Introduction:Ileal conduit diversion is commonly performed after cystectomy and is considered the gold standard. However, late complications can occur. Case Presentation:A 74-year-old woman had undergone cystectomy with ileal conduit diversion for neurogenic bladder dysfunction 47 years earlier. She presented with recurrent urinary tract infections and bilateral hydroureteronephrosis. Imaging revealed conduit stenosis and impaired bilateral renal function. Endoscopy of ileal conduit revealed a pinhole-like stenosis on the proximal side. A 10-Fr catheter was advanced across the stenotic segment, resulting in pyelonephritis resolution and renal function improvement. After 1 month, the catheter was upsized to 16-Fr. Five months later, the catheter was spontaneously expelled, and good urine flow was maintained, with no recurrence over 2 years of follow-up. Conclusion:Ileal conduit stenosis can occur even decades after urinary diversion and can be managed effectively by stepwise dilation. The present case highlights the need for lifelong surveillance in ileal conduit patients.

The urethral caruncle is the most common lesion arising from the posterior lip of the urethral meatus in women; however, various benign and malignant tumours may mimic this condition. We report a case of a solitary fibrous tumour (SFT) presenting as a urethral caruncle. A woman in her late 60s presented with a progressively enlarging urethral mass that was accompanied by urinary spraying. Physical examination revealed a smooth spherical mass measuring 1.2 cm at the posterior urethral meatus. The lesion was completely excised under local anaesthesia. Histologically, the tumour consisted of spindle cells within collagenous stroma. Immunohistochemically, the tumour cells showed nuclear expression of STAT6 with focal CD34 positivity, supporting the diagnosis of SFT. No recurrence was observed during the 9-month follow-up period. This case highlights that lesions clinically resembling urethral caruncle may include mesenchymal tumours such as SFT, underscoring the importance of histopathological evaluation.

BackgroundMetastatic bladder urothelial carcinoma has poor survival, and large comparative genomic studies using uniform targeted sequencing of paired primary and metastatic lesions remain limited. We compared gene- and pathway-level alterations between primary and metastatic tumorsMethodsWe analyzed 2,880 bladder urothelial carcinoma samples (2,305 primary; 575 metastatic) from 2,343 patients profiled with MSK-IMPACT. Somatic mutations and copy number alterations were integrated per gene and compared between primary and metastatic samples in the full cohort and in a paired subset using standard statistical tests.ResultsPrimary and metastatic samples showed broadly similar driver landscapes. In the full cohort, KDM6A, FGFR3, STAG2, and ERCC2 were more frequently altered in primary tumors, whereas no individual genes were enriched in metastases; these differences were not significant in paired analyses. At the pathway level, TP53 pathway alterations were relatively more frequent in metastases, while DNA damage response alterations were enriched in primary tumors; other pathways showed comparable alteration rates. Apoptosis-focused analyses identified no significant gene-level differences, but suggested a trend toward higher alteration rates in the TP53 pathway and apoptosis regulators in metastases.ConclusionPrimary and metastatic lesions of bladder urothelial carcinoma show broadly similar gene- and pathway-level alteration profiles on targeted DNA sequencing. TP53 pathway and apoptosis-related alterations are modestly more frequent in metastases, consistent with impaired stress responses and apoptosis evasion.

Background:At our institution, 99mTc-MAG3 renal scintigraphy is routinely performed preoperatively in living kidney donors and on postoperative Day 1 in recipients. Given the interindividual variability in MAG3 clearance, we hypothesized that postoperative MAG3 clearance could serve as an early indicator of renal graft function. In addition, we explored whether the donor-to-recipient clearance ratio (M-ratio) provides supplemental clinical value. Early identification of such indicators of graft function is essential for optimizing postoperative management and improving outcomes. Methods:This retrospective study analyzed 52 living donor kidney transplants performed between October 2009 and May 2024. Associations were examined between donor and recipient MAG3 clearance values, the M-ratio (elevated ≥ 1.5 vs decreased/stable < 1.5), donor/recipient age and sex, T1/2 pattern (good excretion ≤ 20 min vs delayed > 20 min or unmeasurable), total ischemic time, graft weight, dialysis duration, and estimated glomerular filtration rate (eGFR) at 1 week and 1-12 months postoperatively. Variables with p < 0.05 in univariate analysis entered multivariate regression. Results:Univariate analysis showed that recipient MAG3 clearance, the M-ratio, donor and recipient age, T1/2 (up to 1 month), and graft weight (at 1 week) were significantly associated with graft function. In contrast, donor MAG3 clearance was not correlated with postoperative renal function. In multivariate analysis, recipient MAG3 clearance, recipient age, and graft weight remained independently associated with early graft function, whereas the M-ratio lost significance. Conclusions:Recipient MAG3 clearance on postoperative Day 1 is a practical, noninvasive indicator of renal graft function, while donor clearance and the M-ratio are not independently associated with postoperative outcomes.

BACKGROUND:Active surveillance (AS) offers a strategy to limit unnecessary treatment of prostate cancer while maintaining oncologic safety, yet its adoption in Japan remains limited. To provide Japan-specific evidence, we evaluated the clinical outcomes of patients undergoing AS at our institution. METHODS:We retrospectively reviewed 86 patients who selected AS between 2012 and 2024. Eligibility criteria included ≤ cT2a disease, prostate-specific antigen (PSA) level of ≤ 10 ng/mL, Gleason score (GS) of 3 + 3, and 2 or fewer positive cores, with selected inclusion of GS 3 + 4 or 4 + 3 based on patient preference. AS discontinuation was based on clinical or pathological progression or patient preference. This study was approved by the institutional review board of Gunma University (approval no. IRB2025-033, 2310). RESULTS:The mean observation period was 48 months. No prostate cancer-specific deaths occurred. AS persistence rates were 89% at 1 year, 55% at 5 years, and 27% at 10 years. Older age (≥ 75 years) was associated with longer AS persistence (p = 0.021). Overall, 69% of patients underwent repeat biopsy, most commonly at 1 year. Pathological upgrading occurred in 35% at the first and second repeat biopsies and in 20% at the third. Acceptance of the 1-year repeat biopsy increased from 46% in the early period (2012-2016) to 64% in the later period (2017-2024). CONCLUSIONS:AS demonstrated favorable long-term safety and durability. Improving adherence to repeat biopsy protocols may further enhance AS management in Japan. REGISTRY AND REGISTRATION NO. OF THE STUDY/TRIAL:N/A.

BACKGROUND:[-2]proPSA(p2PSA)-related indices have demonstrated diagnostic value for detecting prostate cancer (PC) in males with modest increases in prostate-specific antigen levels (PSA) of < 10 ng/mL. However, the "leak point" of p2PSA level in the blood circulation before developing screen-detectable PC remains uncertain. Therefore, this study evaluated the ability of p2PSA-related indices in the years before considering conventional biopsy indications. METHODS:This case-control study analyzed database and serum bank information from a population-based screening cohort in Gunma Prefecture. The case group included 58 males diagnosed with PC due to increased PSA (4-10 ng/mL) followed serially for 5 years. The control group comprised 58 males without PC based on biopsy who were matched to the case group by adjusted PSA levels (± 2 ng/mL) and age (± 5 years) at the time of biopsy. p2PSA, free PSA, and PSA were measured from frozen serum samples from 0 to 5 years before biopsy. RESULTS:p2PSA-to-free PSA ratio (%p2PSA) and prostate health index (phi) were significantly higher in the case group than in the control group from five, three, and 3 years before biopsy, respectively. The areas under the receiver operating characteristic curve for predicting PC were 0.437 for PSA, 0.637 for phi, 0.663 for %p2PSA, and 0.618 for free PSA-to PSA ratio (%fPSA) at 3 years before biopsy. CONCLUSIONS:p2PSA-related indices showed group-level differences between future PC cases and matched controls before PSA exceeded conventional cut-offs. These findings should be regarded as hypothesis-generating and require validation in prospective studies before clinical application to risk-stratified screening.

BACKGROUND:Radium-223 dichloride (Ra-223) is an effective treatment for metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. However, predictive factors associated with treatment efficacy remain unclear. This study evaluated prognostic factors associated with the efficacy of Ra-223 and investigated outcomes according to enzalutamide (ENZ) combination patterns. METHODS:We retrospectively analyzed 34 patients with mCRPC treated with Ra-223 between 2016 and 2024. Progression-free survival (PFS) and overall survival (OS) were evaluated according to time to CRPC, pre-treatment prostate-specific antigen (PSA), PSA doubling time (PSADT), metastatic burden, and ENZ treatment patterns. Cutoff values were determined using the Contal-O'Quigley method. This study was approved by the Institutional Review Board of Gunma University (Approval No. 1662). RESULTS:The median time to CRPC, pre-treatment PSA level, and PSADT were 17 months, 6.2 ng/mL, and 2.2 months, respectively. Shorter time to CRPC (≤ 19 months), higher pre-treatment PSA (> 2.67 ng/mL), and shorter PSADT (≤ 2 months) were significantly associated with shorter PFS. Patients with ≥ 4 bone metastatic regions had significantly worse OS than those with ≤ 3 regions. Among the ENZ treatment patterns, continuous ENZ administration combined with Ra-223 was associated with significantly longer PFS than discontinuation of ENZ. CONCLUSIONS:Time to CRPC, pre-treatment PSA, and PSADT may represent potentially useful candidate markers for identifying patients more likely to benefit from Ra-223 therapy. Continued ENZ administration during Ra-223 therapy was associated with favorable PFS in selected patients; however, this finding should be considered exploratory and requires validation in larger cohorts.

Multilocular intratesticular cysts are uncommon benign lesions. We report a case associated with testicular microlithiasis in an 85-year-old man presenting with painless enlargement of the left scrotum. Ultrasonography revealed a multilocular cystic lesion with a 3.0-cm main cyst and several adjacent smaller cysts showing posterior acoustic enhancement without mural irregularity or solid components. Bilateral microlithiasis and small epididymal cysts were also detected, and serum tumor markers were normal. The lesions remained stable during 36 months of follow-up. Recognition of the characteristic ultrasonographic features of benign intratesticular cysts is important to avoid unnecessary surgical intervention.

An 85-year-old man presented with painless enlargement of the left scrotum [...]

INTRODUCTION:Urinary drainage (ureteral stenting or percutaneous nephrostomy) is commonly used for malignant ureteral obstruction (MUO), but optimal indications remain unclear. [99mTc]Tc-mercaptoacetyltriglycine (MAG3) renal scintigraphy assesses urinary tract obstruction and may help identify patients who can avoid drainage. The aim of this case series was to investigate the impact of urinary drainage guided by MAG3 findings on renal function in MUO patients. METHODS:We retrospectively reviewed 44 MUO patients who underwent MAG3 scintigraphy between April 2020 and January 2022. Based on results, 29 patients underwent urinary drainage and 15 patients were treated conservatively. Patients were classified by MAG3 excretion pattern and followed by renal function, pyelonephritis and flank pain at 1, 2, 3 and 6 months. RESULTS:Among the conservative group (n = 15), MAG3 patterns included non-function (n = 7), delayed excretion (n = 7) and obstruction (n = 1). No patients developed renal deterioration or pyelonephritis, though one patient underwent drainage for contralateral flank pain. Among the drainage group (n = 29), MAG3 patterns included obstruction (n = 16), delayed excretion (n = 8), declined excretion (n = 3) and non-function (n = 2). CONCLUSION:Fourteen of 15 patients treated conservatively after MAG3 scintigraphy experienced no renal complications during 6 months of follow-up. MAG3 scintigraphy may support individualised decision-making and help avoid unnecessary drainage. Conservative management may be appropriate for patients with a non-functional MAG3 pattern.

BACKGROUND:C1orf50 encodes a small, evolutionarily conserved protein, the function of which remains unclear. Its significance across various human cancers, particularly its specific role in ovarian cancer within an immunogenomic context, is not yet fully understood. Utilizing The Cancer Genome Atlas and single-cell RNA sequencing (scRNA-seq) public datasets, we conducted a comprehensive profiling of C1orf50 across multiple cancer types, with a particular focus on ovarian cancer, to investigate its associations with copy-number status, genomic instability, tumor programs, and the immune microenvironment. RESULTS:Across cancer types, copy-number gain or amplification of C1orf50 was most frequent in ovarian cancer and closely tracked with higher messenger RNA levels. Higher C1orf50 expression was associated with a greater tumor mutational burden and homologous recombination deficiency, as indicated by gene-set patterns that suggested heightened cell-cycle and cellular stress responses accompanied by reduced oxidative phosphorylation, enrichment of regulatory T cells, and depletion of resting memory CD4 T cells. In ovarian cancer, focal events at chromosome 1p34.2 were accompanied by stepwise increases in C1orf50 expression by clinical stage and were linked to higher tumor mutational burden, homologous recombination deficiency, and greater loss of heterozygosity, together with more frequent gene alterations in BRCA1 or BRCA2. Immune composition clustered into profiles consistent with an immunosuppressive context in tumors with higher C1orf50 expression. The scRNA-seq data further revealed that cancer cells enhanced immune-suppressive interactions with various immune cell populations and diminished antigen-presentation signals. Analyses of genomic instability in ovarian cancer suggested mutational processes compatible with base-substitution patterns associated with cytidine deaminase activity and with insertion-deletion patterns characteristic of homologous recombination failure, while transcript-level patterns pointed to a broad downshift of canonical DNA repair activity with apparent compensatory adjustments in related pathways rather than a uniform change in any single pathway. CONCLUSIONS:The overexpression of C1orf50 characterizes an aggressive immunogenomic phenotype in ovarian cancer, distinguished by genomic instability, impaired DNA repair mechanisms, and extensive immunosuppression. These findings indicate that C1orf50 warrants consideration as a potential biomarker and a prospective target for therapeutic investigation. Furthermore, they advocate for the progression to prospective validation and functional studies to ascertain its clinical significance.

Small cell carcinoma of the urinary bladder (SCCB) is a rare and aggressive malignancy with limited treatment options and a poor prognosis. We present the case of a 63-year-old man who was initially diagnosed to have non-metastatic high-grade non-muscle invasive urothelial carcinoma with sarcomatoid subtype and later developed bone metastases. A bone biopsy confirmed small cell carcinoma, and retrospective review of the original tumor revealed mixed histology comprising small cell, sarcomatoid-like, and conventional urothelial carcinoma components. The patient was treated with six cycles of cisplatin and etoposide, during which genomic profiling identified a high tumor mutational burden (22 mutations/megabase). Based on this finding, pembrolizumab was administered sequentially as monotherapy. The patient achieved a complete response that lasted for more than 1 year, but subsequently developed lymph node metastases and recurrences in bone. This case highlights the role of genomic profiling test for clinical decision-making as tumor mutational burden predicts the efficacy of immune checkpoint inhibitor therapy in SCCB. This case also underscores the urgent need for novel treatment approaches for SCCB.

目 的：ロボット支援根治的前立腺全摘を受けた方の満足度に，術後の排尿，排便，性機能の悩みがどう影響するのか調査した．次いで，術後の性機能障害につきより検討した．