bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Interleukin‐6 levels after Urologic Operations
Authors: Igarashi Tatsuo , Takahashi Hidenori , Tanaka Masashi , Murakami Shino
Published: July 2007

Background: Endourology, extracorporeal shock wave lithotripsy (ESWL), and laparoscopic surgery are considered minimally invasive procedures; however, estimation of operative invasiveness has not been fully accomplished. We measured serum interleukin‐6 (IL‐6) levels, as an indicator for systemic reaction, to examine operative invasiveness of these operations in comparison with open surgery. Method: Serum IL‐6 levels were measured in 119 patients undergoing open surgery, laparoscopic surgery, endourology, and ESWL.

Results: The median IL‐6 levels on day 1 after the operation varied according to operative procedures: 83.5 pg/mL (range, 15–340 pg/mL) for open surgery, 24.8 pg/mL (range, 12–42 pg/mL) for laparoscopic surgery, and 10.8 pg/mL (range, 0–85 pg/mL) for endourology and ESWL. The extent of tissue injury and blood loss were found to be 2 major factors responsible for the serum IL‐6 elevation.

Conclusion: The minimally invasive character of endourology, ESWL, and laparoscopic surgery is attributable to low levels of tissue injury and blood loss, regardless of operative time.
Pyeloplasty in Hydronephrosis: Examination of Surgical Results from a Morphologic Point of View
Authors: Stein Raimund , Ikoma Fumihiko , Salge Stefanie , Miyanaga Takeaki , Mori Yoshinori
Published: July 2007

Background: Dilatation of the upper urinary tract is the most common congenital urogenital anomaly. Pyeloplasty is the therapy of choice in those patients with significant obstruction of the ureteropelvic junction. There are not many reports concerning the operative long‐term results from a morphologic point of view. Furthermore, little information is available about children with giant hydronephrosis treated without resection of the dilated renal pelvis.

Methods: Between 1973 and 1993, 231 children with 262 renal units (kidney, renal pelvis, ureter) were treated at our institution. Giant hydronephrosis was observed in 52 renal units. The clinical and follow‐up data were obtained from the patients' records. The dilatation of the upper urinary tract, confirmed by means of intravenous pyelogram, was divided into 5 grades.

Results: In 215 renal units, reconstructive surgery was performed without reduction of the renal pelvis. Revision of the pyeloplasty was necessary in 5 of the 215 renal units. The dilatation of the upper urinary tract improved or remained stable in 99.4% of the renal units during the follow‐up period of 4.8 years (range, 1 month to 21 years).

Conclusion: Surgical reconstruction of the ureteropelvic junction obstruction is a safe and successful procedure. The excision of the dilated pelvis does not seem to be necessary, even in patients with giant hydronephrosis.
Risk Factors in Urinary Calcium Oxalate Stone Formation and their Relation to Urinary Calcium Oxalate Supersaturation
Authors: Ogawa Yoshihide , Hatano Tadashi
Published: July 2007

Background: We studied the effect of potential risk factors of urinary calcium oxalate saturation on calcium oxalate stone formation.

Methods: Using the Equil2 program, the DG values of calcium oxalate in 390 clinical urine specimens were estimated in 5 healthy male individuals with and without citrate therapy.

Results: Critical calcium‐oxalate supersaturation (DG value, > 2.8) was noted in 15 out of 390 urine specimens. Of the 15, 14 late night or morning specimens had critical calcium oxalate supersaturation, while only 1 afternoon specimen was supersaturated. Critical calcium oxalate supersaturation was often associated with hyperoxaluria and hypercalciuria, while undersaturation was often associated with hypomagnesiuria, a high Ca/Mg ratio, and hypocitraturia.

Conclusions: Hypomagnesiuria, hypocitraturia, and a high Ca/Mg ratio appear to be poor indicators of calcium‐oxalate supersaturation, and it is hard to predict the level of calcium‐oxalate saturation using single parameters.
Radical Prostatectomy for Clinically Localized Prostate Cancer: local Tumor Extension and Prognosis
Authors: Arai Yoichi , Kanamaru Hiroshi , Moroi Seiji , Ishitoya Satoshi , Okubo Kazutoshi , Suzuki Yuji , Yoshida Osamu
Published: July 2007

Background: This study was performed to evaluate the frequency of local tumor extension and its effect on disease progression after radical prostatectomy.

Methods: The study consisted of 66 consecutive men who underwent radical prostatectomy for clinically localized prostate cancer without any prior hormonal therapy. Cases were stratified according to pathologic findings. Sites of capsular penetration were also evaluated.

Results: The overall incidences of lymph node metastases, seminal vesicle invasion, capsular penetration, and positive surgical margin were, respectively, 23%, 32%, 55% and 35%. The disease progression rate in patients with positive lymph nodes differed significantly from that in those without nodal metastases (P < 0.0001). Although seminal vesicle invasion, capsular penetration, or positive surgical margin had an adverse effect on prognosis, the difference in progression missed statistical significance, when patients with positive lymph node metastases were excluded. The most common site of capsular penetration was posterolateral, in the area of the neurovascular bundle.

Conclusions: Extraglandular tumor extension and positive surgical margins are common features of radical prostatectomy specimens. A nerve‐sparing operation should be performed selectively and with great caution. The markedly adverse effect of lymph node involvement on progression must be accounted for when evaluating other variables relating to progression.
Characterization of G Proteins in Obstructed Kidneys
Authors: Fukuzaki Atsushi , Kaneto Hiroyuki , Ishidoya Shigeto , Ikeda Shigenori , Orikasa Seiichi
Published: July 2007

Background: Urinary tract obstruction has a marked effect on renal function. Activation of phospholipases which results in incremental production of vasoactive eicosanoids may contribute to the hemodynamic changes characteristic of an obstructed kidney. G proteins play an important role in transmembrane signal transduction, which controls phospholipase activities and eicosanoid production. The present study was designed to determine the presence of G proteins in obstructed kidneys in rats, and to characterize the differences between unilateral ureteral obstruction (UUO) and bilateral ureteral obstruction (BUO).

Methods: Several G‐protein α subunits (Gas, Gαi1,2, and Gαi3) and the β subunit (Gβ) were determined by immunoblotting and immunocytochemical techniques using specific antibodies against these G proteins.

Results: lmmunoblots demonstrated a decreased Gαi3 content in the outer medullary tubules and a significantly lower Gβ level in the glomeruli of UUO. In BUO, there was an increased leeel of Gβ in the cortical tubules, and the Gαs level was markedly reduced in the inner medullary tubules.

Immunocytochemical studies revealed that these G proteins were predominantly localized in the brush border side of the cortical tubules. However, we could not demonstrate staining differences between UUO and BUO.

Conclusions: These results indicate that a modulation of G‐protein‐coupled transmembrane signal transduction may contribute to the renal functional changes in an obstructed kidney. A different level of expression of G‐protein subunits between UUO and BUO may be a factor in the differences of hemodynamics and renal tubular damage between UUO and BUO.
Gene Expression of TGF‐α, EGF and IL‐6 in Cultured Renal Tubular Cells and Renal Cell Carcinoma
Authors: Aoyagi Teiichiro , Takishima Kunio , Hayakawa Masamichi , Nakamura Hiroshi
Published: July 2007

Background: Renal cell carcinoma (RCC) is thought to arise from the renal tubular cells (RTC). Assuming that proliferating RTC imply a premalignant change of RTC into RCC, messenger RNA expressions of growth factors in cultured RTC were compared to both cultured and frozen noncultured RCC.

Methods: The expression of transforming growth factor‐alpha (TGF‐α), epidermal growth factor (EGF), EGF receptor (EGFR) and Interleukin‐6 (IL‐6) were studied in surgically obtained RCC (n=17), cultured RCC (n=10), and autologous cultured RTC (n = 15). Quantitation of the PCR product was performed using a computer image analyzer which evaluated the intensity of each cytokine relative to β‐actin.

Results: TGF‐α, EGFR and IL‐6 were detected in most of the cultured RTC, and both cultured and noncultured RCC were also expressed at high levels. In contrast to a high positivity of TGF‐α, EGF was not strongly positive in all specimens.

Conclusions: Our results show that there is a predominant autocrine production of TGF‐α in RCC and RTC, suggesting that TGF‐α plays a distinct role in the proliferation of these cells. These studies also indicate that the mechanisms of proliferation and cytokine production of RCC and RTC are similar.
Pyogenic Vertebral Osteomyelitis after Acute Bacterial Prostatitis: A Case Report
Authors: Soda Takeshi , Ogura Keiji , Ishitoya Satoshi , Niibayashi Hiroshi , Yoshida Osamu
Published: July 2007

A case of pyogenic vertebral osteomyelitis after acute bacterial prostatitis in a 78‐year‐old man is reported. The rarity and subtle clinical presentation of this condition, and the delayed appearance of radiologic signs of progression to destructive osteomyelitis, contributed to a significant delay in diagnosis. An arterial blood culture positive for bacterial growth during the episode of acute prostatitis suggested that bacteremia might result from hematogenous spread of the infection to the vertebral column via the venous system. Since intensive antimicrobial therapy proved ineffective, debridement of the first and second lumbar vertebral bodies, and anterior spinal fusion from the twelfth thoracic to the third lumbar vertebrae were performed. The patient's high fever and severe lumbago subsided immediately after the surgery. The possibility of development to pyogenic vertebral osteomyelitis should be kept in mind when treating a serious genitourinary tract infection.
Locally‐Confined Signet‐Ring Cell Carcinoma of the Prostate: A Case Report of a Long‐Term Survivor
Authors: Yoshimura Koji , Fukui Iwao , Ishikawa Yuichi , Maeda Hiroshi , Yamauchi Tamio , Kawai Tsuneo
Published: July 2007

It is generally believed that signet‐ring cell carcinoma (SRCC) of the prostate is a high‐grade neoplasm with a poor prognosis. We report a case of a long‐term survivor diagnosed with localized prostatic SRCC (T3N0M0), who has been alive without any clinical evidence of disease for 100 months after combination therapy which consisted of local irradiation and hormone administration. A posttreatment needle biopsy confirmed the pathological complete response.
Leiomyosarcoma of the Vaginal Wall Causing Difficulty in Micturition: A Case Report
Authors: Isurugi Koichiro , Hasegawa Fumiaki , Shibahara Nobuhisa , Tsutsumi Akira
Published: July 2007

A 52‐year‐old woman was admitted because of a vaginal‐wall tumor adjacent to the external urethral orifice. The tumor had been causing disturbances in micturition for the past year. Magnetic resonance imaging and computed tomography images indicated a 6 ± 3cm solid mass in the anterior vaginal wall. The tumor was enucleated surgically through a median longitudinal incision of the anterior vaginal wail. Micturitional disturbances were rectified after surgery. Histologically, the tumor was a mixture of a high‐cellularity area with a mitosis rate of 7 per 30 high‐power fields, and a less cellular area without mitosis. lmmunohistochemical staining was performed for both areas. The prognostic implications of the tumor are discussed.
Ex Vivo Surgery for Renal Artery Aneurysms
Authors: Toshino Akihiko , Oka Akihiro , Kitajima Keiichi , Akiyama Kazumi , Mitsuhata Naoki , Mannami Rensuke , Yokoyama Masayoshi , Mannami Makoto
Published: July 2007

Background: Renal artery aneurysms (RAAs), once considered rare, are being recognized with increasing frequency. The treatment of aneurysms of the first ramification of the main renal artery is still controversial.

Methods: From November 1984 to May 1992, we treated 8 patients with RAA at the first ramification. All the patients were treated with an ex vivo technique and autotransplantation.

Results: The results, evaluated with intravenous pyelogram and arteriography were satisfactory. No operative deaths and no complications were noted.

Conclusion: We concluded that surgery with an ex vivo technique and autotransplantation is an excellent method of treating this type of lesion.
Phenotype Frequency of Human Leukocyte Antigens in Japanese Patients with Renal Cell Carcinoma who Responded to Interferon‐α Treatment
Authors: Onishi Tetsuro , Ohishi Yukihiko , Iizuka Norio , Imagawa Kenichi
Published: July 2007

Background: Because of the high cost, low overall response rate (10% to 20%), and poor quality of life during interferon therapy for advanced renal cell carcinoma, it is important to distinguish patients likely to respond to treatment. The expression of human leukocyte antigens (HLA) may serve as a clinical marker for response to interferon treatment in patients with renal cell carcinoma.

Methods: We compared HLA phenotype frequency in 37 Japanese patients with advanced renal cell Carcinoma who showed a favorable response to interferon‐α, in 93 similar patients, before treatment, who did not receive interferon‐α, and in 939 healthy Japanese volunteers (historical control data).

Results: Six HLA antigens, B35, Bw48, Bw60, DRw6, DRw8, and DR9, were expressed at a significantly lower rate in the 93 pretreatment patients with renal cell carcinoma, compared with the control subjects. Three HLA antigens, excluding Bw60, DRw6, and DRw8, were expressed at a significantly higher rate in the patients who responded to interferon‐α, compared with the pretreatment patients with renal cell carcinoma and control subjects.

Conclusion: Three HLA antigens, B35, Bw48, and DR9, were expressed at a significantly higher rate in patients with renal cell carcinoma who showed a sensitivity to interferon‐α, and could be important markers for clinical response to this antitumor therapy.
Transrectal Ultrasonography to Predict the Clinical Outcome of Transurethral Microwave Thermotherapy in Patients with Benign Prostatic Hyperplasia
Authors: Kurita Yutaka , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio , Kawabe Kazuki
Published: July 2007

Background: This study evaluated the long‐term efficacy of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia (BPH), and determined whether the indices obtained with transrectal ultrasonography (TRUS) can predict the clinical response to TUMT.

Method: Between November 1991 and June 1992, 43 patients with symptomatic BPH were treated with TUMT using the Prostcare device. The therapy consisted of a 1 ‐hour treatment under topical anesthesia. The findings of uroflowmetry and AUA symptom score before treatment were compared with those obtained dt each visit after the therapy. As the indices, the transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and presumed circle area ratio (PCAR) were calculated.

Results: There was a significant correlation between pretreatment TZ ratio and residual urine volume (r= 0.472, P= 0.0022). The efficacy rates calculated by response criteria on the 3 point scale at 2 months, 12 months, and 30 months were 44.2%, 30.2%, and 25%, respectively. The significant prognostic factors that predicted the clinical effect 1 year after treatment were the TZ ratio and intraprostatic temperature. After controlling for the treatment temperature, the multivariate logistic regression model demonstrated that the TZ ratio was the significant predictor (p= 0.049) of 1 year efficacy of treatment.

Conclusion: The present study showed that the efficacy rate of TUMT at 30 months was 25%, and that TKUS provides a simple parameter, the TZ ratio, which predicts the efficacy of TUMT.
Correlation of Transrectal Ultrasonography and Core Biopsies with Pathology Results in Radical Prostatectomy Specimens
Authors: Turkeri Levent , Tarcan Tufan , Biren Tuǧrul , Küllü Sevgi , Akdaş Atif
Published: July 2007

Background: We compared preoperative tumor location, as identified by transrectal ultrasonography (TRUS), and TRUS‐guided core biopsies with the final histopathological examination of radical prostatectomy specimens.

Methods: Thirty patients who had radical retropubic prostatectomy after evaluation with TRUS are included in the study. Diagnosis of prostate cancer was established with TRUS‐guided systematic (3 cores from base, mid and apex of the peripheral zone, and 1 core from the transition zone of each side of the prostate) and lesion‐directed core biopsies in all cases. Each prostate gland was halved for histopathological examination and results are reported in terms of “sides”.

Results: Histopathological examination of the prostatectomy specimens revealed prostate cancer bilaterally in 29 glands (58 sides) and unilaterally in 1 gland. Preprostatectomy TRUS examinations missed cancer in 29 sides, and core biopsies were negative for cancer in 14 sides.

Conclusion: This study revealed that 49% of prostate cancer lesions (n=29 sides) were not recognized on TRUS and 52% of those (n = 15 sides) were diagnosed only by additional systematic biopsies. Furthermore, even with TRUS‐guided systematic core biopsies, failure to detect the prostate cancer lesions may be as high as 24% (n = 14 sides).
Serum Prostate‐Specific Antigen Values for the Prediction of Clinical Stage and Prognosis in Patients with Prostate Cancer: An Analysis of 749 Cases
Authors: Kuriyama Manabu , Obata Koji , Miyagawa Yoshimasa , Nishikawa Eiji , Koide Takuya , Takeda Akihisa , Komeda Yoshinori , Kanbayashi Tomoyuki , Nakano Masaru , Miyake Koji
Published: July 2007

Background: The clinical significance of pretreatment serum prostate‐specific antigen (PSA) values was studied to determine the ability to predict clinical stage and prognosis using a relatively large number of patients with prostate cancer.

Methods: Serum PSA values at diagnosis were analyzed from 749 patients with newly‐diagnosed prostate cancer and registered in the Tokai Urological Cancer Registry. Correlations between the PSA value, the clinical stage and prognosis of the patients were evaluated.

Results: Serum PSA values at each stage of diagnosis showed positivity (≥ 3.6 ng/mL) in 23% (stage A1) to 91.2% (stage D2) of patients, and it was possible to obtain statistical differences between the stages, even between A1 and A2. Based on a cumulative study of PSA distribution, stages greater than A2 could be diagnosed using a cut‐off of 7.2 ng/mL, with a 99.2% positive predictive value (PPV), and a 16.2% negative predictive value (NPV). At a PSA level of 1 0.8 ng/mL, stages greater than B2 could be predicted with a PPV of 95.3% but an NPV of 40.3%. Pretreatment PSA values were a significant prognostic indicator in stage D2 patients using 100 to 150ng/mL as the cut‐off values. These differences were primarily found in the poorly differentiated group, which showed a statistical difference using cut‐off PSA values from 75 to 150 ng/mL.

Conclusions: Serum PSA levels from a large number of patients can be used to predict the stage and prognosis of prostate cancer patients.
Comparison of Hormonal Therapy and Chemohormonal Therapy in Patients with Newly Diagnosed Clinical Stage D Prostatic Cancer
Authors: Miyake Hideaki , Hara Isao , Fujisawa Masato , Eto Hiroshi , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao
Published: July 2007

Background: In order to examine the usefulness of chemohormonal therapy, we conducted a multicentered randomized trial comparing hormonal therapy, using a luteinizing hormone‐releasing hormone (LH‐RH) agonist, with chemohormonal therapy, hormonal therapy plus cyclophosphamide (CPM), in patients with newly diagnosed clinical stage D prostatic cancer.

Methods: Between January 1991 and March 1995, 41 evaluable patients with stage D prostatic cancer were randomized into 2 groups: group A (hormonal therapy alone), goserelin acetate depot 3.6mg subcutaneously every 4 weeks; group B (chemohormonal therapy), goserelin acetate depot 3.6mg subcutaneously and CPM 1000mg/m2 intravenously every 4 weeks. The responses to the therapies were evaluated based on the criteria of The Japanese Urological Association.

Results: There were no significant differences between the 2 groups with regard to objective and subjective response rates. No advantage in chemohormonal therapy was observed in the survival rate and progression‐free survival rate. However, the survival rate and progression‐free survival rate of responders were significantly higher than those of nonresponders in both groups. When the results were categorized by histologic grade patients with poorly‐differentiated adenocarcinoma had significantly higher response rates, survival rates, and disease‐progression‐free survival rates in Group B compared to similar patients in Group A.

Conclusions: We conclude that chemohormonal therapy does not definitely improve the clinical response and prognosis of patients with stage D prostatic cancer; however, for patients with poorly‐ditferentiated adenocarcinoma, chemohormonal therapy is a useful treatment.
Effects of Alterations in Potassium and Calcium Concentrations on the Pressure Generated in Rat Whole Bladder In Vitro
Authors: Saito Masahiko , Ohmura Masaharu , Kondo Atsuo
Published: July 2007

Background: Various physiologic systems maintain the ionic equilibrium essential tor normal neuron and smooth muscle function. These systems are impaired by nonphysiologic concentrations of extracellular cations. This study investigated the effects of altered extracellular concentrations of potassium and calcium on the in vitro pressure generation in the whole bladder of rats.

Methods: Pressure increases in response to field stimulation, as well as low and high doses of bethanechol, were determined in a Krebs solution containing a normal amount of potassium, and in excess of 10mmol/L and 20mmol/L of potassium. Each of these solutions had calcium concentrations, that were low (0.8mmol/L), normal (2.5mmol/L), or high (7.5mmol/L).

Results: The response to field stimulation was significantly decreased at the 20‐mmol/L concentration of potassium in the presence of the different concentrations of calcium. The response to field stimulation increased as the extracellular concentration of calcium increased. The pressure increase caused by a low dose of bethanechol was significantly enhanced by elevations in the concentrations of both potassium and calcium. There was no difference in the response to a high dose of bethanechol in the presence of the various concentrations of potassium and calcium.

Conclusion: These findings indicated that changes in the cationic equilibrium that result in blocking of the neuronal sodium channels, as well as increasing the level of intracellular bound calcium in smooth muscle, alter bladder function in vitro.
Effects of Chronic Renal Failure on Hypothalamo‐Pituitary‐Testicular Axis Function and Fertility in Rats
Authors: Yamamoto Yasuhisa , Sofikitis Nikolaos , Miyagawa Ikuo
Published: July 2007

Background: We evaluated the effects of chronic renal failure on hypothalamo‐pituitary‐testicular axis function in male Wistar rats.

Methods: Chronic renal failure was induced by five‐sixths nephrectomy in male rats. Seven to 10 weeks after the surgery, serum urea and creatinine concentrations and hematocrits were evaluated, and human chorionic gonadotropin (hCG) and gonadotropin‐releasing hormone (GnRH) tests, and prolactin stimulating antl suppression tests were performed. In addition, androgen‐binding protein, epididymal sperm content, motility, ancl fertile potential were assessed.

Results: Basal serum testosterone concentrations and the response of testosterone to hCG were significantly lower in rats with chronic renal failure than in controls. Basal serum gonadotropin levels were elevated in rats with chronic renal failure, but the gonadotropin response to GnRH did not differ from that in controls. Serum protactin IeveIs responded appropriately to stimuIation and suppression tests. Androgen‐binding protein levels, epididymal sperm content, motility, and fertile potential were significantly lower in uremic rats.

Conclusions: Chronic rend failure in rats interferes with endocrinologic mechanisms and testicular functions. Thus, uremic rats have a low fertile potential.
Adrenocortical Adenoma Producing 18‐Hydroxycorticosterone
Authors: Un‐no Toshiyuki , Kageyama Shinji , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio
Published: July 2007

A 30‐year‐old man presented at our hospital with microscopic hematuria. Ultrasonography and computed tomography scanning revealed a right adrenal mass measuring 20 × 20mm. The tumor was asymptomatic, but there was obvious accumulation on the right side when scintigraphy was performed with radioactive iodine (131I)‐labeled adosterol. Endocrinology studies showed elevation of the plasma cortisol and renin concentrations, while the plasma aldosterone level was low. Right laparoscopic adrenalectomy was done on July 4, 1994. Histologic examination showed an adrenocortical adenoma. Serum levels of adrenocortical hormones were measured before and after surgery, and the tissue content for the same hormones was determined in the resected tumor. The hormonal studies showed that the tumor produced 1 8‐hydroxycorticosterone.
Solitary Colonic Metastasis of Renal Cell Carcinoma Seven Years after Nephrectomy: A Case Report
Authors: Tokonabe Shigeki , Sugimoto Masayuki , Komine Yukikuni , Horii Hitoshi , Matsukuma Susumu
Published: July 2007

An 83‐year‐old man, who had undergone right radical nephrectomy for renal cell Carcinoma about 7 years previously, experienced melena and abdominal mass. Barium enema, colonoscopy, computed tomography, and arteriography showed a hypervascular mass on the transverse colon, and a partial transverse colectomy was performed. The postoperative histologic examination revealed that the tumor was a metastatic clear cell carcinoma.
Inferior Vena Cava Filter Used for Unresectable Renal Cell Carcinoma with Tumor Thrombi
Authors: Gohji Kazuo , Morisue Koichi , Okamoto Masayuki , Nomi Masashi , Fujii Akio , Kamidono Sadao
Published: July 2007

A titanium Greenfield inferior vena cava filter was used for the treatment of 2 patients with unresectable renal cell carcinomas with tumor thrombi to prevent a fatal pulmonary embolism induced by tumor clots released during systemic interferon therapy and embolization of the primary tumor. After treatment, the size of the renal cell carcinomas at the primary site and the tumor thrombi decreased by 50%. There were no fatal pulmonary embolisms or complications related to the filter during the observation period (24 and 25 months) after therapy. This method may be useful in the prevention of a fatal pulmonary embolism induced by embolization and systemic interferon therapy in these patients.
Tuberculoma Arising in the Inguinal Portion of the Spermatic Cord: A Case Report
Authors: Yamasaki Sho , Sugita Osamu , Tanimura Masanobu , Morioka Masaaki
Published: July 2007

A 50‐year‐old man was treated with excisional surgery for an asymptomatic inguinal Spermatic cord mass. The lesion was proved to be tuberculous, and there was no apparent coexisting active disease elsewhere in the body. In addition to an intraoperative frozen‐section examination, clinical findings of a strongly positive tuberculin skin test and normal erythrocyte sedimentation rate are considered to be helpful in establishing the diagnosis of a tuberculoma arising in either the scrotal or inguinal position.
Postoperative UFT Adjuvant and the Risk Factors for Recurrence in Renal Cell Carcinoma: A Long‐Term Follow‐Up Study
Authors: Naito Seiji , Kumazawa Joichi , Omoto Tetsuo , Iguchi Atsushi , Sagiyama Kazuyuki , Osada Yukio , Hiratsuka Yoshiharu
Published: July 2007

Background Radical nephrectomy is the standard therapy for low‐stage renal cell carcinoma. However, recurrence sometimes develops even in patients who are considered to have undergone a curative resection of the primary tumor. The purpose of this study was to evaluate the usefulness of UFT (a 1: 4 mixture of tegafur and uracil) adjuvant and the risk factors for recurrence in renal cell carcinoma.

Methods A prospective randomized trial was conducted to compare the use of long‐term oral UFT adjuvant with nonadjuvant therapy after a radical nephrectomy for Robson stage I or II renal cell carcinoma. A multivariate analysis was also performed to estimate the risk factors for recurrence.

Results A total of 71 patients were entered into this study, and 66 were evaluable (33 for each group). There was no significant difference in patient characteristics between the 2 groups. The nonrecurrence rate at 5 years after a radical nephrectomy was 80.5% and 77.1% in the UFT adjuvant group and the nonadjuvant group, respectively, with a median follow‐up of 112.9 months; the difference was not significant. The toxicity of UFT was generally mild and tolerable. The tumor grade was found to be an important factor influencing recurrence.

Conclusion UFT cannot be universally recommended as an adjuvant therapy for radical nephrectomy in all patients with low‐stage renal cell carcinoma.
Surgical Approach to Tumor Thrombus of Renal Cell Carcinoma at the Level between Hepatic Vein and Diaphragm
Authors: Isaka Shigeo , Okano Tatsuya , Shimazaki Jun , Masuda Masahisa , Miyazaki Masaru
Published: July 2007

BackgroundThe curative resection of tumor thrombus of renal cell carcinoma often provides a good prognosis, but the best surgical method for resection at the level between hepatic vein and diaphragm is still a matter of controversy.

MethodsWe performed transabdominal surgery without cardio‐pulmonary bypass on 4 patients with tumor thrombus at the level between hepatic vein and diaphragm. The surgical procedures were as follows: The right lobe of the liver was separated and detached from the retroperitoneum, and then the vena cava was clamped just below the diaphragm simultaneous with clamping the porta hepatis. After complete circulatory isolation of the vena cava, the tumor thrombus was resected. Results: There were no severe complications postoperatively. Two patients died of cancer 18 and 38 months after surgery, and the other 2 are alive without evidence of disease after 62 and 66 months. Conclusion: This anatomically rational approach is thought to be a good alternative to the pull‐through method or cardio‐pulmonary bypass for removing a tumor thrombus at this level.
Epidemiologic Survey of Lower Urinary Tract Symptoms in Asia and Australia Using the International Prostate Symptom Score
Authors: Homma Yukio , Kawabe Kazuki , Tsukamoto Taiji , Yamanaka Hidetoshi , Okada Kiyoki , Okajima Eigoro , Yoshida Osamu , Kumazawa Joichi , Fang‐Liu Gu , Lee Chongwook , Hsu Te‐Chin , Cruz Reynaldo C dela , Tantiwang Anupan , Lim Peter HC , Sheikh Masood A , Bapat Sharad D , Marshall Villis R , Tajima Kazuo , Aso Yoshio
Published: July 2007

Background The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia.

Methods The symptom index (0 to 35) and quality‐of‐life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia.

Results The percentages of Asian men considered to be symptomatic (symptom index ≧ 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively.

Conclusions Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.
Complications and Reimplantation of Penile Implants
Authors: Nukui Fumihiko , Okamoto Shigehiro , Nagata Mikio , Kurokawa Jun , Fukui Junnosuke
Published: July 2007

Background Complications of penile prosthesis implants can be divided into surgical and mechanical failure. We investigated penile prosthesis implants to clarify the surgical and mechanical complications that have arisen in our clinical experience.

Methods In the 11 years between 1984 and 1995, 83 penile prostheses were implanted in 74 patients ranging from 37 to 82 years of age.

Results Of the 64 malleable and mechanical prostheses, 11 were extracted, including 4 removed because of surgical complications and 2 due to mechanical failure. Of the 19 inflatable prostheses, 6 were removed, including 1 extracted due to surgical complication and 5 extracted due to mechanical failure. Nine reimplantations for 8 patients were performed and all these cases had good results. As a result, 66 out of 74 patients could have coitus after prosthetic surgery.

Conclusions Penile prosthetic surgery is an established method of treating organic impotence, however, it should only be considered for selected and well‐informed patients to avoid complications and revision surgery.
Calcium Independent Contraction of Bladder Smooth Muscle
Authors: Yoshimura Yasukuni , Yamaguchi Osamu
Published: July 2007

Background Recently, it has been suggested that in vascular smooth muscle a Ca2+‐independent mechanism or Ca2+‐sensitization of contractile elements may participate in smooth muscle contraction. In this study, we evaluate this mechanism in detrusor muscle.

Methods Strips of smooth muscle from rabbit aorta, rabbit bladder and human bladder were evaluated by in vitro contraction studies.

Results The results show that (1) in Ca2+‐free solution containing ethyleneglycol bis (‐aminothylether)‐N,N,‐tetraacetic acid (ECTA), carbachol and phorbol ester produced sustained contractions in detrusor muscle (Ca2+‐free contraction); (2) depletion of Ca2+ stores by caffeine did not affect Ca2+‐free contraction induced by carbachol; and (3) VV‐7 (calmodulin inhibitor) and ML‐9 (myosin light chain kinase [MLCK] inhibitor) did not show inhibitory effects on Ca2+‐free contraction, while H‐7 (protein kinase C [PKC] inhibitor) abolished this contraction.

Conclusions These results suggest that neither stored Ca2+ nor the Ca2+‐calmodulin‐MLCK system is involved in the carbachol‐induced Ca2+‐free contraction of detrusor muscle. This Ca2+‐independent contraction seems to be mediated by the activation of PKC coupled with agonist stimulation of the muscarinic receptor.
Correlation of Allelic Loss of the P53 Gene and Tumor Grade, Stage, and Malignant Progression in Bladder Cancer
Authors: Tsutsumi Masakazu , Sugano Kokichi , Yamaguchi Kensei , Kakizoe Tadao , Akaza Hideyuki
Published: July 2007

Background We examined loss of heterozygosity (LOH) of the P53 gene in bladder cancer, and investigated the role of the P53 gene on malignant progression of papillary tumors. In addition, the clonality of recurrent bladder cancer was examined.

Methods LOH of the P53 gene was analyzed in 67 bladder cancers from 47 patients. DNA was extracted from formalin‐fixed, paraffin‐embedded tissues, amplified by the polymerase chain reaction (PCR) at 3 polymorphic loci in the P53 gene, and analyzed with nonradioisotopic single‐strand conformation polymorphism (Non‐RI SSCP) analysis.

Results Out of 40 informative samples, LOH was detected in 1 3 samples, containing 4 of 7 in grade 3 (57%), 9 of 23 in grade 2 (39%), and none of 1 0 in grade 1 (0%). Statistical significance was observed between the LOH in grades 1 and 2, and in grades 1 and 3. An analysis of 5 cases showing malignant progression revealed that 3 (60%) showed an LOH in the primary tumor, and 2 showed LOH in recurrent tumors, in contrast to LOH found in 3 cases of 1 9 (1 6%) not showing malignant progression. Four cases with metachronous recurrence exhibited LOH; 2 at recurrent tumors, 1 only at the initial tumor, and 1 at both tumors.

Conclusions The alterations of the P53 gene were considered to correlate with tumor grade, and contribute to the malignant progression of bladder cancer. LOH in the P53 gene may serve as a clinical indicator for prognosis in superficial bladder cancer.
Renal Angiosarcoma: A Case Report
Authors: Hiratsuka Yoshiharu , Nishimura Hirofumi , Kajiwara Ichiro , Matsuoka Hirofumi , Kawamura Koji
Published: July 2007

We report the first case of angiosarcoma in the kidney occurring in a woman; the tumor was initially believed to be renal cell carcinoma. This malignant tumor was discovered in a patient with macrohematuria. The final diagnosis was confirmed by histologic and immunohistochemical findings. A review of the literature on this tumor is also included in the discussion.
Primary Adenocarcinoma in the Urethrorectal Fistula
Authors: Takaki Ryuji , Nishiyama Tsutomu , Sekiya Masao , Ishizawa Shin , Junicho Akira , Fujishiro Yoshiyuki , Yabuzaki Yutaka
Published: July 2007

A 60‐year‐old Japanese man was hospitalized because of urinary leakage from the anus on October 3, 1994. Retrograde urethrography detected a fistula between the bulbous urethra and the rectum. Urethrocystoscopy revealed a tumor on the urethrorectal fistula. Tumor biopsy showed a well differentiated adenocarcinoma. Cystourethrectomy with fistulectomy, and ileal conduit urinary diversion were performed. Pathological examination revealed primary adenocarcinoma in the fistula with invasion to the prostatic urethra and bladder wall. The patient showed no evidence of a recurrence as of August, 1996.
Unsuspected Rectal Adenocarcinoma Causing a Urinoma
Authors: Sayeed Rana , Nyamekye Isaac , Kinder Richard
Published: July 2007

A middle‐aged man with a history of Hodgkin's disease presented with loin pain and microscopic hematuria. Radiologic studies demonstrated a urinoma secondary to ureteric obstruction at the pelvic brim. Percutaneous nephrostomy was performed to decompress the collection and a ureteric stent inserted to maintain drainage. Laparotomy revealed an unsuspected rectal adenocarcinoma. A metastatic deposit compressing the ureter had produced the urinoma. Metastatic colorectal carcinoma is a rare cause of urinoma.
Metastasis of Prostate Adenocarcinoma to Testis
Authors: Baykal Kadir , Yildirim Sükrü , Inal Haluk , Kalci Erdal , Albayrak Selami , Cingil Hakan , Önol Yavuz
Published: July 2007

Metastatic carcinoma to the testis is very rare. Metastasis of prostate adenocarcinoma to testis was detected incidentally after bilateral orchiectomy for hormonal management of metastatic prostate carcinoma. The metastatic lesion was not identified in physical examination or in macroscopic dissection of the testis after surgery. Microscopy revealed an adenocarcinoma which, given the history of the patient and a positive immunohistochemical stain for PSA, was identified as metastatic prostatic adenocarcinoma.
Percutaneous Treatment of Transitional Cell Carcinoma of the Upper Urinary Tract
Authors: Okada Hiroshi , Eto Hiroshi , Hara Isao , Fujisawa Masato , Kawabata Gaku , Yamanaka Nozomu , Arakawa Soichi , Kamidono Sadao
Published: July 2007

Background We evaluated the long‐term effect of percutaneous resection in 2 Japanese patients with transitional cell carcinoma of the renal pelvis, and reviewed the medical literature on similar patients, to determine the appropriate indications for percutaneous treatment of transitional cell carcinoma in the upper urinary tract.

Results Indications for endoscopic resection in the 2 patients were renal insufficiency and unsuitability for major open surgery. The patients had no recurrence during follow‐up. Seven previous reports described percutaneous resection of upper urinary tract transitional cell carcinoma in 82 patients. Although 72.6% of the patients were successfully treated by percutaneous resection, half of the patients with grade 3 carcinoma developed recurrence.

Conclusion These results, together with those of the 7 published reports, suggest that percutaneous resection should be limited to selected patients with low‐grade transitional cell carcinoma.
Testosterone Replacement Therapy for Male Hypogonadism with a Radiation‐Polymerized Testicular Prosthesis
Authors: Imai Kyoichi , Yamanaka Hidetoshi , Mashimo Masamichi , Asano Masaharu , Yoshida Masaru
Published: July 2007

Background The effect of an artificial testicular prosthesis on sexual disturbance in hypogonadal men was investigated.

Methods Twelve hypogonadal men were treated with testosterone replacement therapy delivered via radiation‐polymerized testicular prostheses surgically implanted in their scrotums.

Results An average serum testosterone level of over 200ng/dl was maintained for 48 months. Most patients treated with this prosthesis were satisfied with the improvement of their sexual activity. Moreover, the patients were psychologically more satisfied with the enlarged scrotum achieved with the implanted prosthesis.

Conclusion We recommend this prosthesis as the first choice among testosterone‐replacement therapies for hypogonadal men.
Biochemical Modulation of 5‐Fluorouracil with Murine Interferon‐α/β Against Murine Renal Cell Carcinoma
Authors: Marumo Ken , Oya Mototsugu , Murai Masaru
Published: July 2007

Department of Urology, School of Medicine, Keio University, Tokyo, Japan

Background Conventional therapy for renal cell carcinoma using interferon (IFN) has shown limited antitumor action. The purpose of our study was to investigate synergistic antitumor effects of IFN and 5‐fluorouracil (5‐FU), and to elucidate the mechanisms of interaction between the 2 agents in mice.

Methods Antitumor effects and biochemical modulation of murine IFN‐α/β and 5‐FU were determined against the murine renal cell carcinoma cell line, Renca, in vivo. The activity of thymidylate synthetase and thymidine kinase was measured using cytosolic extracts of the tumors.

Results Combination treatment with IFN‐α/β and 5‐FU produced a significant enhancement of growth inhibition against Renca tumor. Treatment with 5‐FU resulted in a 2.7‐fold increase in the total amount of thymidylate synthetase and an 11.6‐fold increase in the thymidylate synthetase inhibition rate, while the administration of IFN‐α/β did not significantly reduce the 5‐FU‐induced increase in thymidylate synthetase. The administration of IFN‐α/β decreased thymidine kinase activity to 65.5% maximally, compared with that in the control mice or the mice treated with 5‐FU.

Conclusions The reduction of thymidine kinase caused by treating the mice with IFN‐α/β changes the utilization of exogenous thymidine for DNA synthesis, and may represent the mechanism of the additive antitumor effect of the 2 agents, through the suppression of the salvage pathway for deoxythymidine monophosphate induction.
Screening of H‐ras Gene Point Mutations in 50 Cases of Bladder Carcinoma
Authors: Saito Shiro , Hata Makoto , Fukuyama Ryuichi , Sakai Kosuke , Kudoh Jun , Tazaki Hiroshi , Shimizu Nobuyoshi
Published: July 2007

Background Mutation converts the H‐ras gene into an activated oncogene in about 10% of human bladder cancers. Codons 12 and 61 are the major “hot spots” for activation. A simple and accurate method to detect point mutations in these codons may be clinically useful for early diagnosis of bladder cancer.

Methods Bladder cancer samples from 50 patients, plus 10 samples of normal bladder mucosa, were analyzed for possible point mutation of the H‐ras gene at either codon 12 or codon 61. The H‐ras gene DNA segments that include these 2 codons were amplified by PCR methods, then the possible presence of a point mutation was evaluated at each codon by susceptibility of the respective DNA segments to digestion with the restriction enzyme and by dot blot hybridization assay. A bladder cancer patient who had an H‐ras gene mutation was examined to see whether the mutation was also detectable in the cells released in the urine.

Results Definite or possible point mutations were found in 6 (1 2%) out of 50 bladder cancer patients, while no mutation was detected in normal mucosa. A point mutation could also be detected in cells isolated from the patient's urine sample.

Conclusion The prevalence of point mutations at codon 1 2 or codon 61 of the H‐ras gene found in this study was similar to that previously estimated for human bladder cancer by DNA transfection assay. The method we have used for detecting point mutations of the H‐ras gene provides a simple and highly accurate way to detect mutated cancer cells even in the urine. It may be clinically usable for early diagnosis of bladder cancer.
Morphological and Pharmacological Characterization of Guinea‐Pig Prostatic Smooth Muscle Cells in Vitro
Authors: Mikuma Naohito , Furuya Seiji , Isomura Hiroshi , Yabu Hideo , Sawada Norimasa , Tsukamoto Taiji
Published: July 2007

Background Prostatic smooth muscle is thought to play a major role in the pathogenesis of bladder outlet obstruction in patients with benign prostatic hypertrophy. However, the physiology of prostatic smooth muscle cells remains largely unknown, in part due to the lack of a suitable model system. We therefore sought to establish an in vitro culture of guinea pig prostatic smooth muscle cells. Methods: Immature guinea pig prostate was treated by enzymatic digestion and the cells obtained were used to initiate the primary culture. After 3 to 4 passages, cultured smooth muscle cells were examined morphologically by immunocytochemistry and electron microscopy. The contractile properties of cultured smooth muscle cells were also examined.

Results The cultured prostatic cells demonstrated hill and valley morphology, which is a hallmark of smooth muscle cells in vitro, and stained positively for desmin. In addition, electron microscopic examination of ultrastructural morphology revealed myofilaments. Confluent cultures of prostatic smooth muscle cells showed a clear, dose‐dependent contractile response to phenylephrine. Furthermore, contraction of the prostatic smooth muscle cells by 10‐6 mol/L phenylephrine was completely inhibited by pretreatment with 10‐6 mol/L terazosin.

Conclusions An in vitro culture of prostatic smooth muscle cells was established. This culture is likely to provide a powerful tool for elucidating the physiology and pathophysiology of prostatic smooth muscle.