Daiki Ikarashi

Pyeloplasty is generally considered the standard treatment for congenital hydronephrosis associated with horseshoe kidney. We report a case successfully managed mainly by retroperitoneoscopic isthmusectomy without pyeloplasty. Case Presentation: A 23‐year‐old man presented with left flank‐to‐back pain. CT revealed horseshoe kidney and left hydronephrosis. The left ureteropelvic junction was considered compressed by renal malrotation, causing obstruction. Retroperitoneoscopic isthmusectomy was performed using an articulating endoscopic linear stapler, resulting in hydronephrosis improvement. Conclusion: In selected patients with horseshoe kidney in whom congenital hydronephrosis is primarily caused by renal malrotation associated with isthmic fusion and aberrant vessel involvement appears limited, treatment mainly consisting of retroperitoneoscopic isthmusectomy using an articulating stapling device may be effective.

To evaluate the impact of adjuvant platinum-based chemotherapy (AC) on oncological outcomes in high-risk upper tract urothelial carcinoma (UTUC) patients with postoperative renal impairment following radical nephroureterectomy (RNU). Among 1050 patients who underwent RNU at 10 affiliated hospitals, we retrospectively evaluated 136 UTUC patients with ≥pT3 and/or node-positive UTUC and postoperative eGFR 30–59 mL/min/1.73 m². Patients were divided into an AC group ( n = 52), who received gemcitabine plus cisplatin (GC) or carboplatin (GCa), and a non-AC group ( n = 84). Oncological outcomes, including disease-free survival (DFS) and overall survival (OS), were evaluated using propensity score matching (PSM). In the AC group, DFS and OS were also compared between GC ( n = 33) and GCa ( n = 19). The median follow-up was 48.6 months. Before PSM, three-year DFS was 61.5% versus 27.2% in the AC and non-AC groups, respectively ( p < 0.0001), whereas three-year OS was 76.8% versus 68.6% ( p = 0.16). After PSM, AC remained associated with longer DFS (hazard ratio [HR], 0.36; 95% confidence interval [CI], 0.18–0.70; p = 0.0019), while no statistically significant difference in OS was observed (HR, 0.83; 95% CI, 0.34–2.01; p = 0.676). Within the AC group, cisplatin dosing in the GC regimen was determined according to postoperative renal function. No statistically significant differences in DFS or OS were observed between patients treated with GC and GCa. Platinum-based AC was associated with improved DFS in selected high-risk UTUC patients despite postoperative renal impairment, supporting consideration of GC or GCa according to renal function.

Background: Avelumab maintenance therapy was approved in Japan in February 2021 for patients with unresectable locally advanced or metastatic urothelial carcinoma (la/mUC) without disease progression after platinum-based chemotherapy (PBC). We report subgroup analyses from the JAVEMACS chart review study of avelumab maintenance therapy in Japan by characteristics of first-line (1L) PBC. Methods: This multicenter, retrospective study collected data from medical charts of patients with la/mUC who received avelumab maintenance after 1L PBC. Protocol-specified subgroups defined by 1L PBC characteristics (PBC regimen, number of PBC cycles, and best overall response to PBC) were analyzed. Results: Between February 2021 and December 2023, 350 patients received avelumab maintenance. Patient characteristics were generally similar across subgroups defined by 1L PBC characteristics. In patients who received 1L gemcitabine + cisplatin ( n = 196) or gemcitabine + carboplatin ( n = 116), median overall survival (OS) was not reached (95% CI, 31.2 months-not estimable [NE]) and 24.3 months (95% CI, 19.5–30.6 months), respectively. In patients who received 1–3 cycles ( n = 68), 4 cycles ( n = 205), 5/6 cycles ( n = 61), or ≥ 7 cycles ( n = 16) of 1L PBC, median OS was 25.0 months (95% CI, 15.2 months-NE), not reached (95% CI, 29.3 months-NE), 31.2 months (95% CI, 18.0 months-NE), and 23.6 months (95% CI, 19.3 months-NE), respectively. In patients with complete response ( n = 32), partial response ( n = 180), or stable disease ( n = 138) as best response to 1L PBC, median OS was not reached (95% CI, 30.6 months-NE), 31.2 months (95% CI, 22.6 months-NE), and 26.5 months (95% CI, 20.2 months-NE), respectively. Across all subgroups, enfortumab vedotin was the most common second-line treatment after discontinuation of avelumab. Conclusions: Results from these descriptive subgroup analyses from JAVEMACS suggest that real-world outcomes with avelumab maintenance therapy are generally consistent regardless of 1L PBC regimen, number of 1L PBC cycles, or best response to 1L PBC. These findings further support the use of avelumab maintenance therapy as a standard of care for patients with la/mUC without disease progression after 1L PBC. Trial registration: NCT06412848.

Avelumab maintenance therapy is approved in Japan for patients with aUC without progression after PBC. This report presents subgroup analysis data from the JAVEMACS chart review of avelumab maintenance in patients who received 1L ddMVAC and GC. This retrospective study reviewed medical charts of patients with aUC (February 2021–December 2023). Overall, 350 patients (ddMVAC, n = 32 and GC, n = 196) were included in the study. Baseline characteristics were balanced between the two PBC groups. Median duration from PBC start to avelumab start was 13.2 and 21.1 weeks; median overall survival (OS) was not reached (both groups), progression-free survival (PFS) was 12.0 and 7.4 months, and PFS2 was 27.6 and 21.3 months for the ddMVAC and GC groups, respectively. At data cutoff (June 2024), 25.0% of patients in the ddMVAC and 17.3% in the GC groups were ongoing avelumab treatment. Second-line treatments included EV (64.3% ddMVAC; 64.5% GC), pembrolizumab (21.4% ddMVAC; 8.3% GC), and PBC (14.3% ddMVAC and 21.5% GC). This real-world data from patients with aUC in Japan showed consistent OS patterns with avelumab maintenance across treatment subgroups vs. the overall population despite their inherent heterogeneity. Although patients were not resistant to PBC, 2L EV was more common than 2L PBC.

Olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor approved for treating metastatic castration-resistant prostate cancer (mCRPC) with BRCA mutations, has significant clinical benefits. However, evidence suggests an increased risk of venous thromboembolism, including pulmonary embolism (PE), particularly in patients with PC. However, no case reports of olaparib-associated PE in mCRPC have been published. Here, we report the case of a 70-year-old man with mCRPC harboring a BRCA2 mutation, who developed PE during olaparib therapy. Diagnostic evaluations included contrast-enhanced computed tomography and serum D-dimer level measurement. Clinical decision tools, such as the Wells score and the Khorana score, were used to support the diagnosis and risk assessment. The patient developed acute dyspnea and chest pain 7 months after olaparib initiation. Imaging confirmed multiple pulmonary emboli; laboratory testing revealed markedly elevated D-dimer levels. Anticoagulation therapy with apixaban led to rapid clinical and radiological improvement. However, mCRPC eventually progressed after olaparib discontinuation, and the patient died 15 months after olaparib initiation. This is the first reported case of olaparib-associated PE in mCRPC. It underscores the importance of vigilance for thromboembolic complications during PARP inhibitor therapy. The integration of clinical scoring systems and biomarkers may facilitate timely PE diagnosis and management, potentially improving patient outcomes.

Background: To evaluate the primary resistance factors to enfortumab vedotin (EV) monotherapy by comparing treatment outcomes between the early progressive disease (EPD) group and non-EPD group. Methods: We retrospectively analyzed 121 patients with advanced urothelial carcinoma who received EV monotherapy across five institutions between 2019 and 2024. The patients were categorized into the EPD group (n = 34), defined by radiologically confirmed progressive disease within 3 months of EV initiation, and the non-EPD group (n = 87). The clinical parameters and oncological outcomes were compared between groups. The emergence of new metastatic lesions was defined as the detection of metastases in organs not previously identified as metastatic sites at baseline, during prior chemotherapy or immune checkpoint inhibitors (ICIs) before the initiation of EV. Results: The median overall survival was significantly shorter in the EPD group than in the non-EPD group (6.5 vs. 19.9 months, p < 0.001). The EPD group had a significantly higher incidence of new metastatic lesions and a lower prevalence of normal Hb levels. Multivariate analysis identified low Hb and the presence of new metastatic lesions as independent predictors of EPD. Among patients with new metastases in the EPD group, an average of 74% of lesions emerged during ICI treatment and 75% involved multiple foci. Notably, more than 50% of these new lesions showed progression at the same sites following EV therapy. Conclusions: Patients with low hemoglobin levels and new metastatic lesions before EV treatment may be at increased risk for EPD. For these patients, alternative treatment strategies should be considered before initiating EV.

Introduction: Laparoscopic nephrectomy in patients with severe scoliosis presents significant challenges due to altered anatomy and limited space. This case report discusses using robot‐assisted laparoscopic radical nephrectomy in such a scenario.Case Presentation: A 68‐year‐old man with severe right convex scoliosis was diagnosed with cT3aN0M0 right locally advanced renal cell carcinoma. Given the anatomical distortions caused by scoliosis, traditional laparoscopic techniques posed difficulties. We opted for robot‐assisted laparoscopic radical nephrectomy, carefully planning the port placement and surgical approach to accommodate the patient's unique anatomical features.Conclusion: This is the first reported instance of robot‐assisted laparoscopic radical nephrectomy in a patient with severe scoliosis. The successful outcome demonstrates the feasibility and benefits of robotic assistance in overcoming the technical difficulties associated with scoliosis, offering a viable surgical option for similar cases.

Objective: This study aimed to determine and compare the tumor shrinkage rate and its durability by enfortumab vedotin treatment between primary urothelial carcinoma and metastatic organs.Methods: We retrospectively evaluated the tumor shrinkage rate in 39 Japanese patients treated with enfortumab vedotin for advanced urothelial carcinoma. We also evaluated the periods of tumor shrinkage maintenance (the period when best response was maintained) and regrowth (the period from best response to tumor growth confirmation) between primary and metastatic organs.Results: Measurable metastatic organs included the lung in 17, lymph node in 22, liver in 6, and bone in 5 cases. Primary lesion was detected in 20 cases. The mean tumor shrinkage rates for lung, lymph node, liver, and bone metastases and primary sites were 21% (−212 to 100), 13% (−130 to 86), −8.5% (−158 to 85), −64% (−250 to 21), and 22% (−38 to 79), respectively. The tumor shrinkage was maintained for 5.9 (0.7–14) months in lung metastases, 8.3 (2.6–14.5) months in lymph node metastases, 3.6 months in liver metastases, 0.7 months in bone metastases, and 1.8 (0.7–5.4) months in primary sites, and the period of regrowth was 7.3 (2.2–19.4), 4.8 (2.0–8.9), 2.8, 6.5, and 2.5 (1.1–5.9) months, respectively.Conclusions: Enfortumab vedotin showed significant tumor shrinkage in the primary tumor, lung metastases, and lymph node metastases, whereas the durability of tumor shrinkage was limited in the primary tumor.

Introduction Decreased renal function after radical nephroureterectomy is one of the most important complications because it contributes to the decision to initiate adjuvant chemotherapy. This study aimed to investigate clinical factors associated with changes in renal function after radical nephroureterectomy in elderly patients. Methodology A total of 145 patients who underwent radical nephroureterectomy for upper tract urothelial carcinoma were evaluated. The renal function was calculated preoperatively, postoperatively, and one month postoperatively, and the long-term change in renal function was investigated once a year. The association between clinical factors and changes in renal function following radical nephroureterectomy in univariate and multivariate analyses was stratified by age >75 years and 50 as cisplatin-eligible at one month postoperatively. The long-term renal function in the elderly may decline further than during the stable postoperative periods. In the multivariate analysis, hydronephrosis (HN) was a significant predictor of decreased renal function in patients aged >75 years between the pre- and postoperative periods. Conclusions Elderly patients with HN who have upper tract urothelial carcinoma have a lower risk of decreased renal function after radical nephroureterectomy. This result may be useful in determining adjuvant therapy.