND AND PURPOSE: Distal ureteral calculi can be treated with extracorporeal shockwave lithotripsy (SWL) in situ, which has a high rate of success. As the prostate is in vicinity of this part of the ureter, it is possible that the shockwaves may pass through the prostate also. We evaluated the effect of SWL on the serum concentration of prostate specific antigen (PSA). PATIENTS AND METHODS: A total of 44 men with distal ureteral calculi located a maximum of 20 mm from the ureteral orifice and without any history of recent urinary tract infection, benign prostatic hyperplasia, or prostate cancer underwent SWL with the Dornier HM-4 lithotripter. Their serum PSA values were measured 5 minutes before SWL as well as 3 hours and 1, 7, and 30 days afterward. The differences of these PSA values were estimated. From a control group of 10 healthy donors, two consecutive PSA values were obtained 30 days apart. RESULTS: Of these patients, 93% (41/44) were stone free within 1 month according to plain radiographs and ultrasonography. No statistically significant difference was observed between the PSA concentration before and after treatment or between the patients who underwent SWL and the control group. CONCLUSION: Treatment of distal ureteral calculi with SWL does not affect the serum PSA concentration.     

Percutaneous transrenal ureteroneocystostomy.

Advanced cancer of the prostate causes mechanical obstruction of the ureteral orifice in 10% of patients. In our patient with advanced prostate carcinoma, after the usual method of placement of a ureteral stent had failed, antegrade percutaneous ureteroneocystostomy with placement of a double-J performed by means of the Lawson retrograde nephrostomy set. After removal of the stent 8 months later, the anastomosis functioned without a decrease in caliber until the patient died 2 years later. Our technique represents another new option for the treatment of such patients.     

A case of primary urinary bladder and ureter cancer with a choriocarcinoma

An 85-year-old man had planned a laparoscopic right nephrouretectomy for a right lower ureteral cancer, pT1, G3. Two months prior to the surgery, he was re-examined because of continuing macrohematuria. He had a 50 mm tumor in his urinary bladder and tumors from the right upper to lower urinary tract by computed tomographic (CT) examination and cystoscopy. He did not have any metastasis. We diagnosed a cT3N0M0 for the right ureteral cancer and a cT3N0M0 for the bladder cancer. A right nephrouretectomy and cystectomy were then performed. The histopathologic examination revealed an urothelial carcinoma with a choriocarcinoma.     

Effect of Extracorporeal Shock Wave Lithotripsy on Prostate Specific Antigen

Purpose

We evaluated the effects of extracorporeal shock wave lithotripsy (ESWL^*) of distal ureteral calculi on serum prostate specific antigen (PSA).

Materials and Methods

A total of 29 consecutive men with distal ureteral calculi at a maximum of 25 mm. from the ureteral orifice, and without any history of urinary tract infection, benign prostatic hyperplasia or prostate cancer underwent ESWL with the Dornier MPL 9000 × lithotriptor. The therapeutic focus size was 48 × 7 mm. PSA was measured exactly 5 minutes before ESWL, as well as 120 minutes, 24 hours and 7 days after termination of treatment.

Results

Fragmentation rate was 100 percent and all patients were stone-free within 1 week of therapy. There was no statistically significant difference between PSA values before and after treatment. Only 15 patients had a slight increase in PSA at 120 minutes after treatment (range 0.01 to 0.41 ng./ml., mean 0.07).

Conclusions

ESWL can be performed in men at risk for prostate cancer without impairing the predictive value of PSA.     

Clinical statistics on in-patients and operations during a 14-year period (1986-1999) at Department of Urology, Gunma Cancer Center

The patients, diseases and operations experienced between 1986 and 1999 in our department were analyzed. The number of in-patients has been increasing since 1995. Renal cell carcinoma, urinary bladder cancer and testicular cancer have been gradually increasing recently, and in-patients with prostate cancer have increased markedly. Pelvic and ureteral cancers were almost constant during this period. Radical nephrectomy and prostatectomy have been increasing since 1994 and 1990, respectively. The examinations for malignancy, especially prostate biopsy, have been increasing.     

一例寡转移前列腺癌患者基于循证医学的多学科综合诊治报告

目的探讨基于循证医学寡转移前列腺癌的综合治疗模式,以期延长患者生存时间。 方法回顾性分析一例在我院行多学科协作诊治的寡转移前列腺癌患者临床资料,复习相关文献并予以讨论。 结果患者初诊PSA为60 μg/L,盆腔MRI考虑前列腺癌,双侧精囊受侵,左侧输尿管口受侵,全身骨扫描可见四处骨转移,前列腺穿刺活检诊断为前列腺腺泡癌,Gleason评分4+5=9分。患者自2016年5月起以雄激素剥夺治疗为基础,先后序贯行新辅助化疗、减瘤性根治性前列腺切除术、立体定向放疗、阿比特龙+泼尼松治疗及再次多西他赛化疗,随访至2018年12月,患者无明显疼痛不适,但PSA升高,出现新发骨转移灶。 结论循证医学给此类患者治疗选择带来更多的依据,多学科治疗模式可延长寡转移前列腺癌患者生存时间,改善生活质量。     

A case of needle tract implantation of ureteral carcinoma

Malignant metastasis along the needle tract, called "needle tract implantation" (NTI), has been demonstrated for numerous carcinomas, including prostate, colon and liver. We report a case of NTI of ureteral carcinoma following percutaneous nephrostomy tube replacement. A 57-year-old woman was found to have a subcutaneous mass at the site of nephrostomy. She had a past history of right nephroureterectomy for ureteral carcinoma about one year earlier, and a nephrostomy tube had been inserted before diagnosis postoperatively. We resected the subcutaneous mass. Pathological diagnosis was urothelial carcinoma closely resembling right ureteral carcinoma. To our knowledge, this is the seventh reported case of NTI of upper urinary tract urothelial carcinoma. Percutaneous manipulation carries a potential risk of local tumor spillage and NTI in the nephrostomy tract.     

A case of thyroid cancer metastasizing to the bilateral kidneys

A 66-year-old woman was admitted with a chief complaint of macroscopic hematuria. She had a past history of mediastinal tumor that had been surgically treated 11 years earlier and had been pathologically diagnosed as papillary thyroid cancer. Enhanced computed tomography demonstrated slightly enhanced renal tumors in both kidneys. Endoscopic findings showed bleeding from the left ureteral orifice. To control macroscopic hematuria, left nephrectomy was performed. Since, two months late severe bleeding occurred from the right ureteral orifice, right nephrectomy was performed and hemodialysis was initiated. The pathological findings of the bilateral renal tumors were papillary thyroid cancer suggesting metastases from the primary mediastinal tumor.     

Immediate robot-assisted ureteral reimplantation during robotic prostatectomy in locally advanced prostate cancer

We report the technique and outcomes of immediate robot-assisted ureteral reimplantation due to unexpected ureteral injury during robot-assisted laparoscopic prostatectomy (RALP). A 61-year-old male was diagnosed with locally advanced prostate adenocarcinoma (T3bN0M0). Multiple positive margins at the bladder neck were noted on frozen section during RALP, and re-excision of the bladder neck was done. Unfortunately, the distal third of right ureter was transected. We immediately performed robot-assisted ureteroneocystostomy with double J stent insertion. No complications developed during the follow-up period.     

External radiotherapy in ureteral obstruction secondary to locally invasive prostatic cancer

Sixteen patients with unilateral or bilateral hydroureteronephrosis due to ureteral obstruction secondary to locally invasive prostatic cancer (Stage III) were given 5,000 to 6,000 rads of external radiotherapy to the prostate utilizing Cobalt-60. External radiotherapy was used in 10 patients after they either refused to undergo orchiectomy or had been refractory to orchiectomy and hormone therapy for at least three months. Unilateral nephrostomy was required in 3 patients prior to radiotherapy. Within six months 9 of 10 patients showed a response. The encouraging effects of external radiotherapy on ureteral obstruction secondary to locally invasive prostatic cancer are discussed.     

Three cases of gastric cancer (Borrmann type IV) presenting with right back pain caused by right hydronephrosis as the first symptom

We experienced three cases of right hydronephrosis, which were later diagnosed to have been caused by gastric cancer (Borrmann type IV). The patients were 25-, 38-, and 50-year-old women who complained of right back pain. Ultrasound sonography revealed right hydronephrosis in all three cases. We conducted drip infusion pyelography, computed tomographic scan and retrograde pyelography, but there were no signs of urinary stones or tumors, except for the presence of right ureteral stenosis. Since the patients had upper abdominal discomfort, they underwent gastrofiberscopy, which revealed scirrhous gastric cancer. We suspected that the right ureteral stenosis was caused by metastasis of gastric cancer. After a double J catheter was indwelt at the right ureter, combination chemotherapy of methetrexate + 5-fluorouracil was conducted. The right hydronephrosis diminished and all three patients became catheter-free.     

Transitional cell carcinoma of urachus: a case report

We report a case of transitional cell carcinoma of urachus in a 72-year-old man. At follow up cystoscopy for past history of bladder cancer, we found a papillary tumor in the right orifice that came out to the bladder cavity intermittently. Although there was no cancerous lesion on the surface of the bladder mucosa, a submucosal eminence at the dome of bladder was observed. Sagittal magnetic resonance imaging (MRI) revealed an extravesical tumor (2 cm) at the position of urachus. Under the diagnosis of right ureteral cancer and urachal cancer, we performed right distal ureterectomy, ureteral reimplantation and total resection of urachus. Pathological examination revealed transitional cell carcinoma in the urachus and right ureter. The urachal cavity was isolated completely from the bladder cavity. Tumor infiltrated to the muscularis of the bladder dome from the urachal cavity, but there was no cancerous lesion on the surface of the bladder mucosa. Therefore, our diagnosis was urachal transitional cell carcinoma and right ureteral carcinoma.     

Transurethral coil embolization for the management of ureteroarterial fistula: a case report

A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. Hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.     

A very rare autopsy case of metastatic brain tumor originating from ureteral cancer

We report here a very rare case of metastatic brain tumor originating from ureteral cancer which was verified at autopsy. An 88-year-old elderly woman was admitted to our department because of recurrent convulsions which started in March, 1987. Following this episode, right hemiparesis and speech disturbance appeared on June 6, 1987. Neurological examinations at admission on August 12, 1987 showed slightly disturbed consciousness, motor dominant aphasia, and dysphasia. Enhanced CT scan demonstrated a large tumor in the left frontal lobe with perifocal edema, and a small mass in the right frontal lobe (Fig. 1). Left carotid angiogram showed downward displacement of the middle cerebral artery complex at the Sylvian portion. After admission, she developed marked distention of the abdomen, with occurrence of hematuria followed by aggravation of respiration and consciousness. She died on September 2, 1987. Removal of metastatic brain tumor had not been performed due to the poor general condition of the patient. An autopsy was permitted. A coronal section of the cerebrum clearly demonstrated a large tumor in the left frontal lobe with small mass in the right frontal lobe (Fig. 2). Kidney and the ureter at the right side showed hydronephrosis and hydroureter because of the presence of ipsilateral ureteral tumor at the distal end (Fig. 3). Microscopical findings verified that the metastatic brain tumor was a transitional cell carcinoma, which was, histologically, completely the same as the ureteral tumor (Fig. 4, 5). No case of metastatic brain tumor originating from ureteral cancer has yet been reported, as far as the authors know.(ABSTRACT TRUNCATED AT 250 WORDS)     

Solitary ureteral metastasis from cervical cancer: a case report

A case of solitary ureteral metastasis from cervical cancer in a 36-year-old female is reported. On April 4, 1988, the patient visited the gynecological department of our hospital with abnormal genital bleeding. Colposcopy and cervical biopsy revealed invasive cervical cancer, and computerized tomography (CT) indicated right hydronephrosis. She was referred to the urological department for further examinations. Right retrograde pyelography (RP) however could not be performed. On April 13, 1988, the patient underwent laparotomy due to acute abdomen, which was proved to be caused by subileus. On exploration, a tumor was found in the lower one third section of the right ureter, whereupon a right nephroureterectomy was performed because primary ureteral tumor was suspected. The histology of the ureteral tumor revealed it to be a metastatic squamous cell carcinoma identical to that obtained from punch biopsy of the cervix. At that time, a hysterectomy could not be done because of invasive cervical cancer. Following the operation, radiation therapy was conducted for primary cervical cancer. At present, 7 months after the operation, the patient is alive with good performance status.     

Effect of extracorporeal shockwave lithotripsy on serum prostate specific antigen concentration

PURPOSE: We investigated the effect of extracorporeal shockwave lithotripsy (SWL) on the serum prostate specific antigen (PSA) concentration. PATIENTS AND METHODS: A total of 22 male patients with a mean age of 52.9 years (range 37-67 years) were treated with SWL for distal ureteral calculi close to the ureteral orifice. Serum samples were drawn for measurement of PSA values just before (PSA-1) and 45 minutes (PSA-2) and 7 days (PSA-3) after the session. None of the patients had urinary tract infection or any abnormal finding on digital rectal examination. The SWL sessions were performed with the Wolf piezoelectric 2300 lithotripter that has a therapeutic focus of 3 x 11 mm. The mean number of shockwaves per patient was 2204. Student's t-test was used for statistical analysis. At 1 year, all patients completed a questionnaire concerning recent diagnosis of prostate cancer. RESULTS: The mean total PSA concentration before SWL was 3.13 ng/mL and rose to 3.91 ng/mL 45 minutes after the session. The mean PSA-3 value was 3.76 ng/mL. The mean free PSA values were 0.80, 0.83, and 0.77 ng/mL, respectively. The difference between PSA-1 and PSA-2 was statistically significant; all of the other differences were not significant. None of the patients reported prostate cancer at 1 year. CONCLUSION: Shockwave lithotripsy affects prostate epithelial cells and may cause a minor rise in total serum PSA values. However, this rise does seem to impair the value of PSA in patients with undiagnosed prostate cancer.     

Spontaneous peripelvic urine extravasation associated with ileocecal cancer: a case report

A case of spontaneous peripelvic extravasation with ileocecal cancer is reported. A 60-year-old man with right flank pain was referred to our department. Dripinfusion pyelography showed right peripelvic extravasation. Neither computed tomography (CT) nor retrograde pyelography revealed any ureteral stones or tumors. Urinary cytology was negative. One month later, right retrograde pyelography demonstrated the filling defect in the right ureter, but no stones, ureteral tumors or other tumors related to the ureter were detected by CT. An exploratory laparotomy was done. We found an ileocecal tumor invading to the right ureter and disseminated to the peritoneum. Histological diagnosis was mucinous carcinoma.