Introduction: Adenocarcinoma of the rete testis is a rare malignancy with a poor prognosis. We report a case of adenocarcinoma of the rete testis with a durable response to cisplatin‐based chemotherapy.Case presentation: A 48‐year‐old man with Down syndrome (trisomy 21) presented with a 1‐month history of painless swelling of the left scrotum. The physical examination revealed a left testis with a hydrocele associated with a tumor and enlarged pelvic and para‐aortic lymph nodes. He underwent a radical orchiectomy. The specimen was diagnosed as adenocarcinoma of the rete testis. The patient received 7 cycles of chemotherapy (1 cycle of BEP and 6 cycles of EP) postoperatively. The metastatic lymph nodes were reduced in size for at least 12 months. Our patient with adenocarcinoma of the rete testis obtained an acceptable response to cisplatin‐based chemotherapy.Conclusion: We treated a patient with an adenocarcinoma of the rete testis who had an acceptable response to platinum‐based chemotherapy.

Radiation therapy, including external-beam radiation therapy (EBRT) and brachytherapy, is curative for localized prostate cancer. Hydrogel spacer (HS) placement between the rectum and prostate is popular for reducing radiation-related complications. Criteria to identify patients who benefit from HS placement would be clinically valuable. In a retrospective analysis of 430 patients with localized prostate cancer treated between November 2010 and March 2023 with ≥2 years of follow-up, we evaluated the incidence of rectal hemorrhage and its association with the median distance at the midpoint between the prostate and the rectum (mDPR) on pretreatment MRI. Rectal hemorrhage occurred in 6% of HS cases and 18% of non-HS cases (p < 0.001). Among 268 patients who received EBRT (±brachytherapy), the incidence was 9% with HS and 30% without HS (p < 0.001). In non-HS cases, the rate in patients with mDPR ≤ 1.62 mm was higher than in those with mDPR > 1.62 mm (24% vs. 12%, respectively; p = 0.04). In patients with EBRT and mDPR ≤ 1.62 mm, HS significantly reduced hemorrhage (9% vs. 39%, respectively; p < 0.001). Multivariate analysis identified mDPR and HS as independent predictors of rectal hemorrhage (both p = 0.02). Thus, HS placement may be safely omitted in non-EBRT cases with mDPR ≥ 1.62 mm.

Introduction Primary vaginal calculi are relatively rare, compared with secondary calculi. Primary calculi are often a result of urogenital sinus abnormalities, neurogenic bladder, or chronic incontinence. Case presentation Forty-seven years old female with cerebral palsy since infancy had longstanding urinary incontinence. She visited her doctor for a fever and was referred to us with a urinary tract infection. Imaging revealed a large vaginal calculus. It was not possible to remove the calculus vaginally without crushing it, so we performed rigid cystoscopy with lithotripsy, using a pneumatic lithotripsy device. The calculus was completely removed without complications. Conclusion We were able to remove a large primary vaginal calculus using ultrasonic and pneumatic lithotripsy through a rigid cystoscope. Minimally invasive surgery is a good option for patients with large vaginal calculi.

IntroductionTreatment of urinary tract calculi in patients with Ehlers-Danlos syndrome, a connective tissue disorder, has rarely been reported.Case presentationA 33-year-old woman with Ehlers-Danlos syndrome sought evaluation of right-sided abdominal pain from her family physician. Right-sided hydronephrosis was noted and she was referred to our hospital for further evaluation and treatment. A ureteral calculus with a maximum diameter of 8 mm was demonstrated at the right ureterovesical junction. Transurethral lithotripsy was performed under general anesthesia without complications.ConclusionLithotripsy may be safely performed in patients with Ehlers-Danlos syndrome.

Background Computed tomography-defined low skeletal muscle mass is associated with oncological outcomes in prostate cancer. However, its association with the outcomes in hormone-treated metastatic castration-sensitive prostate cancer is unclear. This study aimed to determine the association between metastatic castration-sensitive prostate cancer and psoas muscle parameters. Methods We retrospectively reviewed 121 patients with N1 and/or M1 metastatic castration-sensitive prostate cancer who underwent primary androgen deprivation therapy either with a luteinizing hormone-releasing hormone agonist/antagonist or with surgical castration accompanied by first-generation anti-androgen bicalutamide treatment between 2005 and 2021. Before treatment, the psoas muscle index at the level of the third lumbar vertebra (psoas muscle area [cm²]/height² [m²]) and the mean Hounsfield units of the psoas muscle were evaluated in relation to oncological outcomes using non-contrast computed tomography. Results The median follow-up was of 56.9 months. Furthermore, 82 (67.7%) and 53 (43.8%) patients progressed to castration-resistant prostate cancer and died during follow-up, respectively. Multivariate analysis of castration-resistant prostate cancer-free survival and overall survival showed significant differences in the Gleason score, clinical N stage, and psoas muscle index (median cut-off: 3.044 cm²/m²). Kaplan–Meier curves of a novel prognostic model using these three risk factors showed significant differences (P <0.001). Conclusions A pretreatment low psoas muscle index was an independent predictor of a poor castration-resistant prostate cancer-free survival and overall survival in patients with N1 and/or M1 metastatic castration-sensitive prostate cancer. Our novel prognostic model could help predict worse outcomes in susceptible patients.