Androgen deprivation therapy changed the body composition and lipid profile of men with prostate cancer. It was demonstrated that even Japanese patients with prostate cancer who are treated with androgen deprivation therapy have the risk of developing metabolic syndrome.

The prognosis of ureteral obstruction secondary to gastric cancer was extremely poor, particularly when chemotherapy was not administered. The indications for palliative urinary diversion should be determined after considering the patient's symptoms, the expected survival time, the possibility of further chemotherapeutic options, and the current quality of life.

BackgroundHereditary leiomyomatosis and renal cell cancer (HLRCC) is a rare tumor predisposition syndrome characterized by cutaneous and uterine leiomyomas and papillary type 2 renal cell cancer. Germline mutation of the fumarate hydratase (FH) gene is known to be associated with HLRCC.Case presentationWe describe a 64-year-old father and his 39-year-old son with HLRCC who developed papillary type 2 RCCs lacking cutaneous leiomyomas at any site. A common missense mutation in the FH gene, (c.1021G > A, p.D341N) in exon 7, was detected in the 2 cases. Functional prediction with the bioinformatics programs, SIFT and Polyphen-2, reported “damaging (SIFT score 0.00)” and “probably damaging (PSIC score 1.621)” values, respectively. In 162 healthy individuals, there were no cases of a G transition to any base. Finally, (c.1021G > A) in exon 7, was identified as a point mutation.ConclusionWe report a family with HLRCC in which a novel missense mutation was detected. A familial papillary type 2 renal cancer should be considered HLRCC unless typical cutaneous leiomyomas do not occur.

We aimed to determine the oncological outcomes of patients with clinical T1 renal cell carcinoma (RCC) upstaged to pathological T3a and to identify the preoperative predictive factors for upstaging. We retrospectively reviewed 272 patients with clinical T1 RCC who underwent surgical treatment. Thirty-three patients (12%) were upstaged to pathological T3a. These patients had a significantly larger tumor size on computed tomography (p < 0.0001), a higher aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (p = 0.037), and an elevated c-reactive protein (CRP) level (p = 0.014) preoperatively compared with those with pathological T1 RCC. On multivariate analysis, tumor diameter was the only significant preoperative predictive factor for upstaging [hazard ratio (HR), 3.61; 95% confidence interval (CI), 1.32–9.84; p = 0.01]. The AST/ALT ratio tended to be a preoperative predictive factor for upstaging, although it was not significant (HR, 2.14; 95% CI, 0.97–4.73; p = 0.06). Pathological T3a upstaging occurred in 25% of those with a tumor diameter ≥30 mm and a preoperative AST/ALT ratio ≥1.1. There was a significant correlation between pathological T3a upstaging and the number of preoperative risk factors (p = 0.0002). The preoperative tumor diameter and serum AST/ALT ratio can be predictive factors for pathological T3a upstaging in patients with clinical T1 RCC.

Objectives: To assess the association between postoperative cystogram findings and subsequent outcomes on urinary continence after robot-assisted laparoscopic radical prostatectomy (RALP).Methods: A retrospective review of 250 consecutive patients who were observed for at least 12 months after RALP. The postoperative cystogram findings examined were: the location of the bladder neck, degree of bladder abnormalities, and presence of outflow of contrast medium into the urethra during the filling phase of cystography. The continence status based on pad usage was recorded. Those who required no pad or only a safety pad were defined as continent.Results: Patients with a bladder neck location above the middle of the pubic symphysis height exhibited significantly higher continence levels than those with a lower bladder neck location at both postoperative 3 and 12 months (P < 0.0001 and P = 0.0002, respectively). The higher a bladder neck was located, the earlier the urinary continence was achieved after RALP (P < 0.0001). Patients without contrast outflow into the urethra during cystogram demonstrated a significantly more favorable continence status at the 3-month follow-up (P = 0.004). Patients without bladder abnormalities on postoperative cystogram demonstrated a significantly more favorable continence status at the 12-month follow-up than those with bladder abnormalities (P = 0.01).Conclusions: Postoperative cystogram findings may predict recovery of urinary continence after RALP. K E Y W O R D S bladder neck, cystogram, prostatectomy, RALP, urinary incontinence 1 | INTRODUCTION The spread of prostate serum antigen (PSA) screening has increased the reported incidence of prostate cancer. Robot-assisted laparoscopic radical prostatectomy (RALP) has become the most common surgical management for prostate cancer. It was reported that 85% of prostatectomies were performed under robotic surgery in the USA in 2009. 1 Although surgical techniques have improved, urinary inconti-nence is one of the most common complications following prostatectomy and has a significant impact on the quality of life (QoL) of patients who undergo radical prostatectomy. The reported incidence of patients with urinary incontinence after radical prostatectomy ranges from 6% to 20%. 2,3 Although nearly 90% of patients achieved urinary continence at the 12-month follow-up following prostatectomy, the incidence of urinary incontinence did not improve remarkably later than 12 months after prostatectomy. 4The pathophysiology of urinary incontinence after RALP has been investigated, and multiple factors are associated with urinary incontinence after prostatectomy, including damage to the urinary sphincter, 5 bladder neck dysfunction, 6 and dysfunction of the pelvic diaphragm. 6In this study, we assessed the association between the postoperative cystogram findings and subsequent urinary continence outcomes to identify factors that predict postoperative urinary incontinence.