Long-term results of lower urinary tract symptoms and urinary flow rate after transurethral resection of the prostate

We investigated lower urinary tract symptoms (LUTS) and the urinary flow rates of patients who underwent transurethral resection of the prostate (TUR-P) for benign prostatic hyperplasia to determine the persistence of the efficacy of TUR-P. We mailed questionnaires for evaluation of LUTS to 1236 patients who had received TUR-P. In addition, we encouraged them to visit a clinic for uroflowmetry if possible. LUTS using the International Prostate Symptom Score (IPSS) and QOL index, and uroflowmetry were analyzed in 847 (68.5%) and 150 patients (12.1%), respectively. The IPSS of patients who had received TUR-P more than 5 years earlier was higher than that of patients who had received it in the preceding 5 years. However, more than 80% of the patients in both groups were satisfied with their urinary condition at evaluation. Although no obvious change in the maximum urinary flow rate was observed in the patients who had received TUR-P in the preceding 5 years, it was significantly decreased in the patients who had received it more than 5 years earlier. The tendency was marked in the patients when TUR-P was performed at 70 years of age and older. Although the change in detrusor function determined by the age at surgery and the postoperative period may cause LUTS and reduce the urinary flow rate in the long-term after TUR-P, the efficacy of TUR-P appears to last for long periods in terms of the maintenance of QOL.     

Role of lymph node dissection in management of bladder cancer

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the gold standard for treatment of muscle-invasive bladder cancer. Recent retrospective series suggest that extended PLND provides a survival benefit, probably by removing undetected micrometastases. There have been several studies suggesting the survival benefit of extended PLND, not only for patients with node-negative disease but also for those who are node positive. The optimal boundaries of PLND seem to be at least up to the level of aortic bifurcation, including Marcille’s fossa, under the present circumstances. Because retrieval of more lymph nodes may help to improve the prognosis of patients, careful approaches should be considered both surgically and pathologically. PLND should be performed for all patients who undergo RC. Prospective randomized studies will give us the answer to the question of whether extended PLND should be performed routinely.     

Gender-affirming hormone treatment causes changes in gender phenotype in a 12-lead electrocardiogram

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Clinical characteristics and treatment outcomes of patients with small cell carcinoma of the urinary bladder

BackgroundSmall cell carcinoma of the urinary bladder (SCUB) is rare. The optimal treatment for SCUB remains unclear. To address the problem of appropriate treatment for each case, we assessed single-modality and surgery-based multimodality treatments in patients with SCUB.Materials and methodsWe retrospectively reviewed the medical records of 12 patients with SCUB between 1990 and 2013. All patients underwent transurethral resection of the bladder tumor and were diagnosed with SCUB. Their clinicopathological characteristics were assessed, and the outcomes were compared according to the treatment modality.ResultsThe median (range) age at diagnosis was 66 years (range, 53–85 years). T1–4N0M0 was observed in 8 patients (66%), N1–3M0 in 2 (17%), and NanyM1 in 2 (17%). After transurethral resection of the bladder tumor, 6 patients (50%) underwent cystectomy alone, and 4 (33%) underwent cystectomy and presurgical or adjuvant chemotherapy with etoposide and cisplatin. During the median follow-up period of 20.7 months, 6 patients (50%) died of cancer, and 2 patients (17%) died of other causes. The median overall survival period was 1.9 years. The 5-year overall survival rate in patients who underwent cystectomy and chemotherapy was 75%, whereas that in those who underwent cystectomy alone and transurethral resection alone were 22% and 0%, respectively (p = 0.012). Recurrence-free survival was significantly correlated with cause-specific survival (r = 0.95; 95% confidence interval, 0.81–0.99; p < 0.001).ConclusionsRadical cystectomy with chemotherapy using the etoposide and cisplatin regimen improved the prognosis of patients with SCUB and TxNxM0. The time from initial progression to death due to cancer was very short, indicating that the initial treatment strategy is crucial.     

Studies on pulmonary metastasis of renal cell carcinoma--pulmonary embolism revealed by lung-perfusion imaging and metastasis

Invasion of renal cell carcinoma to veins is known to have a close relation with pulmonary metastasis. We speculated that a tumor thrombus would lodge in the pulmonary artery before establishment of a clinically apparent pulmonary metastasis. This may be particularly true in patients with renal vein or vena cava involvement of renal cell carcinoma. In this instance, it is crucial to know the clinical consequence of tumor thrombi in the pulmonary artery. Thus, we investigated these issues with the aid of lung-perfusion imaging in 22 renal cell carcinoma patients with and without vein involvement. The lung-perfusion imaging revealed positive in 8 of the patients examined prior to treatment. The incidence of positive finding was well correlated with an extensive vein invasion. Patients with positive imaging prior to treatment were associated with pulmonary metastasis at a higher rate than those with negative findings. These findings have indicated that vein invasion should be related with tumor thrombus formation in the pulmonary artery, and such a status in the lung would, in part, result in pulmonary metastasis. Two different clinical courses were found by an analysis of patients with the positive imaging prior to treatment. One is the clinical course in which positive findings were correlated with a newly developed metastasis in the lung. Thus, care should be taken in development of the metastasis during the follow-up when patients show the positive lung-perfusion imaging prior to treatment. On the other hand, we found two patients in whom the positive findings disappeared during the follow-up.     

INTERFERON-GAMMA AND INTERLEUKIN-2 SUPPRESS THE EXPERIMENTAL METASTASIS OF MOUSE RENAL ADENOCARCINOMA

While cytokines such as interferon-alpha (IFN-α), interferon-gamma (IFN-γ) and interleukin-2 (IL-2) are partially effective in the treatment of metastatic renal cell carcinoma, these cytokines have not been investigated for their ability to suppress the development of metastasis. We investigated whether they suppressed experimental pulmonary metastasis by subline-2 of streptozotocin-induced mouse renal adenocarcinoma (MRAC-PM2). IFN-γ (1 × 10⁴ and 1 × 10⁵ U/mouse) and IL-2 (1 × 10⁴ and 1 × 10⁵ U/mouse) suppressed the experimental pulmonary metastasis of MRAC-PM2 in a dose-dependent manner, but 1 × 10⁵ lU/mouse of IFN-α did not. The combination of 1 × 10⁵ U IFN-γ with 1 × 10⁵ U IL-2 had the most powerful inhibitory effect on pulmonary metastasis without any side-effects. In addition, the combination of 1 × 10⁵ U IFN-γ with 1 × 10⁵ U IL-2 had a synergistic inhibitory effect on the growth of subcutaneous tumors. These results indicate that either IFN-γ or IL-2, or their combination, produce a more favorable effect than IFN-α on the metastatic development of renal adenocarcinoma.     

Treatment for Advanced Testicular Cancer with High-Dose Chemotherapy and Autologous Blood Stem Cell Transplantation

Background This study was carried out to investigate the efficacy and safety of high-dose chemotherapy (HDC) for the treatment of patients with advanced testicular cancer.
Methods Seven patients were treated with high-dose carboplatin, etoposide, and ifosfamide followed by autologous blood stem cell transplantation. One patient received 1 cycle, 4 patients received 2 cycles, and 2 patients received 3 cycles of HDC. We performed a total of 15 autologous blood stem cell transplantations: 8 with autologous bone marrow; 6 with peripheral blood stem cells; and 1 with peripheral blood stem cells in addition to autologous bone marrow.
Results Four of the 7 patients achieved a pathologic complete response via early use of HDC and additional salvage surgery. All 4 patients are still alive without evidence of disease at 12, 30, 33, and 54 months, respectively. One patient is alive with active disease at 35 months. Two patients refractory to conventional chemotherapy died of progressive disease at 5 and 27 months, respectively. The hematologic recovery after HDC was rapid, and peripheral blood stem cells tended to have shorter hematologic recovery compared with those from autologous bone marrow, although the difference was not significant. Nonhematologic toxicity was usually mild and manageable.
Conclusion High-dose chemotherapy, followed by autologous blood stem cell transplantation, may be safe and effective for patients with advanced testicular cancer, particularly when early use of HDC is conducted for chemotherapy-sensitive patients. A further large, long-term, follow-up study will be needed to define the role of HDC.     

Modified and bilateral retroperitoneal lymph node dissection for testicular cancer: peri- and postoperative complications and therapeutic outcome

OBJECTIVE: To characterize surgical invasiveness and morbidity and to verify therapeutic efficacy, we reviewed perioperative and postoperative courses and therapeutic outcomes of patients who underwent retroperitoneal lymph node dissection (RPLND) for testicular germ cell cancers. METHODS: The study included 31 patients who underwent retroperitoneal lymph node dissection. A modified template was used if retroperitoneal metastasis was limited to the areas below the level of the renal hilus and above the level of the inferior mesenteric artery (IMA). Perioperative and postoperative courses and complications were reviewed as well as therapeutic outcomes. RESULTS: Overall, 27 perioperative and postoperative complications were observed in 15 patients (48.4%). Superficial surgical site infection and paralytic ileus were seen most frequently. All of them were resolved without special additional treatments; however, patients who underwent retrocrural dissection had a tendency to have severe symptomatic complications such as chylothorax, phrenic nerve palsy and orthostatic hypotension. Antegrade ejaculation was preserved in 94.1% of patients with modified template dissection, whereas no patients with additional dissection below the level of the IMA had the function preserved. One patient (3.2%) developed a postoperative recurrent disease in the retroperitoneum, which was outside the dissection field, as well as in the mediastinum. CONCLUSIONS: Although RLND had high morbidity, most peri- and postoperative complications were manageable conservatively. Modified template dissection enabled patients to preserve antegrade ejaculation without compromising its therapeutic efficacy, if the disease extension allowed us to use the template.