A 7-year-old boy who had been under observation after being diagnosed with a disc kidney, right hydronephrosis and poor right renal function was urgently transported to our hospital for treatment of a right perirenal urinary leakage caused by abdominal trauma. We performed interventional radiology-computed tomography (IVR-CT) before nephrectomy of the nonfunctioning right hydronephrotic kidney. Preoperative IVR-CT revealed five and four arterial branches supplying the right and left kidney, respectively, derived from the abdominal aorta, bilateral common iliac arteries, and the sacral artery. On day 370 after injury, single-port laparoscopic right nephrectomy was performed. The arterial supply to the left kidney was preserved, and the kidneys were dissected at the fusion site. The patient did not experience any complications for three yearsafter the operation.

Delayed graft function (DGF) is a rare complication following living-donor kidney transplantation, most commonly caused by ischemic acute tubular necrosis (ATN). We report a case in a 51-year-old woman with diabetic nephropathy who underwent an ABO-compatible living-donor kidney transplant from her younger brother. Although the procedure was completed without major complications, the patient developed persistent oliguria postoperatively. Serial allograft biopsies on postoperative days 1, 3, and 13 consistently showed findings of ATN without evidence of acute rejection or calcineurin inhibitor toxicity. Imaging studies revealed no vascular abnormalities or urinary tract obstruction. Despite adequate fluid management and stable hemodynamics, urine output remained below 500 ml/day for 26 days, and dialysis was required. On postoperative day 27, urine output gradually increased, allowing for withdrawal from dialysis by day 29. The patient was discharged on postoperative day 44, and renal function remained stable with a serum creatinine of 1.0 mg/dl at 9 months post-transplant. Intraoperative review of the donor nephrectomy video revealed purplish discoloration of the graft surface, raising suspicion of transient ischemia potentially caused by venous congestion during renal mobilization. This case emphasizes the importance of gentle vascular handling during donor nephrectomy and vigilant postoperative monitoring. Even in cases of prolonged DGF, recovery may be achieved with continued supportive therapy and repeated biopsies to rule out rejection. This report highlights that timely diagnosis and conservative management can lead to successful graft recovery, even after extended periods of oliguria.

We report a case of agranulocytosis associated with apalutamide treatment in a patient with non-metastatic castration-resistant prostate cancer (nmCRPC). An 89-year-old man was diagnosed with prostate cancer (cT2cN0M0) four years earlier and treated with surgical castration and anti-androgen therapy. Subsequently, his PSA levels increased. Imaging studies showed no obvious metastases, and he was diagnosed with nmCRPC. Darolutamide was initiated but discontinued because of liver dysfunction, and treatment was switched to apalutamide. Forty-five days after the initiation of apalutamide, the patient presented with fatigue. Laboratory findings revealed severe neutropenia, with a neutrophil count of 54/μl, leading to a diagnosis of apalutamide-induced agranulocytosis. Apalutamide was discontinued, and granulocyte-colony stimulating factor (G-CSF) and antibiotics were administered. The neutrophil count recovered to the normal range 13 days after treatment. Clinicians should be aware of the potential risk of agranulocytosis when neutropenia develops during apalutamide therapy.

We report two cases in which inguinal hernia repair was performed concurrently with robot-assisted radical prostatectomy (RARP). Case 1 was in a 74-year-old male with a history of right inguinal hernia repair. He noticed a bulge in his left groin. He was diagnosed with localised prostate cancer. Inguinal hernia repair was performed concurrently withRARP. Case 2 was in a 65-year-old male witha left inguinal hernia that had been managed with observation. He was diagnosed with localised prostate cancer. Simultaneous inguinal hernia repair was performed during RARP and pelvic lymph node dissection. Both cases progressed without perioperative complications or recurrence of the inguinal hernia. In patients with symptomatic inguinal hernia, simultaneous RARP and inguinal hernia repair may be a useful option.

We analyzed the incidence and risk factors associated with urinary retention following transurethral resection of the bladder tumors (TURBT). This retrospective study included a total of 218 TURBT cases we experienced from September 2021 to April 2023. Twenty-six patients (12%) experienced urinary retention after the procedure. The use of a thick urethral catheter (20 Fr or larger) post-surgery (p＝0.013) was identified as a significant risk factor. Of the 26 patients with urinary retention, 18 were able to recover spontaneous urination, while the remaining 8 required either permanent urethral catheter placement or intermittent catheterization. Healthcare professionals should be vigilant of urinary retention as a potential adverse event following TURBT.

We report a case involving an 81-year-old woman who developed pyogenic spondylitis following laparoscopic sacrocolpopexy (LSC) for a cystocele in November year X. During concomitant uterine resection, purulent discharge was observed, and oral levofloxacin was administered for 5 days postoperatively. Pathological examination revealed xanthogranulomatous endometritis, which was considered the source of the mesh infection. The patient was discharged on postoperative day 7 without complications. In early January year X＋1, she developed buttock pain that persisted for approximately 2 weeks without improvement, prompting her to return to our hospital. Magnetic resonance imaging findings indicated pyogenic spondylitis. She was admitted and treated with intravenous sulbactam/ampicillin for 1 week, but her symptoms did not improve. Laparoscopic mesh removal was subsequently performed. After surgery, the antibiotic regimen was switched to intravenous imipenem/cilastatin, resulting in good infection control. However, progressive bone destruction was noted, and on postoperative day 37, posterior spinal fusion from L3 to the pelvis was performed by our orthopedic team. The postoperative course following spinal surgery was favorable, with marked symptom relief. Oral minocycline was initiated on postoperative day 69 and continued until day 133. The patient was discharged ambulatorily on postoperative day 139. Although pyogenic spondylitis is recognized as a serious complication of LSC, this represents postoperative case encountered at our institution. On the basis of a review of the literature, we discuss this case and its clinical implications.

A man in his 70s underwent ABO-incompatible renal transplantation 19 years ago at another hospital for end-stage renal failure due to IgA nephropathy. The immunosuppressive regimen included tacrolimus 4mg/day, mycophenolate mofetil 500 mg/day, and prednisolone 5 mg/day. Renal function remained stable post transplantation, withserum creatinine levels ranging from 1.0 to 1.2 mg/dl. Contrast-enhanced computed tomography performed for the sudden onset of the aortic dissection showed a tumor 14 mm in diameter on the ventral side of the kidney allograft, with early contrast enhancement. The tumor was less than 10 mm deep into the renal cortex. Based on these findings, the patient was diagnosed with cT1aN0M0 renal cell carcinoma in a kidney allograft, and an open partial nephrectomy was performed without renal ischemia. Histopathological examination demonstrated clear cell renal cell carcinoma, WHO/ISUP Grade 2, without vascular invasion, and negative surgical margins. Postoperatively, renal function was preserved, and no recurrence has been observed during a 2-year follow-up period.

The present retrospective study investigated the efficacy and safety of keishibukuryogan for hot flashes associated with androgen deprivation therapy (ADT) in patients with prostate cancer. Between January 2018 and September 2024, 102 prostate cancer patients who were administered keishibukuryogan for the first time for treatment of hot flash were included in this study. Three months after the treatment, the efficacy of this drugs was assessed based on any improvement in subjective symptoms by the medical interview as follows ;"ineffective", "slightly effective", "moderately effective", and"excellently effective". Desire to continue this drug, the duration of continuation, and adverse effects were investigated. The cases in which efficacy was"slightly effective"or better were defined as the responder group, and patients'characteristics were compared between the responder and non-responder groups. The mean age was 72.2 years, and the mean period from the start of ADT to keishibukuryogan administration was 14.5 months. The efficacy of this drug was excellent in 3 cases, moderately effective in 11, slightly effective in 36, and ineffective in 52. Fifty-six patients desired to continue the treatment after three months. The average duration of drug continuation in the responder group was 13.7 months. In the responder group, the cases with a history of radiation therapy were significantly frequent (p＝0.0277). Six patients discontinued the drug administration due to adverse effects, with 3 experiencing itching, and 1 each experiencing loose stools, nightmares, and difficulty taking the drug. Keishibukuryogan was effective in approximately half of the cases with hot flash.

A 68-year-old woman presented to a local physician with lower abdominal pain. Urinary bladder stones were identified, and the patient was referred to our department. She had undergone laparoscopic sacrocolpopexy (LSC) for uterine prolapse 2 years ago. Transurethral cystolithotripsy (TUCL) was performed, and a suture was found in the stone arising from the posterior bladder wall. We speculated that the suture migrated into the urinary bladder after LSC and formed a bladder stone. The sutures could not be removed transurethrally using a laser. A nephroscope was employed to attempt suture division using laparoscopic scissors ; however, the suture remained difficult to grasp or cut. The second surgery was performed using a transurethral nephroscope and a transvaginal laparoscopic trocar. The suture was grasped using forceps inserted through the trocar and excised through a nephroscope using scissors. No postoperative complications or recurrences were observed. Combined transurethral and transvesical approaches are useful for treating foreign bladder bodies that require grasping for removal.

Primary malignant lymphoma of the renal pelvis is extremely rare ; only 13 cases have been reported to date, and it is often difficult to distinguish from urothelial carcinoma. A 63-year-old woman presented with fever and right flank pain. Computed tomography revealed right hydronephrosis, a renal pelvic mass, and para-aortic lymphadenopathy. Selective urinary cytology was negative, and ureteroscopic examination showed no visible tumor. Because of recurrent febrile urinary tract infections, retroperitoneal laparoscopic right nephrectomy was performed. The resected specimen showed mucosal thickening and a mass lesion in the renal pelvis. Histopathological examination demonstrated diffuse proliferation of atypical lymphoid cells positive for CD20 and CD79a, consistent with diffuse large B-cell lymphoma (DLBCL). The patient received eight cycles of R-THP-COP (rituximab, pirarubicin, cyclophosphamide, vincristine and prednisolone) chemotherapy, and para-aortic lymphadenopathy regressed. She remains in complete remission 60 months after surgery. As imaging findings are nonspecific and urinary cytology is usually negative, preoperative diagnosis of renal pelvic lymphoma is challenging. Nephroureterectomy can serve as both a diagnostic and therapeutic procedure, and malignant lymphoma should be considered in the differential diagnosis of renal pelvic tumors.

A 66-year-old man receiving medication for Castleman disease was found to have a gradually enlarging renal mass on a computed tomography (CT) scan. Contrast-enhanced CT and magnetic resonance imaging scan were performed for diagnostic evaluation, and renal cell carcinoma was suspected, prompting consideration of surgical resection. However, we determined that histopathological confirmation was necessary to rule out recurrent Castleman disease and other conditions. Therefore, we performed a tumor biopsy before any surgical intervention. An ultrasound-guided percutaneous needle biopsy revealed extramedullary hematopoiesis. Currently, the lesion is under observation without intervention.

According to the 5th edition of the Japanese General Rule for Clinical and Pathological Studies on Prostate Cancer, clinical T2c is defined as"a tumor involving both lobes". It is not defined whether this refers only to continuous lesions spreading across both lobes or also includes small, non-continuous lesions present in both lobes. Furthermore, the General Rule stated that"it is generally understood that pathological findings from biopsies are not taken into consideration when determining T categories". We investigated how physicians interpret the General Rule and perform T classification in real-world clinical practice. We prepared five hypothetical cases with negative digital rectal examination findings but with lesions identified on magnetic resonance imaging (MRI) and conducted a questionnaire survey targeting board-certified urologists certified by the Japanese Urological Association. We received responses from 58 participants. Twenty-six participants (44.8%) diagnosed cases with discontinuous lesions in both lobes as cT2a, and 32 participants (55.2%) diagnosed them as cT2c. In addition, 41 participants (70.7%) diagnosed cases in which lesions were found in one lobe on MRI and cancer was detected in both lobes by biopsies as cT2a, while 17 participants (29.3%) diagnosed them as cT2c. Furthermore, three participants (5.2%) diagnosed cases in which cancer was detected by biopsies only from the contralateral side where lesions were found on MRI as cT1c, 49 participants (84.5%) diagnosed them as cT2a, and six participants (10.3%) diagnosed them as cT2c. In staging prostate cancer, the General Rule can have multiple meanings and there are cases in which even specialists disagree. Since T classification affects treatment strategies, it is desirable to have a uniform understanding based on a clear definition.

A 43-year-old man visited our clinic to have surgeryfor contraception. Vasectomywas performed under local anesthesia. The scrotal skin was incised with a scalpel. The vas deferens was cut and the bilateral ends were ligated twofold using 2-0 silk and 4-0 polyglycolic acid suture without mucosal cautery of the vas deferens. Semen analysis revealed two nonmotile sperms in the entire high-power field one month after the surgery. However, eight months later, his partner was pregnant, and subsequent semen analysis revealed 10 to 20 motile sperms per high-power field. Post vasectomyrecanalization of the vas deferens was suspected. It is important to inform couples of the possibilityof pregnancypost vasectomydue to recanalization of the vas deferens. Therefore, obtaining prior informed consent not onlyfrom the patient but also from the partner is needed to avoid litigation.

Pyoderma gangrenosum is a non-bacterial inflammatory disease that forms ulcers and abscesses and can be exacerbated by mechanical stimulation. Surgical intervention for abscesses in the corpora cavernosa may exacerbate penile pyoderma gangrenosum. We report a case of penile pyoderma gangrenosum that was diagnosed minimally invasively by biopsy alone and treated with steroids. A 77-year-old man with penile swelling and pain was referred to our institution by his primary care physician for suspected penile cancer. Both infectious diseases and penile cancer were ruled out based on physical examination and laboratory test results. Magnetic resonance imaging revealed fluid accumulation in the corpora cavernosa, leading to the decision to perform a penile biopsy. The biopsy revealed no malignancy, but an abscess was identified. Based on the clinical presentation, penile pyoderma gangrenosum was suspected and steroid therapy was initiated, resulting in rapid symptomatic improvement. The steroid dose was gradually tapered, and after 18 months of treatment, the steroids were discontinued. The patient has remained asymptomatic with no recurrence of the abscess or other subjective complaints.

We report a case of high-risk prostate cancer (pT3bN1Gleason score 4＋5), in a 63-year-old male who underwent robot-assisted radical prostatectomy with extended pelvic lymph node dissection in May 2019, followed by adjuvant combined androgen blockade (CAB) therapy. In June 2022, the case progressed to castration-resistant prostate cancer (CRPC), and enzalutamide was initiated. Bone metastases to the sacrum and seventh thoracic vertebra were identified concurrently and treated with radiotherapy. In January 2024, the patient presented with lower back pain and left thigh pain. Computed tomography revealed a right iliac fracture and multiple fractures of the left sacroiliac joint, consistent with radiotherapy-related pelvic insufficiency fractures (PIFs). While PIFs are well-documented in patients with gynecologic malignancies, reports on prostate cancer patients remain limited. We analyzed cases of pelvic fractures following pelvic radiotherapy for prostate cancer at our institution, including the present case, and discussed them in the context of the existing literature.