The Fifth CJUA annual meeting
2011

China­Japan urological association

PROGRAM ＆ ABSTRACTS

DateOct. 29, 2011
Venue
Nanjing international convention center

CJUA Home­page

URL: http://www.uro.jp/nichu/index.html

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PROGRAM of the Fifth CJUA annual meeting(2011.10.29

Nanjing

China)

Meeting address: Room 208，Nanjing international convention center

8:30 ­ 8:40

Opening Address
Prof. Yanqun Na, President of CJUA (China)

8:40 ­ 9:50

Session I (7 minutes presentation following 3 minutes discussion)

Chairmen:

Prof. Yukio Homma,Tokyo, Japan
Prof. Xianghua Zhang, Beijing, China

1. Early experience of botulinum toxin type A injection in patients with interstitial
cystitis/ hypersensitive bladder syndrome.
Akira Nomia, et al.

Tokyo University, Japan.

2. Urine alkalization by Citrates improves pain and other symptoms in patientswith interstitial cystitis/bladder pain syndrome (IC/BPS).
Masaaki Ito, et al.

Kyoto City Hospital, Japan

3. Synergistic anti­tumor effect of combined knockdown of the IAP genes on human
bladder cancer T24 cells.
Yang D, et al.

First Affiliated Hospital of Dalian Medical University, China

4. Over­expression of G­protein­coupled receptor 87 (GPR87) closely correlated withtumor proliferation in urothelial carcinomas of the bladder.
Xia Zhang, et al.

Kagawa University, Japan

5. ncRAN, a Newly Identified Long Non­coding RNA, Enhances Human Bladder
Tumor Growth, Invasion and Survival.
Yuyan Zhu, et al.

No.1 Hospital of China Medical University, China

6. A Correlational Study between Expression of NGF and Diabetic Cystopathy in
Diabetic Rats.
Xiaoqiang Liu, et al.

2nd hospital of Tianjin Medical University, China

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7. Cooperative Research on Genetic Predisposition for Prostate Cancer in Asia byAnalyzing Cumulative Association of SNPs ­The Final Data.
Haruki Kaku, et al.

Okayama University, Japan

9:50 ­ 10:10

Coffee Break

10:10 ­ 11:20

Session II

Chairmen:

Prof. Atsushi Nagai，Kawasaki，Japan(7 minutes presentation following 3 minutes discussion)

Prof. Jianbin Bi, Shenyang, China
1. Initial results of Robot­assisted laparoscopic radical prostatectomy at Okayama
University.
Shinya Uehara, et al.

Okayama University Graduate School of Medicine, Japan

2. Benign lesions in surgically removed renal masses preoperatively suspected asrenal cell carcinoma: the clinical and CT imaging features.
Wen Kong, et al.

Renji Hospital, Shanghai Jiao Tong University School of

Medicine, China
3. Health­Related Quality of Life in Patients with Localized Prostate Cancer
Received High­Dose­Rate Brachytherapy: A Time­Course Analysis.
Atsushi Nagai, et al.

Kawasaki Medical School, Japan

4. Salvage high­dose­rate brachytherapy for local prostate cancer recurrence after
initial treatment.
Yoshimasa Jo, et al.

Kawasaki Medical School, Japan

5. Clinical Study of Individual Therapy of Benign Prostate Hyperplasia withDifferent Dose Terazosin.
Jianliang Cai, et al. Peking University Wujieping Urology Center, China
6. Forty percent of patients with ureteral stones who visit the emergency room firstare not followed by urologists.
Masaichiro Fujita, et al.

Kawasaki Medical School, Japan

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7. Development and application of a porcine heart tissue model for 2 micron
continuous wave laser endoscopic technique training.
Kai Zhang, et al. Peking University Wujieping Urology Center, China

11:20 ­ 11:30

Closing Address
Prof. Hiromi Kumon, President of CJUA (Japan)

11:30 ­ 12:30

CJUA Leadership Meeting4

[ Abstracts ]Session I
１．Early experience of botulinum toxin type A injection in patients with interstitial
cystitis/ hypersensitive bladder syndrome.
Akira Nomia 1, Tetsuya Fujimura1, Takashi Naruse3, Motofumi Suzuki1,
Hiroshi Fukuhara1, Yutaka Enomoto1, Hiroaki Nishimatsu1, Akira Ishikawa1,
Haruki Kume1, Yasuhiko Igawa2, Yukio Homma1( 1.Department of Urology, University of Tokyo
2.Department of Continence Medicine, University of Tokyo
3.Department of Community Health Nursing, University of Tokyo, Japan )The aim of the study
Interstitial cystitis/ hypersensitive bladder syndrome (IC/ HBS) is a chronic
inflammatory disease of urothelium with unknown reason, with few effective
therapeutic modalities. Recently, effectiveness and safety of botulinum toxin A(BTX­A) injection in patients with IC/ HBS has been reported. In this study, we
examined effectiveness and safety of BTX­A injection therapy in Japanese IC/ HBS
patients.
Materials and Methods
Patients with poor control of IC/ HBS symptoms (O’Leary and Sant’s Interstitial
Cystitis symptom index / problem index (OSSI/OSPI) both scored more than 6
points and visual analogue scale for pain more than 3 points) despite of various
therapies (ex. hydrodistention, medical treatment, etc.) were enrolled in the study.
All the patients had been diagnosed as IC/ HBS with hydrodistention at our
institution. All the patients were injected into submucosal layer of the bladder
trigone with 100 units of BTX­A under spinal or general anesthesia.
For symptom evaluation, OSSI/OSPI, VAS, overactive bladder symptom score(OABSS), International Prostate Symptom Score (IPSS), Core Lower urinary tract
Symptom Score (CLSS), frequency volume chart (FVC), uroflowmetry were used
before the therapy as the baseline and a month after the therapy. The protocol of thestudy was approved by our Institutional Review Board and was fully explained tothe patients before informed consent was obtained.

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Results
From October 2010 to March 2011, 18 patients (13 women and 5 men) with theaverage age of 64.4 years (range 35 to 79) were treated with BTX­A injection
therapy. Before the therapy, OSSI/ OSPI scored 12.5 and 11.4 points, VAS was 6.5
points, OABSS was 8.1 points, and IPSS was 23.8 points in average. According toFVC, they voided 21.6 times during daytime and 4.0 times during night, andaverage voided volume was 95.0ml.
A month after the BTX­A injection, OSSI/ OSPI scored 10.9 and 8.6 points, VAS was
4.4 points, OABSS was 6.2 points, and IPSS was 17.3 points in average whichchanges were significant (p<0.05) except for OSSI. As for voiding, they voided 17.6
times during daytime and 3.3 times during night with average voided volume130.0ml which changes were also significant (p<0.05).
No significant change in uroflowmetry was observed and no side effects which
required additional therapy occurred
Conclusions
Trigonal injection therapy with 100 units of BTX­A can be one of effective and safe
therapeutic modality for refractory IC/ HBS.

２．Urine alkalization by Citrates improves pain and other symptoms in patientswith interstitial cystitis/bladder pain syndrome (IC/BPS).
Masaaki Ito, Hideki Tanoue, Toru Yoshida and Tomohiro Ueda
（Kyoto City Hospital, Japan)
Aims of study
Acidic urine may play a role in the development of symptoms in patients withinterstitial cystitis/bladder pain syndrome (IC/BPS) because activation of afferentC­fibers can be triggered by excessive H+ ions. Here, we report the result of thestudy that was designed to evaluate the data of urine pH value and pain intensity.
We also investigated sleep disturbance in this study.
Materials and methods

6Thirty­four participants who provided written consent were enrolled in this study,
and thirty were selected based on symptoms recorded in 2­day voiding diaries andurine pH of each voiding during the screening period. Kings health questionnaire(KHQ), OLeary & Sant IC symptom and problem indices (ICSI and ICPI) were also
used to evaluate the symptoms. Sleep disturbance was investigated using Pittsburg
sleep quality index questionnaire (PSQI). The intensities of pain and of discomfort
were recorded by patients at each voiding using a 4­point scale (0 – 3). Following thescreening period, the participants were administered citrates (a mixture ofpotassium citrate and sodium citrate) for four weeks. A compact pH meter was used
to measure the pH. Patients with insufficient alkalization of urine wereadministered higher dose of the citrates for four more weeks, and then changes insymptoms were evaluated.
Results
Spot urine tests using the pH meter before treatment revealed that many patients
had urine pH lower than 5.2, which is lower limit of the urine pH test paper. Afterthe treatment, the urine pH at each voiding was increased, and the number ofpatients with low urine pH was also decreased. The average volume per voiding andthe maximum voided volume were increased significantly (P=0.001 and <0.001,
respectively). The mean intensities of pain and discomfort at voiding weredecreased significantly (P=0.001 and 0.013, respectively). For the KHQ, general
health perception, incontinence impact, and physical limitations improved
significantly (P=0.043, 0.026, and 0.015, respectively). The ICSI and ICPI were also
decreased significantly (P=0.01).
With respect to sleep disturbances, a small improvement was observed in the PSQI,
but the improvement was not significant.
Conclusion
In this study, we could evaluate precisely the elevation of urine pH after theadministration of citrates throughout the day. The results of this study suggest thaturine alkalization could be effective to reduce the symptoms of patients with
IC/BPS.

３．Synergistic anti­tumor effect of combined knockdown of the IAP genes on human
bladder cancer T24 cells.

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Yang D1, Song X1, Zhang J2, Ye L1, Wang S2, Che X1, Wang J1, Zhang Z1, Wang L1,
Shi W2.
（1.Department of Urology, First Affiliated Hospital of Dalian Medical University,
2.Department of Biochemistry, Dalian Medical University, China）

Abstract
Livin, X­linked inhibitor of apoptosis (XIAP), and Survivin are three well­known
inhibitors of apoptosis almost exclusively over­expressed in cancer cells and areconsidered potent targets for cancer treatment. In the present study, we found that
Livin, XIAP, and Survivin were simultaneously expressed in bladder cancer cells.
We speculated that Livin, XIAP, and Survivin might have synergistic effects on cell
growth and apoptosis. Our results confirmed that combined knockdown of all thesethree genes can synergistically inhibit the proliferation and transformation abilityof high­grade bladder cancer T24 cells and promote the cell apoptotic sensitivity tochemotherapy. Furthermore, combined knockdown of Livin, XIAP, and Survivin canmarkedly increase the abundance of active caspase­3, active caspase­7, active
caspase­9, and cytosolic Smac. Our findings imply that combined silencing of Livin,
XIAP, and Survivin may be a potent multitargeted gene therapy for bladder cancer.

４．Over­expression of G­protein­coupled receptor 87 (GPR87) closely correlatedwith tumor proliferation in urothelial carcinomas of the bladder.
Xia Zhang, Homare Okazoe, Dage liu, Xiuxian Wu, Shinsuke Shibuya, Mikio
Sugimoto, Yoshiyuki Kakehi（Department of Urology, 2nd Department of Surgery, Faculty of Med, Kagawa Univ,
Japan)
Introduction and Objective
The orphan G­protein­coupled receptor 87 (GPR87) has recently been deorphanized
and shown to be a receptor of lysophosphatidic acid (LPA). A comprehensive
analysis using gene chip technology demonstrated that GPR87 mRNA waspreferentially over­expressed in squamous cell carcinoma of different location. It

8was over­expressed in some bladder cancer tissues and adenocarcinoma of the lung.
In this study, expression levels of GPR87 mRNA were analyzed in bladder cell lines
and influence of silencing GPR87 mRNA on cell proliferation was investigated.
Protein expression of GPR87 in bladder cancer was also analyzed with special
relevance to cell proliferation including tumor grade and Ki­67 index.
Methods
GPR87 mRNA levels were measured by real­time RT­PCR in 7 human bladdercancer cell lines, HT1197, J253, J28, RT112, RT4, T24 and TCSSP. Small interfering
RNA (siRNA) knockdown of GPR87 also performed using a SMART pool­plus set of
4 individual siRNAs. The cell viability was established using the MTT assay.
Bladder urothelial carcinomas (UCs) were obtained from 103 patients (3 Tis, 68 Ta,
21 T1, 11 T2<) by transurethral resection during the period between 2006 and 2009.
Median age of these patients was 71 years ranging 43 to 95. Formalin­fixated andparaffin­embedded tumor specimens were subjected to immunohistochemical
analysis.
Results
Relative expression of GPR87 to GAPDH was highest in HT1197 and lowest in T24
cells. Silencing of GPR87 mRNA resulted in 59% reduction of cell viability in
HT1197 cells. GPR87 expression of bladder tumors was immunohistochemically
positive in 61 (59%) of 103 patients. Positive rate of GPR87 immuno­staining highgrade (n=44) and low grade (n=59) tumors (WHO/ISUP 2004) were 75% and 48%,
respectively (p=0.008). Ki­67 proliferation index in GPR87 negative tumors was
4.4±5.8% whereas that in GPR87 positive tumors was 22.1±17.8% (p<0.0001). The
positive rate of GPR87 in Ki­67 positive (n=36) and negative (n=67) tumors were
94% and 40%, respectively (p<0.0001).
Conclusions
These data strongly suggest that GPR87 expression is associated with tumor
proliferation of bladder UC. It is imperative to be elucidated whether GPR87
expression in bladder UCs is associated with recurrence and malignant progressionin bladder UCs.

５．ncRAN, a Newly Identified Long Non­coding RNA, Enhances Human Bladder9Tumor Growth, Invasion and Survival.
Yuyan Zhu1, Meng Yu2, Zhenhua Li1, Chuize Kong1, Jianbin Bi1, Jun Li1, Zeliang Li1（1.Department of Urology, No.1 Hospital of China Medical University
2.Department of Reproductive Biology and Transgenic Animals, China Medical
University, China.）
Objectives
To study the functional significance of ncRAN, a newly identified long non­coding
RNA, expression in bladder cancer growth, invasion and survival.
Methods
Expression of ncRAN isoforms was analyzed by RT­PCR in 40 clinical specimens
and 4 bladder cancer cell lines, respectively. The expression of ncRAN in the clinicalspecimens was correlated to clinical stage or grade to assess for potential
relationship. ncRAN­long form or ncRAN­short form was stably overexpressed inhuman bladder cancer cell line, RT­4(superficial) exhibiting low endogenous
expression of ncRAN, respectively. The influence of ncRAN on cancer cell survival
was evaluated by silencing with short hairpin RNA in 5637 cells(invasive).
Functional assays were performed to study the resulting changes in cellproliferation, motility, invasion and survival.
Results
Expression of ncRAN was significantly higher in bladder cancers compared withnormal tissues (P<0.01) and in invasive tumor compared with superficial
ones(P<0.01). Consistently, ncRAN expressed significantly higher in invasive
bladder tumor cell lines (5637, T24, EJ)than that in superficial tumor cell lines(RT­4). Overexpression of ncRAN in RT­4 cells significantly enhanced cellproliferation, migration and invasion. Silencing of ncRAN improved chemotherapy
sensitivity in 5637 cells.
Conclusions
These observations suggest that ncRAN may play an important role in cancer cell
growth，invasion and survival as a potential target for bladder cancer therapy.

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６．A Correlational Study between Expression of NGF and Diabetic Cystopathy in
Diabetic Rats.
Xiaoqiang Liu, Weifan Jiang, Gaofeng Zhang, Guang Sun（ Urology Dep. 2nd hospital of Tianjin Medical University,Tianjin Institute of
Urology, China.）
Abstract
Objective To provide experimental basis for further study of the urodynamics ofurinary storage dysfunction of diabetic cystopathy (DCP),and find out therelationship between NGF(nerve growth factor) in bladder and DCP in its
occurrence and development as well as their effects.
Methods
Steptozotocin(STZ)­induced diabetic rats were employed as DCP models. Normal
rats served as controls. 6、9、12 weeks after the induction of DM, the residual urine
volume was measured and compliance of the bladder was evaluated by cystometry.
The histopathologic appearance was observed under light and electric microscopes.
Results（1）DCP models：6 weeks after the STZ administration, the diabetic rats showed
weight loss from their initial body weight(248.05±15.517 vs. 322.80±15.920) and asignificant

increase

in

the

blood

glucoselevel

compared

with

the

controls(30.900±3.2942 vs. 4.787±0.2973） They also displayed remarkably greater
bladder weight than the controls(171.15±6.081 vs. 135.53±5.330)(mg). （ 2 ）Cystometry findings：Cystometry

showed significant increase of bladder capacity,

single voided volume, and post­void residual volume in the diabetic rats comparedwith the controls. In addition, the diabetic rats showed frequent unstablespontaneous contraction in the filling phase, which did not occur in the control rats.
（ 3 ） Performance under the microscope ： Microscopically, the muscle bundle
arranged haphazardly and loosely in the observation group, collagen fibers in themuscle bundles reduced compared to control group. Ultrastructurally, the quantityof collagen fibers and intermediate junction among detrusor muscle cells decreased.
（4）
NGF：The expression of mean NGF protein level in the bladder at the 6th、9th、12th weeks was significantly reduced compared with that in the normal rats，and
showed a decreasing trend over time.

11Conclusions
Reduced expression of NGF and the progression of DCP are correlated.

７．Cooperative Research on Genetic Predisposition for Prostate Cancer in Asia byAnalyzing Cumulative Association of SNPs ­The Final Data.
Haruki Kaku1,2, Masami Watanabe2, Peng Huang1, Akiko Sakai3, Yasutomo Nasu1,
Kenji Shimizu3, Lei Wang4, Kexin Xu4, Kai Yang5, Jiheng Zhang6, Ming Li6, Liping
Xie5, Xiaofeng Wang4, Yanqun Na7 and Hiromi Kumon1,2（1.Department of Urology, Okayama University
2.Center of Gene and Cell Therapy, Okayama University
3.Department of Molecular Genetics, Okayama University
4.Department of Urology, Peking University People’s Hospital
5.Department of Urology, the First Affiliated Hospital, School of Medicine,
Zhejiang University;
6.Department of Urology, Peking University School of Oncology, Beijing Cancer
Hospital
7.Department of Urology, Peking University Shougang Hospital, Japan)
Introduction and Objective
A cooperative research on genetic predisposition for prostate cancer in Japan, Korea,
China and Singapore by analyzing cumulative association of SNPs was completed
on March 2011. We herein report the final comprehensive results of genetic
predisposition for prostate cancer in these countries.
Materials and Methods
We have genotyped more than 50 non­synonymous missense­SNPs of cancer­related
genes in 619 prostate cancer patients and 1565 matched healthy male volunteers inJapan. We have also genotyped 150 prostate cancer patients (at Beijing andHangzhou) and 114 healthy males in China, 143 prostate cancer patients and 150
healthy males (including 50 Chinese, 50 Indian and 50 Malayan people) in
Singapore, and 100 prostate cancer patients and 100 volunteers with benign
prostate hyperplasia in Korea.
Results

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Genetic background and Risk­SNPs comparison were analyzed in the people ofthese countries. As a result, genetic background was similar : [the Japanese vs.
Chinese 93%, Korean 92%, Chinese­Singaporean 91%, Malayan­Singaporean 87%
and Indian­Singaporean 73%]. As for the Risk­SNPs comparison between theJapanese and Chinese, 4 were identical, 4 were similar and 3 were Chinese specific.
Furthermore, we disclosed that at least 3 to 4 Risk­SNPs which were useful in theJapanese might be also available in Chinese and Korean people.
Conclusions
Our novel way of combining the risk factors and the specific SNPs analyses would
be useful for predicting prostate cancer predisposition in the Asian people. We
believe that the strategy can be also applied for the other malignancies and for theother ethnic populations by selecting proper SNPs combinations.

Session Ⅱ
１．Initial results of Robot­assisted laparoscopic radical prostatectomy at Okayama
University.
Shinya Uehara, Takashi Saika, Yasuyuki Kobayashi, Shin Ebara, Motoo Araki,
Katsumi Sasaki, Katsushi Ishii, Masami Watanabe, Toyohiko Watanabe, Haruki
Kaku, Yasutomo Nasu, Hiromi Kumon（ Department of Urology, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan）
Objectives
Initial results of Robot Assisted Laparoscopic Radical Prostatectomy (RALP) using
the daVinci Surgical System at Okayama University were evaluated.
Patients/Method
A total of 12 patients of median age 68 years (range: 55­75), baseline BMI 24%(range: 20­27) and pre­operative serum PSA level 7.7 ng/ml (range: 4.0­10.3),
underwent RALP at Okayama University between October 2010 and May 2011.

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Result
The mean operative time was 341 minutes (range: 256­481), of which the mean
operative time using the daVinci Surgical System was 266 minutes (range: 200­388).
The mean estimated blood loss was 100 ml (range: 50­250). Histopathology showedpT stages, pT2 in (n=2); pT2b in (n=3) and pT2c in (n=7) patients, respectively. All
specimens had a negative surgical margin .Catheterization was discontinued 6 days
post operatively. Following catheter removal, 0­1 urinary pads were used in 58%
patients soon after ; in 83％ patients at 1 month and in 91％ patients, at 3 months.
The median serum PSA level was found to be 0.003ng/ml (range: 0.003­0.092), at 3
months post operatively. One patient developed pulmonary infarction, one day after
operation, but improved following conservative treatment.
Conclusion
The present results indicate that RALP is useful in assisting tumor removal andimproving postoperative continence. . Further study is required to establish theusefulness of RALP in lessening operative time and preserving sexual function.

２．Benign lesions in surgically removed renal masses preoperatively suspected asrenal cell carcinoma: the clinical and CT imaging features.
Wen Kong, Ji­wei Huang, Jin Zhang, Bai­jun Dong, Chen Yong­hui, Wei Xue, Zhou
Li­xin, Dong­ming Liu, Yi­ran Huang（Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of
Medicine, Shanghai, China）
Objective
To analyze the clinical and CT imaging features of benign kidney lesions presumed
to be renal cell carcinoma (RCC) before surgery in order to improve the diagnostic
accuracy for renal masses.
Methods
From January 2003 to September 2010, 1531 patients underwent radical or partial
nephrectomy for solitary renal cortical neoplasms presumed to be RCCs inpreoperative imaging. Preoperative CT images, clinical records and pathologicalfindings were retrospectively reviewed. Logistic regression was used to identify the14clinical predictors for benign lesions. For small renal masses (≤4cm), CT imaging
features, including plain phase attenuation, enhancement degree and enhancement
patterns were compared between benign tumors (mainly angiomyolipoma andoncocytoma) and pathologically confirmed RCCs (mainly clear cell carcinoma,
papillary carcinoma and chromophobe carcinoma).
Results
Pathological examinations revealed 81 (5.3%) benign lesions among 1531 patients.
The incidence of benign lesions was 7.8% in small renal masses (≤4cm), 3.8% in
masses between 4cm and 7cm, and 1.1% in masses larger than 7cm (P<0.01).
Angiomyolipoma was the most predominant histologic subtype in benign renal
lesions. Female gender（OR：3.13，P<0.01）, younger age（OR：0.94，P<0.01） andsmaller tumor size （OR：0.75，P<0.01） were independent predictors for benign
kidney lesions. Thirty­nine cases of benign tumors (32 angiomyolipomas and 7
oncocytomas) and 60 cases of contemporary pathologically confirmed RCCs (42 clear
cell carcinomas, 7 papillary carcinomas and 11 chromophobe carcinomas) were
included for image analysis. None of 32 angiomyolipomas showed negative
attenuation in unenhanced CT scans. High tumor attenuation in the plain phase
was more common in cases of benign tumors (P<0.01). In the arterial phase, themean amount of enhancement for clear cell carcinomas was 87.18±44.36HU, which
was greater than other pathologic types (P ＜0.05); While oncocytomas exhibitedthe greatest enhancement degree in the venous phase with the mean enhancement
attenuation 165.27±29.32HU (P＜0.01). The enhancement pattern over time wasdifferent among variant pathologic types. An early washout pattern was observed inmost cases of clear cell carcinomas (n=35, 83.3%) and part of cases withchromophobe carcinomas (n=7, 63.6%); a gradual enhancement pattern was themost significant feature for oncocytomas (n=7, 100%); all the papillary carcinomas(n=7, 100%) and more than half of angiomyolipomas (n=20, 62.5%) exhibited
prolonged enhancement characteristic (P ＜0.05). Considering the homogeneity oftumor enhancement, clear cell carcinomas (n=39, 92.9%) and oncocytomas (n=4,57.1%) usually showed heterogeneous enhancement, while all papillary carcinomas(n=7, 100%), most angiomyolipomas (n=26, 81.3%) and chromophobe carcinomas(n=10, 90.9%) showed homogeneous enhancement (P＜0.01).
Conclusions
Despite a low frequency, 5.3% of patients underwent surgery for benign kidney

15lesions, mainly including angiomyolipoma and oncocytoma. Female gender, younger
age and smaller tumor size are clinical predictors for benign lesions. Homogeneousenhancement and prolonged enhancement are valuable CTfeatures forangiomyolipomas. Oncocytomas tend to be hypervascular and have a gradualenhancement pattern. The high­degree and heterogeneous enhancement, as well as
the early washout pattern are useful parameters to identify clear cell carcinoma.
Papillary carcinomas may manifest low­degree enhancement, prolonged andhomogenous enhancement pattern; while chromophobe carcinomas usually show
homogenous and moderate enhancement. All the above CT imaging features may be
helpful to differentiate renal malignancy and benign lesions, as well as different
histologic subtypes.

３．Health­Related Quality of Life in Patients with Localized Prostate Cancer
Received High­Dose­Rate Brachytherapy: A Time­Course Analysis.
Atsushi Nagai, Masaichiro Fujita, Aya Obatake, Shin Ohira, Shohei Tsukimori,Kazuhiko Fukumoto, Tomohiro Fujii, Yoshimasa Jo, Teruhiko Yokoyama andYoshiyuki Miyaji（ Department of Urology, Kawasaki Medical School, Kurashiki, Okayama, Japan)
Objectives
The purpose of this study was to make a time­course analysis of HRQoL in patientswith localized prostate cancer receiving High­dose­rate brachytherapy (HDR­BT)
employing general and disease­specific measures.
Methods
The examination of HRQoL has been performed since May 1, 2004. The 36­item
Short­Form Health Survey version 2.0 (SF­36v2) and the University of California,
Los Angeles Prostate Cancer Index (UCLA­PCI) were adopted. Patients wererequired to complete these two questionnaires before treatment (baseline), andagain at 1, 6, 12 and 24 months after treatment. Only patients who completed all
the questionnaires throughout the time period were eligible for this study. The
average scores of both the SF­36 and the UCLA­PCI were calculated at each point toshow a clear time­course change.

16Results
The total number of patients was 229. The average scores in all aspects of the SF­36
at 24 months were better than those at the baseline. For the UCLA­PCI, theaverage scores for urination (UF and UB) and bowel movement (BF and BB) showeda similar transition to these of the SF­36, but those for sexuality (SF and SB)
showed a significant declination.
Conclusions
HRQoL associated with HDR­BT seemed to be favorable, but the effects on sexualfunction and sexual bother were not so favorable. Therefore, more attention shouldbe paid to sexuality to achieve a better patient HRQoL.

４．Salvage high­dose­rate brachytherapy for local prostate cancer recurrence after
initial treatment.
Yoshimasa Jo, Masaichiro Fujita, Aya Obatake, Shin Ohira, Shohei Tsukimori,Kazuhiko Fukumoto, Tomohiro Fujii, Teruhiko Yokoyama, Yoshiyuki Miyaji andAtsushi Nagai( Department of Urology, Kawasaki Medical School, Kurashiki, Okayama, Japan）
Objectives
We assessed the preliminary clinical results of salvage high­dose­rate
brachytherapy (HDR­BT) applied in cases of suspected local recurrence or ofresidual tumor after initial treatment.
Patients and methods
The subjects were 20 patients who met the above conditions and underwent salvage
HDR­BT between December 2006 and July 2010. The T stage at the initial
treatment was T1c in 3 patients, T2 in 13 patients, and T3 in 4 patients. Seventeen
patients received HDR­BT±external beam radiation therapy (EBRT), two patient
received proton­beam irradiation and one patient received HIFU. Follow­up after
the completion of salvage HDR­BT lasted 12­51 months (median: 24 months). A doseof 11.0 Gy radiation was delivered twice (22.0 Gy in total), separated by a 6­hourinterval, on the day the applicators were inserted.

17

Results
Fourteen of the 20 cases (70%) remained in a biochemical non­evidence of disease(bNED) state. Three year PSA failure free survival rate was 52.6%. Hormone
administration was initiated in the six cases of recurrence. No G3 or more severe
events occurred, and the incidence of G2 was low during this study period.
Conclusion
Twenty cases treated with salvage HDR­BT, PSA levels remained low in fourteen
cases, and the incidence of complications was also low. This suggests that salvage
HDR­BT is effective as an option for treatment of local prostate cancer recurrence
after initial treatment.

５. Clinical Study of Individual Therapy of Benign Prostate Hyperplasia withDifferent Dose Terazosin.
Jianliang Cai, Hongfeng Guo, Ningchen Li, Xianghua Zhang, Yanqun Na（Peking University Wujieping Urology Center, China）
Objective
To investigate the therapeutic effect and safety of increasing Terazosin dose forbenign prostate hyperplasia(BPH) treatment after the failure of common dose.
Methods
Twenty three BPH patients who had negative response with common dose
Terazosin(2mg Qn) were investigate, 3mg Terazosin were taken orally every night,
and the dose increased to 4mg when the therapeutic effects were not good after 2
weeks follow­up. IPSS value, QOL score, Qmax, adverse effects and blood pressurechanges were evaluated in 4, 12 and 24 weeks.
Results
All 23 patients were finished clinical study, 11 patients took 3mg Terazosin Qn and12 cases took 4mg Qn in the whole observation period. The base line(0 week) IPSS
value were 22.78±5.83, QOL score were 3.95±0.42 and Qmax were 8.36±3.78; in 4
weeks, were IPSS value were 15.92±4.37, QOL score were 3.23±0.54, Qmax were
12.85±3.27; in 12 weeks IPSS were 11.16±4.93，QOL were 3.06±0.65, Qmax were18

14.49±4.50；in 24 weeks IPSS were 10.16±4.07, QOL were 3.01±0.45, Qmax were
14.70±5.36. Statistical analysis indicated that: IPSS value, the difference between
0/4 week, 0/12 week, 0/24 week, 4/12 week, 4/24 week had statisticalsignificance(P<0.05), while between 12/24 week, had no significance(P>0.05); QOL
score, the difference between 0/4 week, 0/12 week, 0/24 week had statisticallysignificant difference(P<0.05), 4/12 week, 4/24 week and 12/24 week had no
significance(P>0.05); Qmax, the differences between 0/4 week, 0/12 week, 0/24 week,
4/12 week and 4/24 week were statistically significant(P<0.05), 12/24 week wasnot(P>0.05). 2 cases who took 4mg Terazosin had dizziness complaint in the earlystage, the symptom relieved after adjustment of hypertension treatment plan; no
postural hypotension were found. The systolic blood pressure(SBP) of cases were:141±15.6mmHg(0 week), 138±13.4mmHg(4 week), 135±16.2mmHg(12 week),
138±17.3mmHg(24 week),
significance(P>0.05),

the difference among

diastolic

blood

them

pressure(DBP)

had no statistical
were:

85±7.4mmHg,

82±5.4mmHg, 80±7.7mmHg, 83±9.1mmHg in 0 week, 4 week, 12 week and 24 week,
respectively, their difference were also not statistically significant(P>0.05).
Conclusion
For benign prostate hyperplasia patients, when common dose terazosin(2mg Qn)
treatment fail, increase the drug dose to 3­4mg Qn, their therapeutic effect can
restore, and the side effect do not increase.

６．Forty percent of patients with ureteral stones who visit the emergency room firstare not followed by urologists.
Fujita M, Tsukimori S, Yokoyama T, Obatake A, Ohira S, Fukumoto K, Fujii T, Jo Y,
Miyaji Y, Nagai A（Department of Urology, Kawasaki Medical School, Kurashiki, Japan)
Introduction and Objective
Renal colic due to ureteral stone is one of the most common urological diseases andmany patients visit the emergency room first. We investigated the backgrounds andpatterns of follow­up of patients diagnosed as having ureteral stones in a single
emergency department over the past 2 years.

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Materials and Methods
After approval of the ethics committee of Kawasaki Medial School (KMS), we
performed a retrospective study of 197 patients who were diagnosed as having
ureteral stones in the emergency department at KMS Hospital between September
2008 and September 2010.
Results
The mean age of these patients was 49 years (range, 15­91 years), and the male tofemale ratio was 142:55. One hundred and thirty six patients had no previous
history of urolithiasis. Ureteral stones were identified at the right ureter in 71 cases
and at the left ureter in 94 cases. The ureteral stones were located at the proximal
ureter in 21 patients, at the middle ureter in 14 patients, at the distal ureter in 72
patients, and the remaining 86 were not identified. The mean stone size was 3.0 mm(range, 1 ­20 mm). One hundred and eighteen patients (59.9%) were followed up in
our urological department. Spontaneous discharge of the stones was confirmed in 77
patients. Ultimately, 8, 7, and 1 patient underwent transurethral lithotripsy (TUL),
extracorporeal shock wave lithotripsy (ESWL), and percutaneous nephrolithotripsy(PNL), respectively.
Conclusions
The stone sizes were relatively small and only 8.1% of the patients required
urological surgery among these patients who visited the emergency room. Only
59.9% of the patients saw urologists after their emergency room visits. We need to
be aware that many patients with ureteral stones who are seen in the emergency
room are not followed up by urologists.

７. Development and application of a porcine heart tissue model for 2 micron
continuous wave laser endoscopic technique training.
Kai Zhang 1, Gang Zhu 2, Li Ningchen1, Zhang Xianghua1, Na Yanqun1（1.Peking University Wujieping Urology Center
2.Beijing Hospital , China）
Objective
To develop and evaluate a porcine heart tissue model for 2 micron continuous wave

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laser endoscopic technique training.
Methods
Defrozen porcine heart was used as the training tissue model and fixed in the
training box. 10 junior surgeons without laser benign prostatic hyperplasia (BPH)
treatment experience were involved in the evaluation training study. The training
program was in two stages. In each stage, the trainees used 26 French laser
resectoscope and performed laser resection and vaporization of left ventricle chorda
tendineae cordis separately.

The continuous irrigation with physiologic saline

solution ensured good visibility. Before the 1st and the 2nd training stage, thetrainees were trained with theory and technique by an experienced trainer who wasusing 2 micron laser prostate resection and vaporization in the treatment of BPH.
Time consumed in each technique and sum of resection and vaporization time wasrecorded for further analysis.
Results
This animal model had plentiful space in porcine left ventricle for precise resection
and vaporization technique training. The training model was friendly used by
Trainees. The two stage training was conducted smoothly without risk event. There
were two trainees missed the second stage training and 8 groups of comparative
data were collected. The first stage resection time, vaporization time and sum ofresection and vaporization time were 166±94s，224±81s，390±145s；The second stage
resection time, vaporization time and sum of resection and vaporization time
were75±28s，105±28s，180±46s. Compared with the first stage, there was significant
improvement in terms of resection time, vaporization time and sum of resection andvaporization time (P<0.01) in the 2nd stage.
Conclusion
The establishment and application of defozen porcine heart as the 2 micron
continuous wave laser endoscopic technique animal tissue training model is feasible.
By using this model, trainees could improve their basic techniques, such as
resection and vaporization technique.

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