ABSTRACT Introduction Essential renal bleeding is rare and lacks standardized treatment; organ‐preserving options are critical in older patients with impaired renal function. Case Presentation A woman in her early 80s with atrial fibrillation treated with edoxaban, chronic heart failure, and advanced chronic kidney disease presented with gross hematuria and bladder tamponade. Bleeding was localized to the right renal pelvis and ureter, with no tumor, urolithiasis, vascular malformation, or glomerular disease; essential renal bleeding was diagnosed. Hematuria persisted despite edoxaban discontinuation, red blood cell and plasma transfusions, and carbazochrome sodium sulfonate administration. Isolated factor XIII activity was 22%. Intravenous plasma‐derived factor XIII concentrate achieved sustained hemostasis, renal function remained stable, and reduced‐dose edoxaban was safely resumed. Hematuria did not recur within 24 months. Conclusion In this population, factor XIII deficiency may contribute to persistent unilateral hematuria despite normal conventional coagulation tests.

IntroductionThe da Vinci surgical system (DVSS) has been the prevalent surgical robotic platform; however, novel systems, such as the hinotori surgical robot system (HSRS), are emerging. In this study, we compared the short-term surgical outcomes and step-specific operative times between the DVSS and HSRS for robot-assisted radical prostatectomy (RARP).MethodsTwo experienced DVSS-RARP surgeons transitioned to HSRS-RARP. They performed 88 DVSS-RARP procedures between 2019 and 2022 and 42 HSRS-RARP procedures beginning in 2022. We compared the perioperative outcomes and step-specific operative times between the DVSS-RARP and the HSRS-RARP groups.ResultsThe perioperative and short-term postoperative outcomes were comparable between the two groups. The total operative and console times were significantly longer in the HSRS-RARP group than in the DVSS-RARP group (235 min vs. 200 min, p = 0.0001; 168.5 min vs. 142.5 min, p = 0.0008). Surgical steps, such as preparation, posterior dissection, Retzius space dissection, prostate removal, and reconstruction, were longer in the HSRS-RARP group compared to the DVSS-RARP group. No significant differences in the surgical step time of pelvic lymph node dissection and vesico-urethral anastomosis were observed between the two groups.ConclusionAlthough HSRS-RARP exhibited short-term surgical outcomes comparable to those of DVSS-RARP, it required longer total operative and console times. Notably, technically demanding steps, such as pelvic lymph node dissection and vesico-urethral anastomosis, remained unaffected, suggesting that the DVSS-RARP skills can be transferred to HSRS-RARP professionals without major challenges.

Olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor approved for treating metastatic castration-resistant prostate cancer (mCRPC) with BRCA mutations, has significant clinical benefits. However, evidence suggests an increased risk of venous thromboembolism, including pulmonary embolism (PE), particularly in patients with PC. However, no case reports of olaparib-associated PE in mCRPC have been published. Here, we report the case of a 70-year-old man with mCRPC harboring a BRCA2 mutation, who developed PE during olaparib therapy. Diagnostic evaluations included contrast-enhanced computed tomography and serum D-dimer level measurement. Clinical decision tools, such as the Wells score and the Khorana score, were used to support the diagnosis and risk assessment. The patient developed acute dyspnea and chest pain 7 months after olaparib initiation. Imaging confirmed multiple pulmonary emboli; laboratory testing revealed markedly elevated D-dimer levels. Anticoagulation therapy with apixaban led to rapid clinical and radiological improvement. However, mCRPC eventually progressed after olaparib discontinuation, and the patient died 15 months after olaparib initiation. This is the first reported case of olaparib-associated PE in mCRPC. It underscores the importance of vigilance for thromboembolic complications during PARP inhibitor therapy. The integration of clinical scoring systems and biomarkers may facilitate timely PE diagnosis and management, potentially improving patient outcomes.

Renal cancer arising in the horseshoe kidney is very rare. In the present case, a 70-year-old man with cT3aN0M0 renal cancer arising in the horseshoe kidney was treated with intraoperative camera positioning and indocyanine green and near-infrared catheter to safely perform robot-assisted radical nephrectomy, which enabled a safer and smoother procedure. These techniques are useful for robot-assisted radical nephrectomy in cases of renal cell carcinoma of the horseshoe kidney.

A 68-year-old man with muscle invasive bladder cancer underwent robot-assisted radical cystectomy and ileal conduit for urinary diversion using the Wallace procedure. Two months after surgery, the patient developed recurrent urinary tract infections, and computed tomography showed left hydronephrosis. Nephrostography revealed a left ureteroileal anastomotic obstruction. Ho-YAG laser-assisted incision and transureter dilatation were performed 6 months after surgery. Nephrostography performed 1 month after dilatation confirmed improvement of the obstructed area and no symptom recurrence.

ObjectiveThis study aimed to determine and compare the tumor shrinkage rate and its durability by enfortumab vedotin treatment between primary urothelial carcinoma and metastatic organs.MethodsWe retrospectively evaluated the tumor shrinkage rate in 39 Japanese patients treated with enfortumab vedotin for advanced urothelial carcinoma. We also evaluated the periods of tumor shrinkage maintenance (the period when best response was maintained) and regrowth (the period from best response to tumor growth confirmation) between primary and metastatic organs.ResultsMeasurable metastatic organs included the lung in 17, lymph node in 22, liver in 6, and bone in 5 cases. Primary lesion was detected in 20 cases. The mean tumor shrinkage rates for lung, lymph node, liver, and bone metastases and primary sites were 21% (−212 to 100), 13% (−130 to 86), −8.5% (−158 to 85), −64% (−250 to 21), and 22% (−38 to 79), respectively. The tumor shrinkage was maintained for 5.9 (0.7–14) months in lung metastases, 8.3 (2.6–14.5) months in lymph node metastases, 3.6 months in liver metastases, 0.7 months in bone metastases, and 1.8 (0.7–5.4) months in primary sites, and the period of regrowth was 7.3 (2.2–19.4), 4.8 (2.0–8.9), 2.8, 6.5, and 2.5 (1.1–5.9) months, respectively.ConclusionsEnfortumab vedotin showed significant tumor shrinkage in the primary tumor, lung metastases, and lymph node metastases, whereas the durability of tumor shrinkage was limited in the primary tumor.

Abstract Background: The enzyme of catechol-O-methyltransferase (COMT) inhibits the proliferation of prostate cancer (PCa). There has been no obvious biomarker that contributes to the selection of a therapeutic agent among new-generation androgen receptor-axis targeted (ARAT) therapy, such as abiraterone (ABI) or enzalutamide (ENZ). We aimed to assess the possibility of using COMT expression as a biomarker for PCa progression and the criteria for selecting ABI or ENZ. Methods: We retrospectively evaluated 60 patients with PCa treated with ABI or ENZ via needle biopsy or radical prostatectomy. Immunostaining of COMT was performed using formalin-fixed, paraffin-embedded blocks obtained from the initial prostate biopsy for diagnosis or prostatectomy. Immunostaining evaluations were scored by immunostaining intensity (0-3) and staining area (0-3), and the total score ≥4 was defined as "high expression" and the total score <4 was defined as "low expression.” The associations between COMT expression levels and clinical outcomes, including the duration of ENZ or ABI response, were also assessed. Results: Of the 60 cases, nine (15%) showed low expression of COMT. Overall survival was significantly shorter in patients with lower COMT expression (hazard ratio [HR] = 0.24, 95% confidence interval [CI] 0.07-0.83, P= 0.024). When ENZ was administered as the first ARAT, progression-free survival (PFS) was significantly different between patients with COMT expression scores <4 and ≥4 (median 5.9 and 23.3 months, respectively). However, when ABI was administered as the first ARAT, there was no significant difference in the PFS of ARAT between COMT expression scores <4 and ≥4. Conclusion: Patients with lower COMT expression have a significantly poorer prognosis for PCa. In addition, PFS after ENZ administration, as the first ARAT, correlated with COMT expression levels. To our knowledge, this is the first report of an association between COMT expression and the duration of ARAT. Citation Format: Shigekatsu Maekawa, Ryo Takata, Ei Shiomi, Daiki Ikarashi, Tomohiko Matsuura, Renpei Kato, Mitsugu Kanehira, Jun Sugimura, Wataru Obara. Association between COMT expression and therapeutic efficacy of androgen receptor-axis targeted in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7629.

Objective The companion diagnosis for olaparib, a poly (ADP-ribose) polymerase inhibitor for prostate cancer, aims to detect BRCA1/2 gene variants. In clinical practice, the frequency of germline BRCA1/2 variants in patients receiving castration-resistant prostate cancer treatment is unknown. We aimed to evaluate the prevalence of germline BRCA1/2 variants and their relationship to prognosis and treatment efficacy in castration-resistant prostate cancer.Methods Between June 2021 and 2023, 92 patients receiving castration-resistant prostate cancer treatment were examined for germline BRCA1/2 variants using BRACAnalysis CDx (R). Furthermore, the associations between BRCA1/2 pathogenic variants and clinical outcomes were assessed.Results Of the 92 patients referred for genetic testing, 6 (6.5%) carried germline pathogenic variants in BRCA1/2. The BRCA2 variant was the most frequent (n = 5), followed by BRCA1 variant (n = 1). Among the five variants in BRCA2, the p.Asp427Thrfs*3 variant was identified for the first time in prostate cancer. Overall survival from castration-resistant prostate cancer for patients with BRCA1/2 variants was significantly shorter than for patients without BRCA1/2 variants (P = 0.043). Progression-free survival of androgen receptor signaling inhibitors for patients with BRCA1/2 variants was significantly shorter than for those without (P = 0.003). Progression-free survival of taxane chemotherapy was significantly shorter in patients with BRCA1/2 variants than in those without (P = 0.0149).Conclusions In clinical practice, 6.5% of patients treated with castration-resistant prostate cancer carried germline BRCA1/2 pathogenic variants. Japanese castration-resistant prostate cancer patients with germline BRCA1/2 mutants have a poor prognosis and may be less responsive to treatment with androgen receptor signaling inhibitors and taxane-based chemotherapy for castration-resistant prostate cancer. In total, 6.5% of patients carried the germline BRCA1/2 pathogenic variants, exhibiting poor prognosis and poor clinical response to androgen receptor-axis-targeted therapy and taxane chemotherapy for castration-resistant prostate cancer.

Chronic kidney disease (CKD) is a progressive disease with no curative treatment. Urinary albumin and estimated glomerular filtration rate (eGFR), which are used for CKD diagnosis, reflect kidney damage and are not effective for early CKD detection. Indoxyl sulfate (IS) is a uremic toxin that promotes renal failure via renal sclerosis and is a potential biomarker of early CKD detection. This retrospective study of a large cohort of healthy subject aimed to evaluate factors associated with serum IS levels and to assess the utility of serum IS as a biomarker for early CKD detection.

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma III (PD41)1 May 2024PD41-06 EVALUATION OF THE TUMOR MICROENVIRONMENT OF UPPER TRACT UROTHELIAL CARCINOMA USING MULTIPLEX FLUORESCENCE IMMUNOHISTOCHEMISTRY Kenta Takahashi, Daiki Ikarashi, Tatsuya Kawamura, Ei Shiomi, Tomohiko Matsuura, Shigekatsu Maekawa, Renpei Kato, Mitsugu Kanehira, Jun Sugimura, Takaya Abe, and Wataru Obara Kenta TakahashiKenta Takahashi , Daiki IkarashiDaiki Ikarashi , Tatsuya KawamuraTatsuya Kawamura , Ei ShiomiEi Shiomi , Tomohiko MatsuuraTomohiko Matsuura , Shigekatsu MaekawaShigekatsu Maekawa , Renpei KatoRenpei Kato , Mitsugu KanehiraMitsugu Kanehira , Jun SugimuraJun Sugimura , Takaya AbeTakaya Abe , and Wataru ObaraWataru Obara View All Author Informationhttps://doi.org/10.1097/01.JU.0001008568.76803.f1.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer was recently classified at the molecular level, including a detailed analysis conducted on oncogene mutations and the tumor microenvironment. However, the association between oncogene mutations and the tumor microenvironment in upper tract urothelial carcinoma is unclear. The aim of this study was to determine the relationship between the tumor microenvironment and the characteristic oncogene mutations in patients with upper tract urothelial carcinoma using multiplex fluorescent immunohistochemistry. METHODS: We evaluated tumor specimens from 17 patients who underwent nephroureterectomy for upper tract urothelial carcinoma and oncogene mutation analysis. The density of each immune cell type, including CD4+ T cells, CD8+ T cells, CD4+Foxp3+ T cells, and CD204+ cells was assessed in the intratumoral and peritumoral areas between fibroblast growth factor receptor (FGFR)3, tumor protein (TP)53, and RAS mutations via multiplex fluorescent immunohistochemistry. RESULTS: The median patient age was 72 (61–82) years, and 12 (70%) patients were men. The primary lesions included renal pelvis cancer in nine patients and ureteral cancer in eight patients. Five patients (16%) received neoadjuvant chemotherapy. Genetic mutation analysis revealed FGFR3, TP53, and RAS mutations in six (35%), four (24%), and one patient (6%), respectively. Seven patients were ≥ pT3 or ypT2, and ten patients were < pT2 or ypT1. Patients with ≥ pT3 or ypT2 tended to have a lower density of immune cells in the intratumoral area compared with the density in other patients. Interestingly, patients with FGFR3 mutations tended to have a lower density of immune cells in the intratumoral areas compared with patients having TP53 or RAS mutations, regardless of pT stage (Figure 1). CONCLUSIONS: Patients with FGFR3 mutations tended to have fewer intratumoral and peritumoral immune cells, suggesting that the therapeutic effect of immune checkpoint inhibitors alone as adjuvant therapy may be limited in these patients. Download PPT Source of Funding: The authors declare no source of funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e888 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kenta Takahashi More articles by this author Daiki Ikarashi More articles by this author Tatsuya Kawamura More articles by this author Ei Shiomi More articles by this author Tomohiko Matsuura More articles by this author Shigekatsu Maekawa More articles by this author Renpei Kato More articles by this author Mitsugu Kanehira More articles by this author Jun Sugimura More articles by this author Takaya Abe More articles by this author Wataru Obara More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (PD61)1 May 2024PD61-11 INITIAL EXPERIENCE OF ROBOT-ASSISTED RADICAL PROSTATECTOMY USING HINOTORI SURGICAL ROBOT SYSTEM Mitsugu Kanehira, Makoto Moriwaka, Moe Toyoshima, Masahiro Kurokawa, Kenta Takahashi, Ei Shiomi, Shuhei Ishii, Daiki Ikarashi, Shigekatsu Maekawa, Renpei Kato, Ryo Takata, Jun Sugimura, Takaya Abe, and Wataru Obara Mitsugu KanehiraMitsugu Kanehira , Makoto MoriwakaMakoto Moriwaka , Moe ToyoshimaMoe Toyoshima , Masahiro KurokawaMasahiro Kurokawa , Kenta TakahashiKenta Takahashi , Ei ShiomiEi Shiomi , Shuhei IshiiShuhei Ishii , Daiki IkarashiDaiki Ikarashi , Shigekatsu MaekawaShigekatsu Maekawa , Renpei KatoRenpei Kato , Ryo TakataRyo Takata , Jun SugimuraJun Sugimura , Takaya AbeTakaya Abe , and Wataru ObaraWataru Obara View All Author Informationhttps://doi.org/10.1097/01.JU.0001009352.31737.3d.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the introduction of robot-assisted surgery, minimally invasive surgery in the field of urology has advanced dramatically. In Japan, only the da Vinci surgical sysytem, a surgical robot approved in 2009, had been available, but the hinotori surgical robot system, a novel domestic robot-assisted surgical system developed, was released in 2020. We started robot-assisted radical prostatectomy using hinotori (hinotori-RARP) in November 2022. Initial outcomes of hinotori-RARP are reported. METHODS: The study cohort consisted of 34 patients who underwent hinotori-RARP from November 2022 to July 2023 in our institute. The surgical procedures were performed by three surgeons. In general, hinotori-RARP was performed by posterior surgical approach, and nerve-sparing was considered on the side where cancer was not detected by biopsy or radiological examination. Lymph node dissection was added to patients based on guidelines. Characteristics, perioperative and postoperative outcomes were retrospectively analyzed.In addition, we compared the outcomes with RARP using da Vinci surgical system (DVSS-RARP) performed by the same surgeons. RESULTS: Median age and iPSA were 69 years and 6.9 ng/mL. There were 5, 19 and 10 patients in low-, Intermediate- and high-risk prostate cancer. Median total operative and cockpit time were 234 and 171 min. Median estimated blood loss was 159.5 mL, and no blood transfusion was needed. There was no conversion to open or laparoscopic surgery. Only one patient had a major complication. Positive surgical margin rates for pT2 and pT3 were 16.7 and 25 %.Compared with DVSS-RARP, there were no differences in outcomes between them. CONCLUSIONS: hinotori-RARP had been safely introduced. The favorable outcomes of hinotori-RARP was comparable to that of DVSS-RARP. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1284 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Mitsugu Kanehira More articles by this author Makoto Moriwaka More articles by this author Moe Toyoshima More articles by this author Masahiro Kurokawa More articles by this author Kenta Takahashi More articles by this author Ei Shiomi More articles by this author Shuhei Ishii More articles by this author Daiki Ikarashi More articles by this author Shigekatsu Maekawa More articles by this author Renpei Kato More articles by this author Ryo Takata More articles by this author Jun Sugimura More articles by this author Takaya Abe More articles by this author Wataru Obara More articles by this author Expand All Advertisement PDF downloadLoading ...

Carnitine not only serves as a transporter, shuttling free fatty acids (FFAs) into the mitochondria, but it also plays a crucial role in essential lipid metabolism processes within the mitochondria, including beta oxidation.

Introduction Renal autotransplantation is considered a surgical procedure for extensive ureteral defects. Herein, we report a case of severe ureteral injury repaired by laparoscopic nephrectomy and renal autotransplantation with an iliac vein patch using bovine pericardium. Case presentation A 56‐year‐old woman who had previously undergone gynecological surgery complained of right‐sided abdominal pain. She was then later diagnosed with a right middle ureteral injury with a 5‐cm long defect. We performed retroperitoneal laparoscopic nephrectomy and renal autotransplantation. As the iliac vein was fragile, venous patching using bovine pericardium was performed. The patient's renal function was well preserved after surgery. Conclusion Laparoscopic nephrectomy and renal autotransplantation is an effective method for repairing severe ureteral injury with the preservation of renal function. A venous patch using bovine pericardium might be considered as a replacement for a fragile vein.

BackgroundThis study aimed to compare the outcomes of living donor kidney transplantation with blood- and non-blood-related donors across multiple facilities. Previous reports comparing these outcomes have been single-center studies. As the donors were the recipients' spouses in all cases with non-blood-related donors, we independently compared the outcomes of wife-to-husband (WTH) and husband-to-wife (HTW) transplantations. No previous multicenter studies have compared transplant outcomes between spouses in this manner.MethodsThis retrospective study used a shared database including 643 cases from 6 facilities that primarily used tacrolimus as a calcineurin inhibitor. We used propensity score matching to compare the outcomes of transplantations with blood- and non-blood-related donors and those of WTH and HTW transplantations.ResultsOf the 643 cases examined, 381 and 262 had blood- and non-blood-related donors, respectively. All non-blood-related donor cases had spouses as donors. After propensity score matching, 84 cases each were selected from the blood- and non-blood-related donor groups for comparison, with no significant intergroup difference in the time to graft loss. Among the 262 interspousal transplantations, 91 were HTW transplantations and 171 were WTH transplantations. Following propensity score matching, 58 cases each were selected from the WTH and HTW groups for comparison, with no significant intergroup difference in the time to graft loss.ConclusionsIn this large multicenter retrospective study, no significant differences were observed in the outcomes of transplantations with blood- and non-blood-related donors. Furthermore, no significant differences were observed in the outcomes of WTH and HTW cases. Many centers that use tacrolimus-based four-drug immunosuppressive therapy may have similar trends as those observed in this study, making our findings significant for planning transplantation involving kidneys donated from patients' spouses.

BACKGROUND:Thrombotic microangiopathy (TMA) after kidney transplantation (KTx), particularly early onset de novo (dn) TMA, requires immediate interventions to prevent irreversible organ damage. This multicenter study was performed to investigate the allogeneic clinical factors and complement genetic background of dnTMA after KTx.METHODS:Perioperative dnTMA after KTx within 1 week after KTx were diagnosed based on pathological or/and hematological criteria at each center, and their immunological backgrounds were researched. Twelve aHUS-related gene variants were examined in dnTMA cases.RESULTS:Seventeen recipients (15 donors) were enrolled, and all dnTMA cases were onset within 72-h of KTx, and 16 of 17 cases were ABO incompatible. The implementation rate of pre-transplant plasmaphereses therapies were low, including cases with high titers of anti-A/anti-B antibodies. Examination of aHUS-related gene variants revealed some deletions and variants with minor allele frequency (MAF) in Japan or East Asian genome databases in genes encoding alternative pathways and complement regulatory factors. These variants was positive in 8 cases, 6 of which were positive in both recipient and donor, but only in one graft loss case.CONCLUSIONS:Although some immunological risks were found for dnTMA after KTx, only a few cases developed into TMA. The characteristic variations revealed in the present study may be novel candidates related to dnTMA in Japanese or Asian patients, but not pathogenic variants of aHUS. Future studies on genetic and antigenic factors are needed to identify factors contributing to dnTMA after KTx.