A 58-year-old man presented with anal pain and fecal incontinence. He was diagnosed with locally advanced rectal cancer (cT4bN3M0) with prostate invasion and referred for combined surgery. Robotic abdominoperineal resection and retzius-sparing robot-assisted radical prostatectomy (RS-RARP) were performed. On postoperative day 14, cystography showed no evidence of vesicourethral anastomotic leakage, and the urethral catheter was removed. The postoperative course was uneventful without urinary incontinence. Pathological findings confirmed prostate invasion with negative surgical margins. Adjuvant chemotherapy was administered, and no recurrence has been observed at one year. In cases of rectal cancer with prostate invasion, concomitant prostate and seminal vesicle resection is often required, which carries a high risk of vesicourethral leakage and incontinence. RS-RARP preserves the anterior structures of the prostate and may reduce the risk of anastomotic failure while maintaining continence and sexual function. This case suggests that RS-RARP combined with APR could be a feasible surgical option for achieving curative resection and functional preservation in selected patients with locally advanced rectal cancer invading the prostate.

This study investigates whether ureteroscopy (URS) increases intravesical recurrence (IVR) risk following radical nephroureterectomy for upper tract urothelial carcinoma and identifies vulnerable patient subgroups. Previous studies did not fully clarify the impact of URS and biopsy on IVR risk, or whether the risk is elevated in specific subgroups. We retrospectively analyzed 1,483 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma at nine institutions between January 2001 and April 2024. Cox proportional hazards models identified risk factors for IVR. Subgroup analyses determined characteristics increasing recurrence susceptibility. Inverse probability of treatment weighting validated subgroup analyses results. The median follow-up period was 45.1 (IQR 21.1–79.4) months. Multivariable analysis revealed that male sex, lower clinical T stage, concomitant bladder cancer, and pathological node-negative status were significantly associated with shorter IVR-free survival and confirmed URS as an independent risk factor for recurrence (HR = 1.30, 95% CI: 1.10–1.53, P < 0.001). URS-associated recurrence risk varied most by the presence of hydronephrosis. In weight-adjusted cohorts, IVR-free survival was significantly shorter with URS compared to non-URS among patients without hydronephrosis (HR = 1.73, 95% CI: 1.35–2.21, P < 0.001), whereas no significant differences were observed among patients with hydronephrosis (HR = 1.11, 95% CI: 0.88–1.40, P = 0.4). URS was an independent risk factor for IVR, but was not associated with increased risk among patients with hydronephrosis, whereas significantly increased risk was observed in patients without hydronephrosis.

PURPOSE:We analyze determinants of postoperative recovery from urinary incontinence following robot-assisted laparoscopic radical prostatectomy, with a focus on membranous urethral length and inclusion of nerve sparing. MATERIALS AND METHODS:This retrospective study included patients who underwent robot-assisted laparoscopic radical prostatectomy from 2017 to 2022 performed at a single institution. Cox proportional hazards analysis was conducted for postoperative recovery from urinary incontinence, defined as use of zero or one pad/day. Examined patient factors were age, body mass index, prostate volume, and membranous urethral length, while surgical factors were nerve-sparing status, operative time, and console time. RESULTS:A total of 197 patients were included in the analysis. Median membranous urethral length was 11.6 mm. Nerve sparing was performed in 92 (46.7%), with unilateral preservation in 68 and bilateral preservation in 24. In total, patients both univariate and multivariate Cox hazard analyses showed that the only significant factor for recovery from urinary incontinence was membranous urethral length (hazard ratio 1.059, p = 0.01), while nerve sparing was not significant (hazard ratio 1.132, p = 0.43). However, when patients were subdivided into two groups based on the median value for membranous urethral length (11.6 mm), nerve sparing was not a significant factor for recovery in the longer group (≥ 11.6 mm, n = 99, hazard ratio 0.898, p = 0.64), while that was significant in the shorter group (< 11.6 mm, n = 98, hazard ratio 1.55, p = 0.049). CONCLUSION:The present results may indicate that nerve sparing is more recommended for patients with a shorter membranous urethral length.

Introduction Pembrolizumab administration has become the standard of care for patients with urothelial carcinoma, though a variety of adverse events have been reported. Presented here is a rare case of pancreatitis that occurred as an immune‐related adverse event. Case presentation An 81‐year‐old man undergoing treatment with pembrolizumab for multiple lung metastases from renal pelvic cancer was presented with a fever and diagnosed with pancreatitis based on elevated pancreatic enzyme levels and imaging findings. There was no history of alcohol consumption or findings indicating gallstones, elevated liver enzymes, or abdominal complications. The patient was diagnosed with immune‐related adverse event pancreatitis and treated with Lactate Ringer's solution (3000 mL/day) and steroids, during which his condition improved. Conclusion Although pancreatitis is a rare complication, it should always be considered as a potential immune‐related adverse event in patients treated with an immune checkpoint inhibitor such as pembrolizumab.

Abstract Purpose: New markers that enable the percentage of transitional cell carcinomas (TCC) of the bladder that are diagnosed before invasion of the bladder muscle layers to be increased would reduce the morbidity and mortality associated with this disease. The purpose of this study was to develop a simple, accurate urine test based on mRNA markers and simple gene signatures that (a) could detect TCC before muscle invasion while maintaining high specificity in patients with hematuria or urinary tract infections and (b) identify patients most likely to have grade 3 or stage ≥T1 disease. Experimental Design: RNA markers with high overexpression in stage Ta tumors and/or T1 to T4 tumors but low expression in blood or inflammatory cells were characterized by quantitative reverse transcription-PCR using 2 mL of voided urine from 75 TCC patients and 77 control patients with other urological diseases. Results: A combination of the RNAs CDC2, MDK, IGFBP5, and HOXA13 detected 48%, 90%, and 100% of stage Ta, T1, and >T1 TCCs, respectively, at a specificity of 85%. Detection of Ta tumors increased to 60% for primary (non-recurrent) Ta tumors and 76% for Ta tumors ≥1 cm in diameter. Test specificity was 80% for the 20 control patients with urinary tract infections. The combination of CDC2 and HOXA13 distinguished between grade 1 to 2 TCCs and grade 3 or stage ≥T1 TCCs with ∼80% specificity and sensitivity. Conclusions: Simple gene expression signatures can be used as urine markers for the accurate detection and characterization of bladder cancer.

A 74-year-old man was diagnosed with bladder cancer and referred to our department. For definitive diagnosis, transurethral resection of the bladder tumor(TURBT) was performed. The pathological result showed plasmacytoid variant of urothelial carcinoma. Subsequently, robot-assisted radical cystectomy, lymph node dissection and ileal conduit was performed, but multiple bone metastases and periaortic lymph node metastases newly appeared 30 days later. Gemcitabine and cisplatin (GC) was started, and after 4 courses, the patient became Partial Response (PR), and was switched to Avelumab as maintenance therapy. After about 1 year of maintenance therapy, the patient is still in PR.

Supplementary Data from Development of a Multiplex RNA Urine Test for the Detection and Stratification of Transitional Cell Carcinoma of the Bladder

Supplementary Table S2 from Secreted CXCL1 Is a Potential Mediator and Marker of the Tumor Invasion of Bladder Cancer

Perivascular epithelioid cell tumor (PEComa) was introduced in the WHO classification of bone and soft tissue tumors in 2002, and Bladder PEComa is very rare. A 60-year-old man underwent TURBT after CT and cystoscopy revealed a 2.5 cm tumor with a concave center on the posterior wall of the bladder. Pathological examination revealed a perivascular epithelioid cell tumor, which was diagnosed as primary bladder PEComa after systemic examination. We report a case of partial bladder resection for bladder PEComa, a type of mesenchymal tumor that does not originate from the bladder mucosa.

Intravesical Bacillus Calmette-Guérin instillation therapy after transurethral resection of bladder tumor is considered as the most effective treatment for prophylaxis against the recurrence of high-risk, non-muscle bladder cancer. However, intravesical Bacillus Calmette-Guérin instillation therapy has some characteristic complications. Here, we report a case of infectious thoracic aortic aneurysm related to prior intravesical Bacillus Calmette-Guérin instillation, which consequently allows the spread into the adjacent lung tissue and secretion in sputum of Mycobacterium bovis.

Background: This study investigated the optimal timing for starting docetaxel (DOC) and cabazitaxel (CBZ) by examining the correlation of their efficacy and evaluating factors associated with the prognosis of patients with castration-resistant prostate cancer (CRPC) receiving DOC-CBZ sequential treatment. Methods: We retrospectively evaluated data for 146 patients who received DOC followed by CBZ. The correlations of prostate specific antigen (PSA) decrease rate and time to progression between DOC and CBZ treatment were examined. The association of parameters with progression-free survival (PFS) and overall survival (OS) were evaluated. Survival rates were compared between patients with high and low PSA levels at the start of DOC and CBZ treatment. Results: No correlations of PSA decrease rate and time to progression were observed between DOC and CBZ. In multivariate analyses, higher PSA level at the start of DOC was significantly associated with shorter PFS ( P = 0.004) and OS ( P = 0.001). The OS of patients who started DOC and CBZ at low PSA levels was significantly longer than those that started at high PSA levels ( P = 0.002 and P = 0.003). In patients who started DOC at high PSA levels, those who switched to CBZ at low PSA levels had longer OS than those who switched at high PSA levels ( P = 0.048). Conclusions: For patients for whom DOC was not effective, sequential CBZ might reduce PSA for a long duration. Starting DOC and switching to CBZ at low PSA levels might result in improved prognoses in CRPC patients. Trial registration: This study was registered retrospectively.

IntroductionThere have been some reports describing metastasis to the stomach from renal cell carcinomas. However, there are few reports describing solitary synchronous gastric metastasis of renal cell carcinomas.Case presentationThe patient was a 70‐year‐old woman who underwent an upper gastrointestinal endoscopy to examine her progressive weight loss. There was a submucosal tumor in the stomach, which was biopsied. The gastric tumor was pathologically proven to be a metastatic clear cell renal cell carcinoma. Furthermore, contrast‐enhanced computed tomography showed right renal cell carcinoma invading the renal vein (cT3aN0M0). The patient underwent right radical nephrectomy and endoscopic resection for the treatment of the primary renal cancer and the gastric metastatic lesion, respectively. The resected specimen of the stomach had a clear resection margin.ConclusionEndoscopic resection for early stage gastric metastatic lesions of renal cell carcinomas is a reasonable approach because it is a minimally invasive surgical technique.

Malignant rhabdoid tumours (MRTs) in the kidney are rare paediatric tumours that are extremely rare in adults. We herein report the case of an adult patient with a renal MRT. A 79-year-old Japanese woman was found to have a tumour sized 63×48 mm in the left kidney, in addition to multiple metastatic bone and lymph node lesions. The needle biopsy specimen obtained from the patient's kidney revealed tumour cells with rhabdoid characteristics: The cells appeared large, round or polygonal, with eccentrically located nuclei and prominent nucleoli. Immunohistochemically, the tumour cells were positive for vimentin, epithelial membrane antigen, CAM 5.2, and p53, and negative for INI1, cytokeratin (CK)7, CK20, α-methylacyl-CoA racemase, S100, CD45, renal cell carcinoma marker, anaplastic lymphoma kinase, α-smooth muscle actin, desmin, MyoD, myogenin, human melanoma black 45 and melan A. Therefore, the tumour was diagnosed as an MRT located in the kidney. Although the patient was treated with axitinib, a tyrosine kinase inhibitor, the renal tumour and its metastatic lesions continued to progress, and the number of metastatic lesions increased. The patient succumbed to the disease 5 months after the first hospital visit. The disease progression was rapid, with a poor prognosis, consistently with previous reports that of MRTs in the adult kidney.

Mucinous tubular and spindle cell carcinoma (MTSCC) is rare in renal cell carcinoma (RCC) and usually demonstrates a low nuclear grade and a better prognosis compared with other RCCs. The authors present a case report of MTSCC containing an area of Fuhrman nuclear grade 3, in addition to an area with a micropapillary pattern. An 82-year-old man consulted a hospital due to macrohematuria, and a tumor in the right kidney was detected. The tumor was resected and histologically examined. The tumor consisted of various growth patterns: Elongated tubular structure, a papillary structure containing a micropapillary pattern and solid pattern with spindle cells. The tumor cells demonstrated Fuhrman nuclear grades 2 and 3. Invasion into the lymph vessel and metastasis into the regional lymph node were observed. Thus, the tumor was diagnosed as a high grade MTSCC. Five months following resection, a computed tomography scan suggested metastasis of the tumor into the para-aortic lymph nodes and liver, and the patient succumbed to brain metastasis. When MTSCC of kidney is observed, careful histological observation is important to avoid missing a high nuclear grade area.

A 59-year-old man was referred to our hospital with right hydronephrosis, which was diagnosed from a medical examination. On imaging studies, he had concentric thickness of the right ureteral wall, and retroperitoneal and mesenteric lymphadenopathy. Urine cytology was negative, and an ureteroscopic biopsy showed no malignancy. We performed laparoscopic biopsy of the retroperitoneal lymphadenopathy, and the histopathological diagnosis was B-cell follicular lymphoma. The patient received four cycles of RCVP (rituximab, cyclophosphamide, vincristine, prednisolone) chemotherapy and four cycles of rituximab monotherapy and then he obtained complete remission. If concentric thickness of the ureteral wall is found, physicians should be aware of the possibility of malignant lymphoma and should consider laparoscopic biopsy for diagnosis.

A 46-year-old woman with gross hematuria was referred to our hospital with suspicion of bilateral renal cell carcinoma. Computed tomography (CT) showed multiple renal tumors with contrast enhancement and multiple lung nodules. Based on a diagnosis of bilateral multiple renal cell carcinoma with multiple lung metastases, a combination therapy with interferon-alpha (IFN-alpha) and 5-flurouracil (5-FU) was initiated. Six months later, all the renal and pulmonary lesions remained the same, and IFN-alpha alone was continued thereafter. One tumor in the right upper pole decreased in size during the next six years, while all the other lesions remained unchanged. Then the immunotherapy was discontinued on the basis of possibility that the tumors could be benign lesions. Three years later,the right upper renal tumor disappeared on CT, but, one of the left renal tumors showed progressive disease. The patient underwent left partial nephrectomy together with resection of neighboring small tumors. All the excised tumors were diagnosed as chromophobe renal cell carcinoma on histological examination. There has been no change with the remaining tumors for 1.5 years postoperatively.

Purpose: We evaluated the use of narrow-band imaging (NBI) cystoscopy for the detection of bladder cancer and analyzed its diagnostic efficacy in cases of carcinoma in situ (CIS) and in cases with known urine cytology results. Patients and Methods: A prospective controlled study of NBI was conducted in 104 consecutive patients with definite or suspected bladder cancer. Transurethral targeted biopsies were performed after white light imaging (WLI) and NBI cystoscopy, and the histologic outcomes were compared. Results: A total of 313 biopsies were taken, including 161 from sites identified as potentially abnormal by NBI and/or WLI cystoscopy, and 152 from apparently normal sites. The percentage of malignancies in the sites identified only by NBI was 55.7% (39/70 places). In 26.9% of patients (28/104), bladder tumors were detected only by NBI. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of a negative test (NLR) for the detection of bladder tumors using NBI in all patients were 92.7%, 70.9%, 63.4%, 94.7%, and 0.10, respectively. The sensitivity, specificity, PPV, NPV, and NLR for the detection of CIS using NBI were 89.7%, 74.5%, 78.8%, 87.2%, and 0.14, respectively. The sensitivity, specificity, PPV, NPV, and NLR for the detection of bladder tumors using NBI in patients with positive vs negative urine cytology were 85.4% vs 98.4%, 75.7% vs 66.3%, 61.2% vs 64.5%, 92.0% vs 98.5%, and 0.19 vs 0.02, respectively. Conclusions: NBI is a simple and effective method for identifying bladder tumors including CIS without the need for dyes because of its high sensitivity, high NPV, and low NLR.

Sorafenib (Nexavar®) has been approved for the treatment of advanced renal cell carcinoma (RCC) and hepatocellular carcinoma. There is little information on the dosage adjustment of sorafenib for patients with end-stage renal failure. Herein, we have examined the effect of hemodialysis on the pharmacokinetics of sorafenib and its major active metabolite, M-2, and assessed sorafenib-related toxicity throughout the therapy. The patient was a 54-year-old man who was diagnosed with advanced RCC. Pharmacokinetic analysis was carried out on days 9 and 183. The patient had stable disease on day 77 and showed progression on day 181. He has received about 6 months of continuous treatment with sorafenib 800 mg/day without any clinically relevant toxicity. The pharmacokinetic parameters of sorafenib such as C max and AUC0–12 on day 183 were in the range of the reference values reported in patients with normal renal function. Our results suggest that sorafenib administered at a dose of 400 mg twice per day was well tolerated, at least for 6 months, for a patient undergoing hemodialysis.

We previously reported that the expression of CXC chemokine receptor-4 (CXCR4) was upregulated in invasive bladder cancers and that the small peptide T140 was a highly sensitive antagonist for CXCR4. In this study, we identified that CXCR4 expression was induced in high-grade superficial bladder tumors, including carcinoma in situ and invasive bladder tumors. To visualize the bladder cancer cells using urinary sediments from the patients and chemically induced mouse bladder cancer model, a novel fluorescent CXCR4 antagonist TY14003 was developed, that is a T140 derivative. TY14003 could label bladder cancer cell lines expressing CXCR4, whereas negative-control fluorescent peptides did not label them. When labeling urinary sediments from patients with invasive bladder cancer, positive-stained cells were identified in all patients with bladder cancer and positive urine cytology but not in controls. Although white blood cells in urine were also labeled with TY14003, they could be easily discriminated from urothelial cells by their shape and size. Finally, intravesical instillation of TY14003 into mouse bladder, using N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN)-induced bladder cancer model, demonstrated that fluorescent signals were detected in the focal areas of bladder of all mice examined at 12 weeks of BBN drinking by confocal microscopy and fluorescent endoscopy. On the contrary, all the normal bladders were found to be negative for TY14003 staining. In conclusion, these results indicate that TY14003 is a promising diagnostic tool to visualize small or flat high-grade superficial bladder cancer.

In Japan, until now, the treatment of bladder cancer has been based on guidelines from overseas. The problem with this practice is that the options recommended in overseas guidelines are not necessarily suitable for Japanese clinical practice. A relatively large number of clinical trials have been conducted in Japan in the field of bladder cancer, and the Japanese Urological Association (JUA) considered it appropriate to formulate their own guidelines. These Guidelines present an overview of bladder cancer at each clinical stage, followed by clinical questions that address problems frequently faced in everyday clinical practice. In this English translation of a shortened version of the original Guidelines, we have abridged each overview, summarized each clinical question and its answer, and only included the references we considered of particular importance.