A 61-year-old man visited our department with the complaint ofa palpable hard mass in the penile shaft which showed a significant uptake on fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT). He had undergone a surgery for local invasive esophageal cancer and had received adjuvant chemotherapy. Open biopsy revealed metastases in the carvenous body and the glans of the penis from esophageal squamous cell carcinoma. He died from the cancer 5 months after the biopsy in spite ofadditional chemotherapy.

Our patient was a 31-year-old man who presented with right flank pain. Computed tomography revealed multiple tumors in the liver and lungs, with marked elevation of serum human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels. In addition, no testicular abnormalities were detected by palpation or ultrasonography. On the bases of these results, the patient was diagnosed with extragonadal germ cell tumor and was therefore started on chemotherapy with bleomycin, etoposide, and cisplatin (BEP). However, the result of a subsequent blood test showed marked pancytopenia at the initial stage of treatment. We speculated that the cause of anemia was not only bone marrow suppression but also intratumoral hemorrhage, collectively termed choriocarcinoma syndrome. After conservative treatment involving blood transfusion and administration of granulocyte colony-stimulating factor, he recovered. After several chemotherapy sessions, the levels of all tumor markers returned to normal. Finally, the patient underwent hepatectomy for residual tumors ; but, the resected specimen showed no viable cancer cells. Currently, the patient is free from disease since the last chemotherapy session, administered 5 months ago.

Acquired hemophilia is a rare disease that can result in life threatening bleeding associated with coagulation factor VIII inhibitors. A 61-year-old man presented gross hematuria and urinary retention. A retrograde pyelography, cystoscopy, abdominal computed tomography and prostate biopsy showed no finding suggestive of malignancy. Extensive subcutaneous hemorrhage over the perineal region and severe hematuria were observed after the prostate biopsy. Further hematological evaluation showed the presence of coagulation factor VIII inhibitors, which led to the diagnosis of acquired hemophilia. All symptoms disappeared without complication after administration of predonisolone and recombinant activated factor VII.

A 60-year-old man was examined at a local clinic for difficulty in urinating, and was diagnosed with prostatic hypertrophy. He was referred to our department because his prostate-specific antigen (PSA) level was elevated (276 ng/ml). His Gleason score was 4＋3, there was one bone metastasis in the left ileac bone, and multiple lung metastases were present. The patient was accordingly diagnosed with stage D2 prostate cancer. Lutenizing hormone-releasing hormone (LH-RH) analogue treatment was initiated in April 1999, and 9 months later the PSA level had decreased to 4.3 ng/ml. Six years and 9 months after the start of hormone therapy, the cancer had developed into castration-resistant prostate cancer and the PSA level had risen to 43.8 ng/ml. Paclitaxel-carboplatin therapy was therefore initiated. Eight months after the start of chemotherapy, the PSA level had decreased to 25.9 ng/ml, but 6 years and 1 month later it had risen to 925 ng/ml, and the chemotherapy was discontinued. Docetaxel-predonine therapy was initiated in March 2012. Three months after the start of chemotherapy, the PSA level had decreased to 3.1 ng/ml, and the bone metastasis was reduced.

We report a rare case of adenocarcinoma developing in an ileal conduit. A 78-year-old woman was referred complaining of abdominal pain. She had undergone radical cystectomy and ileal conduit formation for invasive bladder cancer 8 years previously. The pathological diagnosis was urothelial carcinoma, and distant metastasis was not found. She was lost to follow-up over 2 years postoperatively. Computed tomography at this time showed bilateral hydronephrosis. Metastasis was not revealed. Because renal failure progressed and gross hematuria developed, endoscopic examination through the stoma was performed. A mass adjacent to the ureteroileal anastomosis site was found. Biopsy led to a diagnosis of moderately differentiated adenocarcinoma. She died of renal failure 1.5 months after admission. To our knowledge, 9 cases of adenocarcinoma arising in an ileal conduit have previously been reported.

A 70-year-old man visited a urological clinic with a chief complaint of pollakiuria, which was refractory to various medications. Pelvic magnetic resonance imaging (MRI) revealed a mass 6 cm in diameter immediately next to the left side of the bladder. The patient was referred to our hospital for further examination. Since he had a past history of neurofibroma of cauda equina, we suspected neurofibromatosis type 1. 18Fluorodeoxyglucose (FDG)-positron emission tomography (PET) demonstrated a high accumulation of FDG in the pelvic mass. Under a diagnosis of neurogenic tumor, surgery was performed. As an examination of frozen section during the surgery led us to suspect a sarcoma, the tumor was excised radically. The pathological examination demonstrated diffuse large B cell lymphoma.

We report a case of deep vein thrombosis and acute pulmonary thromboembolism that occurred during chemotherapy for urethral carcinoma. A 68-year-old woman suffered from dysuria for a period of 2 years. When the symptoms worsened, a urethral catheter was placed and she was referred to our hospital for further examinations. Imaging analysis revealed a urethral tumor with multiple metastases. Pathological diagnosis on a specimen obtained from transurethral resection of the urethral mucosa was urothelial carcinoma and combined chemotherapy with gemcitabine and cisplatin was administered. On day 6 of the second course, the patient collapsed and was found to be in cardiorespiratory arrest. Cardiopulmonary resuscitation was successful and she received percutaneous cardiopulmonary support. Computed tomography at that time revealed a pulmonary embolism and deep vein thrombosis in the right popliteal vein. After her condition improved, an inferior vena cava filter was inserted to avoid further thromboembolism. The patient decided to continue the chemotherapy despite this episode. After the fourth course of combined chemotherapy, the urethral tumor and metastatic tumors were downsized, and she could urinate as she did before.

Between January 2005 and August 2010, transurethral lithotripsy (TUL) was performed in 117 patients with upper urinary tract stones. TUL was performed without the basket catheter ZeroTipTM in 50 patients (group A) and with ZeroTip TM in 67 patients (group B). There was no significant difference in the successful stone disintegration rate between group A (86%) and group B (90%). However, the postoperative successful stone-free rate was 76 and 88% (p＝0.04) in groups A and B, respectively, and the intraoperative successful stone-free rate was 43 and 71% (p＝0.002), respectively. Intraoperative ureteral stents were placed in 62 and 46% of the patients in groups A and B (p＝0.004), respectively. By successfully becoming stone-free with this procedure, the need of ureteral stent placement decreased, thereby reducing the postoperative cases of irritable bladder caused by a ureteral catheter, and contributing to improvement of the patient's quality of life.

Systemic cisplatin-based chemotherapy regimens are the gold standard in advanced bladder cancer. Gemcitabine plus cisplatin (GC) therapy has often been used, although there is no significant evidence that it is better than methotrexate, vinblastine, adriamycin, and cisplatin (MVAC) therapy in neoadjuvant chemotherapy. We retrospectively evaluated the relative efficacy of the two chemotherapeutic regimens in the management of muscle-invasive bladder cancer on patients who had had radical cystectomy for clinical stage T2-T4, N and, M0 bladder cancer. Fourteen patients (24.1%) and 44 (75.9%) patients were treated with GC and MVAC therapy, respectively. GC therapy was significantly more effective than MVAC therapy in pathological down-staging (to pT0) rate. On multivariate analysis, the choice of regimen (MVAC) was an independent predictor of the presence of residual cancer after a neoadjuvant chemotherapy. The clinical response to neoadjuvant GC therapy was superior to that to neoadjuvant MVAC therapy. Moreover, GC therapy was associated with less non-hematologic toxicity than MVAC therapy, especially with respect to the occurrence of nausea.

Erectile dysfunction following radical prostatectomy (RP) is still a significant burden as a post-operative morbidity, despite advances in nerve-sparing techniques and penile (erectile function) rehabilitation (PR) programs. We assessed the effects of stimulation with the masturbation device "EGG" on enhancement of erectile response along with administration of phospho diesterase type 5 inhibitor. We also studied the change of self-esteem and motivation for continuation of PR after stimulation with EGG. Eight nonresponders for PDE5-I who underwent retropubic RP were enrolled. Patients' median age was 71.5 years old. No patients received adjuvant therapy for prostate cancer. The patients' erectile response in the penile rehabilitation session (masturbation) with PDE5-I＋manual stimulation and PDE5-I＋stimulation with EGG were evaluated by erection hardness score (EHS). Changes of self-esteem and motivation for penile rehabilitation were assessed by the self-esteem subscale of the Self-Esteem and Relationship (SEAR) questionnaire and one original question, respectively. PDE5-I ＋ stimulation with EGG significantly enhanced EHS compared to PDE5-I＋manual stimulation in the eight patients (p＝0.027). Transformed score of self-esteem subscale score of SEAR questionnaire was significantly increased in the PR session with EGG compared to the PR session with manual stimulation (p＝0.043). Six patients who showed a better erectile response with EGG retained motivation for continuation of PR. PDE5-I＋stimulation with EGG improved the erectile response in post-RP patients. EGG as a masturbation device may have a potential for contribution to successful PR.