bluuebunny/crossref_metadata_2025 huggingface dataset:
Prostate Screening — The Singapore Experience
Authors: Tay Kah Phuan , Chin Chong Min , Lim Peter Huat Chye , Chng Hong Chee
Published: July 2007

Background: The prevalence of benign prostatic hyperplasia (BPH) is believed to be highly significant in most communities. In our country, many elderly men are unaware that something can be done for their troublesome urinary symptoms. The main objective of our prostate health screening was to educate our elderly male population that this is an abnormality, for which treatment is readily available. At the same time, we attempted to determine the prevalence of BPH, to detect possible prostate cancer, and to derive normal prostate specific antigen (PSA) and uroflow values for our population.

Methods: Over an eight‐day period in April 1994, 799 men above the age of 50 years volunteered to participate in a free prostate screening exercise held at our hospital. The parameters assessed were PSA level, American Urological Association (AUA) symptom score, uroflowmelry, and digital rectal examination (ORE) of the prostate.

Results: Elevated PSA levels of more than 4 μg/L were detected in 105 men (13.1%). Of these, 23 men (2.9%) had PSA values above 10 μg/L. Abnormal AUA symptom scores of more than eight (moderate and severe categories) were noted in 540 men (67.6%). Clinically enlarged prostate glands of more than 20 g on DRE were noted in 80 men (10.0%), and abnormal ORE findings were detected in 48 men (6.01%). Impaired maximal uroflow rates of less than 10 mL/s were recorded in 224 mm (30%), while another 167 men (29.1%) had maximal uroflow values in the equivocal zone (between 10 to 1S mL/s). The reference PSA levels at the 8th percentile, 10th percentile, median. mean, 90th percentile and 95th percentile were 0.38, 0.47, 1.05, 1.57, 3.27 and 4.25 μg/L, respectively. The age‐specific PSA values were 3.51, 3.78 and 6.02 μg/L in the 50 to 59. 60 to 69, and 70 to 79 years age groups. respectively, and the reference mean maximal uroflow rates was 14.8 mL/s.

Conclusions: Although controversial, our experience with prostate screening was generally positive. As far as our population is concerned, the free prostate screening exercise generated publicity, and succeeded in enhancing public awareness for better prostate health.
A Non‐Randomized Comparative Study of Visual laser Ablation and Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia
Authors: Uchida Toyoaki , Egawa Shin , Iwamura Masatsugu , Ohori Makoto , Yokoyama Eiji , Endo Tadao , Koshiba Ken
Published: July 2007

Background: Transurethral resection of the prustate (TURP) haz been the ‐preferred surgical treatment for benign prostatic hyperplasia (BPH) for the past 50 years. Alternative methods for treating BPH such as visual laser ablation (VLAP) have been established during the past decade. In order to assess the safety and efficacy of VLAP, this alternative method was performed using a Urolase fiber and neodymium: yttrium‐aluminum‐garnet laser and compared to results obtained in patients treated with TURP for BPH Methods: In this non‐randomized comparative study, 100 BPH patients were equally split between treatment with VLAP or TURP, and their cases compared. The efficacy was assessed using an International Prostate Symptom Score, urinary flow rates, post‐void residual urinary volume and an estimated prostate volume.

Results: There was a clinically significant improvement in all parameters in both groups. In the VIAP and TGRP groups. 92.0%, and 81.6% 90.2% and 862 and 931% and 100.0% were categorized as effectively‐treated cases at 3, 6 and 12 months post‐operatively, respectively. So severe side effect was seen in VLAP group. The total and post‐operative lengths of hospitalization in the VLAP group were shorter, but the duration of post‐operative bladder irrigation was longer in these patients.

Conclusions: Although TURP remains the standard surgical treatment for BPH, VLAP is associated with less morbidity and the clinical outcome is similar compared to patients treated with TURP. VLAP in conjunction with TURP may result in less risk of postoperative urinary retention and vesicle irritability.
bcl‐2 Expression in Prostate Cancer and its Relationship to Cell Cycle and Prognosis
Authors: Matsushima Hisashi , Hosaka Yoshio , Suzuki Makoto , Mizutani Takashi , Ishizuka Hideshi , Kawabe Kazuki
Published: July 2007

Background: bcl‐2 protein is an oncoprotein encoded by J protooncogene bcl‐2 which is thought to be a key gene for the regulation of cell life and death. bcl‐2 protein has been reported to be expressed in a subset of prostate cancers, and its biological role in this disedse has not yet been elucidated. This present study focused on the cell cycle analysis of bcl‐2 immunoreactivity in prostate tumor samples and correlated findings with the prognosis of the patients.

Methods: Archival tissues from 37 prostate cancers were submitted for immunohistochemistry and DNA analysis via flow cytometry. All tissues were obtained before the patients received my treatment. Immunohistochemistry was performed using streptavidin biotin procedures, and DNA flow cytometry was done by J combination of two methods.

Results: Fourteen of 37 prostate cmcers (38%) exhibited bcl‐2 immunoreactivity. bcl‐2 positive prostate cancers significantly correlated with DNA aneuploidy and higher proliferation indices, but not with histological differentiation. Clinically, there was a poorer prognosis for patients with bcl‐2 positive prostate cancer.

Conclusions: Our data indicates that bcl‐2 protein expression in prostate canctv is associated with cell proliferation and may serve as a predictive factor for the prognosis of prostate cancer.
In Vitro Parathyroid Hormone Release in Patients with Secondary Hyperparathyroidism
Authors: Yano Shoichi , Nomura Yoshio , Mizoguchi Hiroaki , Ogata Jiro
Published: July 2007

Background: The purpose of this study was to determine the precise endocrim. characteristics of parathyroid function in secondary hyperparathyroidism (sHPT).

Methods: We examined the effects of extracellular ionized calcium (Ca2+) varying from 0.5 to 2.0 mM on parathyroid hormone (PTH) release in parathyroid cell suspensions using a mid‐regional PTH assay. Cells were obtained from 26 patients with sHPT who were divided into two groups according to the type of hyperplasia they exhibited, either nodular (n=16) or diffuse [n= 10). For compdrison, we also analyzed data from nine patients with primary hyperparathyroidism (pHPT; adenomas).

Results: Significant in vitro suppression of PTH release by Ca2+ was observed in the majority of subjects, regardless of the histologic abnormality. The pHPT group exhibited no significant relationship between clinical and in vitro data. In contrast, in the sHPT group (taken as a whole), suppression of PTH release by Ca2+ exhibited a plateau at a total serum calcium concentration of 2.5 mmol/L, and a parathyroid gland weight of 2 g.

Conclusions: These findings suggest that there is a curvilinear relationship in sHPT, but not pHPT, between the in vitro calcium sensitivity of parathyroid cells and total serum calcium, as well as gland weight. The in vitro calcium sensitivity in sHPT remains constant when the total serum calcium concentration exceeds 2.5 mmol/L, or when the gland weight exceeds 2 g.
Cumulative Renal Damage in Oogs by Repeated Treatment with Extracorporeal Shock Waves
Authors: Koga Hiroshi , Matsuoka Kei , Noda Shinshi , Yamashita Takuro
Published: July 2007

Background: Extracorporeal shock wave Iithotripsy (ESWL) has become a routine method for the treatment of renal and ureteral calculi. Occasionally, multisequential ESWL tredtments and high energy shock waves are required to treat large calculi. The purpose of the study was to compare renal histopathologic damage caused by varying the application of shock waves.

Methods: Six groups of dogs were defined by the frequency of shocks, application time and numbers of sessions. Bilateral nephrectomies were performed immediately, 3, 7 and 60 days after the application of shock waves. Histopathologic features of the kidneys were assessed by both light and electron microscopy.

Results: Irreversible damage was observed in all exposed kidneys. After J single session of low application frequency, damage by shock waves occurred with progressive deterioration of the nephron. At any frequency rate, the damage was caused by tissue hypoxia due to rupturing of the interstitial capillaries. As the application frequency increased, capillary rupture became more severe, and consequently, morphological damage tended to be more intense. Repeated sessions at any application frequency made the damage more intense, suggesting that an accumulation of damage had occurred. Conclusions: Minimal doses of shock waves cause renal damage and repeated ESWL sessions may result in an accumulation of damage. Considering that the damage is dose‐dependent, divided ESWL treatments at a low frequency rate are advisable in a clinical setting.
Pharmacokinetics and Antitumor Effects of an Interleukin‐2 lmmunocomplexing Agent in Murine Renal Cell Carcinoma
Authors: Oya Mototsugu , Marumo Ken , Murai Masaru , Tazaki Hiroshi
Published: July 2007

Background: Conventional therapy for renal cell carcinoma (RCC) using systemic administration of interleukin‐2 (IL‐2) has shown limited anti‐tumor action. The purpose of this study was to investigate the anti‐tumor effects of a newly developed immune complex of IL‐2 (IC) against RCC.

Methods: IC was prepared by mixing IL‐2 and an anti‐IL‐2 monoclonal antibody at a molar ratio of 2:l. The pharmacokinetics and anti‐tumor effects of IC were then studied in a murine KCC line, Renca. Results: Serum IL‐2 levels were sustained longer in mice given IC than in mice given IL‐2 alone after either subcutaneous or intratumoral injections. After an intratumoral injection of IC, the IL‐2 concentration in the tumor nodules remained higher compared with mice given IL‐2 alone. The anti‐tumor effect was most pronounced in mice treated with intratumoral injections of 1C.

Conclusions: Results obtained here indicate that an immune complex of IL‐2 provides d useful tool for the treatment of RCC by altering the pharmacokinetics of IL‐2 in vivo.
Effect of Cyclosporin A on Isolated Rabbit Bladder and Urethral Smooth Muscle
Authors: Kilani Kohsuke , Machida Jiroh , Wada Yoshihiro , Yoshida Masaki , Ueda Shoichi
Published: July 2007

Background: The effects of Cyclosporin A (CsA) on vascular smooth muscle inducing hypertension have been established. However, there is no information available concerning the effects of CsA on urinary smooth muscle. Therefore, the effects of CsA were investigated on the bladder and urethral smooth muscle in rabbits.

Methods: CsA (10 mg/kg/day. intravtmouslyl was given to rsbbits for 14 days. Rabbit bladder and urethral smooth muscles were then isolated and evaluatd using a muscle bath technique.

Results: 10 111‐‐ 5 × 10 M CsA done had no direct effect on bladder or urethral smooth muscles. The Emax. (maximum contractile response) and ED values for acetylcholine‐induced contraclions and the Emax (maximum relaxation response) for isoproterenol‐induced relaxation in bladder smooth muscles were not significantly different between CsA‐treated and control grouos. The ED for isoproterenol‐induccd relaxation was significantly lower in the CsA group (P< 0.05). The Emax for phenylephrine‐ and clonidinci‐induced contractions in urethral smooth muscle was significantly higher in the CsA‐treated group (P< 0.05). The ratio of the maximum response of the urethral smooth muscle to phepylephrine. and clonidine in Ca free solution to the normal solution in the CsA group (1 3.42% and 4.40%, respectively was signiticantly higher than the maximal response ratios in the control group th.34%, and 3.00%, respectively; P<0.05.

Conclusions: CsA treatmemt augments the relaxation response of the bladder to isoprolerenol and the contractile response of the urethra to phenylephrine and clonidine. In addition, CsA increases the iilling of intracellular stores of releasable Ca++, and also increases the permeability of Ca++ in rabbit urethral smooth muscle. Thus, it is suggested that CsA may cause a urinary disturbance in patients treated with CsA via increased urethral resistance.
Bilateral Renal Cell Carcinoma in a Patient with Tuberous Sclerosis
Authors: Aoyarna Teruyoshi , Fujikawa Keita , Yoshimura Koji , Sasaki Miharu , Ltoh Tadahiro
Published: July 2007

A case of pure bilateral renal tell carcinoma (RCC) in a 21‐year‐old female diagnosed as having tuberous selerosis is reported. She underwent a left nephrectomv because of her loss of appetite possibly caused by the tumor compressing her intestines. The preoperalive CI scan showed the presence of adipose tissue in bilateral renal tumors, which is highly suggestive of angiomvolipoma (AML). Histological examination, however, revealed no area or component ot the tumor with features characteristic of AML.
Bladder Cancer Producing Granulocyte Colony‐Stimulating Factor: A Case Report
Authors: Nishimura Kenji , Higashino Makoto , Hara Tsuneo , Oka Toshitsugu
Published: July 2007

A rare case of bladtier cancer prtducing granulocyte colony‐stimulating factor (G‐CSF) is reported. A 63‐year‐old man with a progressive, grade 3 transitional cell bladder cacinoma, showed niarked leukocytosis (maximum 181,800/mm1) and an elevated serum G‐CSF to 131.7 pg/mL. After rdical cystectomy and neoadjuvant chemotherapy, the tumor recurred locally. Immunohistochemical examination with monoclonal antibody specific for G‐CSF revealed positive staininfi in the lotal recurrtant tumor. To our knowledge, there have been only seven cases reported of bladder cancer producing C;‐CSF.
A Case of Prostate Carcinoma Metastasizing to Renal Cell Carcinoma
Authors: Inatomi Hisato , Yamada Yoji , Okamura Tomohiko
Published: July 2007

Metastasis of one cancer to another cancer is extremely rare. The most frequent metastisizing tumor is a king carcinoma, and the most common recipient tumor is a renal cell carcinoma. We report herein a case of prostate carcinoma metastasizing to a renal cell carcinoma, which has previously been reported only four times.
A Case of Primary Localized Amyloidosis of the Penile Urethra
Authors: Sakuma Shunji , Miyazaki Tokuyoshi , Hirata Hiroshi
Published: July 2007

Primary localized amyloidosis of the penile urethra is rare. We report a case in which the urethra was obstructed by amyloid tissue without evidence of systemic amyloidosis. After urethral dilatation, the patient reported a markedly improved urinary stream with minimal dysuria.
Three‐Times‐Daily Monotherapy with Tacrolimus (FK 506) in Kidney Transplantation
Authors: Ichikawa Yasuji , Hanafusa Touru , Kyo Masahiro , Fukunishi Takanobu , Nagano Shunsuke
Published: July 2007

Background: Tacrolimus (FK 506) was introduced into organ transplantation as a powerful immunosuppressive but with several adverse effects. In fact, an appropriate protocol for using this agent has not yet been established. On the basis of pharmacokinetic studies and the reports of its administration as a continuous intravenous infusion, we designed the regimen of every eight hours in order to reduce the daily dosage.

Methods: Tacrolimus was given to nine patients in the Japanese FK506 study. Although it was discontinued in two patients within two months because of adverse effects and acute rejection, seven other patients tolerated the agent for a long period and received the drug three times a day. Concomitant prednisolone was gradually tapered and finally withdrawn in these patients.

Results: The smaller dosage of tacrolimus led to a higher trough concentration of 14.1 ± 1.6ng/mL in the three‐times‐a‐day regimen compared with 12.7 ± 1.9ng/ml in twice‐a‐day therapy (P <0.01). The daily dosage of tacrolimus proved to be reducible even further. Our target trough concentration was decreased finally to < 5ng/mL. Concomitant prednisolone was withdrawn in all of the seven patients. The course of these patients has been uneventful for a year after withdrawal of prednisolone. Conclusion: Our regimen of three‐times‐a‐day oral administration of tacrolimus is a likely protocol for reduction of its daily dosage, which lowers its adverse effects while maintaining its immunosuppressive action at a lower trough concentration without concomitant prednisolone.
Inhibitory Effects of Interleukin‐4 on Human Renal Cell Carcinoma Cells In Vitro: In Combination with Interferon‐α, Tumor Necrosis Factor‐α or Interleukin‐2
Authors: Cheon Jun , Chung Dong Joon , Kim Je Jong , Koh Sung Kun , Sohn Jeongwon
Published: July 2007

Background: Immune cytokines have been shown to play important roles in regulating the growth of neoplastic cells, as well as the function of immune cells. The present study assessed the effects of interleukin (IL)‐4 alone, and in combination with recombinant interferon (IFN)‐α2b, or with IL‐2, or with tumor necrosis factor (TNF)‐α on the in vitro proliferation of human renal cell carcinoma (RCC) cell‐lines.

Methods: Growth‐inhibitory effects of IL‐4 alone, and in combination with other cytokines, on three human RCC cell‐lines, Caki‐1, CURC‐II, and A‐498, were measured by the [3H]thymidine incorporation assay.

Results: IL‐4 inhibited proliferation of all three human RCC cell‐lines (P< 0.001). The maximum growth inhibition of RCC cell‐lines by IL‐4 alone was observed at the concentration of 1 to 3 ng/mL, depending on the cell‐line. Antihuman IL‐4 antisera was able to reverse the growth‐inhibitory effects of IL‐4 on Caki‐1 in a dose‐dependent manner, proving that the growth inhibition was mediated by IL‐4 itself. When other cytokines were added in combination with IL‐4, only IFN‐α2b resulted in significant additional growth inhibition (P < 0.005). However, when the proliferation was compared to that of RCC cells that were not treated with any cytokine, all combinations produced marked growth inhibition. Conclusion: Our data suggest that IL‐4 alone, or in combination with IFN‐α2b, can be used to develop new strategies for treatment of human RCC.
Detection of Proteus mirabilis Urease Gene in Urinary Calculi by Polymerase Chain Reaction
Authors: Takeuchi Hideo , Yamamoto Shingo , Terai Akito , Kurazono Hisao , Takeda Yoshifumi , Okada Yusaku , Yoshida Osamu
Published: July 2007

Background: Urea‐splitting microorganisms cannot always be detected by stone or urine culture in patients with infection stones. Detection of genetic elements within the calculi by the polymerase chain reaction (PCR) may be a useful alternative. In this study, we assessed the usefulness of the PCR method in detecting the urease gene specific to Proteus mirabilis in urinary calculi.

Methods: Thirty‐eight metabolic stones (calcium oxalate and/or calcium phosphate, uric acid, or cystine) and 49 struvite stones were examined. The PCR was applied with DNA extracted by boiling pulverized stone pieces.

Results: Of the 87 stones, PCR demonstrated the presence of the P. mirabilis urease elements ureC1 and ureC2 in 1 7, all of which were struvite. Stone culture and urine culture had been performed in 22 and 46 struvite stone cases, respectively, and the PCR was positive in all of the 10 culture‐positive calculi and also in two calculi from which P. mirabilis was not isolated.

Conclusion: PCR was reliable and convenient for detecting P. mirabilis in desiccated struvite calculi. Study to detect other species such as Ureaplasma or Corynebacterium would be useful in elucidating the role of bacterial infection in the formation of these stones.
Alteration of Intercellular Communication in a Human Urothelial Carcinoma Cell‐Line by Tumor‐Promoting Agents
Authors: Morimoto Shinji
Published: July 2007

Background: Most of the findings that support a good association between inhibition of intercellular communication and tumor promotion have been demonstrated by studies of animal cells, while it has been accepted that most tumor‐promoting agents are specific to species and organs. Therefore, the influence of tumor‐promoting agents on intercellular communication was investigated using a human urothelial cell‐line.

Methods: The effects of six tumor‐promoting agents, including dichlorodiphenyltrichloroethane (DDT), butylated hydroxyanisole (BHA), saccharin, cyclamic acid, phenobarbital, and DL‐tryptophan, on intercellular communication in a human urothelial cell‐line (JTC‐30) were investigated by using a dye‐transfer assay after 48‐and 96‐hour exposure to each agent. Cytotoxicity was determined using the colony‐forming method after 48‐hour and 7‐day exposure to each agent.

Results: DDT, BHA, saccharin, and cyclamic acid inhibited intercellular communication after either 48‐or 96‐hour exposure at concentrations that were nontoxic to the cells after 7‐day exposure. Phenobarbital and DL‐tryptophan inhibited intercellular communication only at toxic concentrations. Conclusions: Since the former four agents are known to be direct tumor promoters, and the metabolites of the later two agents have been regarded as tumor promoters, the results suggest that current methodology using the JTC‐30 cell‐line may be applicable to the screening to detect direct tumor promoters of human urothelium.
Strangulated Prolapsed Ureterocele: A Solid Vulval Mass in a Woman
Authors: Nishimura Hirofumi , Takeuchi Toshio , Tahara Haruo , Oshima Kazuhiro
Published: July 2007

We report a rare case of prolapsed ureterocele in an adult female, which had been identified as a small finger‐tip sized orthotopic ureterocele 12 years earlier and recently presented a hard neoplastic mass due to strangulation at the urethra and long‐standing inflammation.
Ectopic Ureterocele with a Horseshoe Kidney in an Adult
Authors: Mikuma Naohito , Adachi Hideki , Takatsuka Keiji , Yokoo Akifumi , Wada Hideki , Takahashi Atsushi
Published: July 2007

A rare adult case of a left ectopic ureterocele associated with a duplex horseshoe kidney is reported. To the best of our knowledge, only one pediatric case of horseshoe kidney with an ectopic ureterocele has been reported. The present case was successfully treated by ureteropyelostomy, upper ureterectomy and unroofing of the ureterocele. The patient is currently followed with excretory urograms and renograms.
Estimate Criteria for Diagnosis and Severity in Benign Prostatic Hyperplasia
Authors: Hornma Yukio , Kawabe Kazuki , Tsukamoto Taiji , Yarnaguchi Osamu , Okada Kiyoki , Aso Yoshio , Watanabe Hiroki , Okajima Eigoro , Kumazawa Joichi , Yamaguchi Takuhiro , Ohashi Yasuo
Published: July 2007

Background: Standard severity criteria for benign prostatic hyperplasia (BPH) are needed to facilitate clinical and epidemiologic investigations in the common terminology.

Patients and Methods: A total of 692 BPH patients from 8 institutions were judged by specialized physicians for their overall disease severity and severity in 4 domains: symptom, function, anatomy, and quality of life (QOL). The items measuring severity in these 4 domains were the International Prostate Symptom Score (I‐PSS) questionnaire, uroflowmetry, transrectal ultrasonography (TRUS), and questionnaires on bother and I‐PSS QOL index, respectively. By Spearman's rank correlation and multiple regression analysis using physicians' judgement as the criterion variable (gold standard) the items and their cut‐off levels were selected so that high predictivity, practicality and clinical significance were maintained, while the number of items in use was minimized.

Results: The item(s) and their ranges of values for each severity grade were summarized as follows; the evaluation domain (the selected item(s): range of mild, moderate, severe): symptom (I‐PSS: 0–7,8–19, 20–35), function (maximum flow rate and residual urine volume: ≥ 1 5 mL/s and < 50 mL, ≥ 5 mL/s and < 1 00 mL, < 5 mL/s or ≥ 100 mL), anatomy (prostate volume on TRUS: < 20 mL, < 50 mL, ≥ 50 mL), QOL (QOL index: 0 and 1, 2 to 4, 5 and 6). The overall severity was efficiently predicted when defined according to the combinations of severity grades of the 4 domains. These criteria predicted physicians' judgement with accuracy of about 80% for overall severity and severity of individual domains.

Conclusion: The proposed criteria are valid, practical, and would be useful for the common scale of the BPH severity in clinical and epidemiologic studies.
Estimate Criteria for Efficacy of Treatment in Benign Prostatic Hyperplasia
Authors: Homma Yukio , Kawabe Kazuki , Tsukamoto Taiji , Yamaguchi Osamu , Okada Kiyoki , Aso Yoshio , Watanabe Hiroki , Okajima Eigoro , Kumazawa Joichi , Yamaguchi Takuhiro , Ohashi Yasuo
Published: July 2007

Background: Various treatment modalities for benign prostatic hyperplasia (BPH) have emerged and are now in use or await evaluation of clinical usefulness. It is difficult, however, to compare their efficacies on a single scale, because standardized criteria for therapeutic efficacy of BPH treatments have not been established.

Patients and Methods: A total of 692 BPH patients from 8 institutions in Japan received various treatments, and were judged by specialized physicians for overall efficacy, and for efficacy in 4 domains: symptom, function, anatomy, and quality of life (QOL). Efficacy of treatment was graded as excellent, good, fair or poor, and assessed using items based on conventional clinical measurements. These items included 1) the difference (post‐pretreatment value), 2) relative ratio (post/pre) and, 3) the individual values of pre or posttreatment measurements. The cut off levels for each grade were heuristically selected by Spearman's rank correlation and multiple regression analysis so that the results accurately predicted physicians' judgement, while the feasibility was maintained.

Results: The results for each efficacy grade (range of excellent, range of good, range of, fair, range of poor) were summarized as follows:

Symptom: (post/pre treatment ratio of I‐PSS) ≤ 0.25, ≤ 0.5, ≤ 0.75, > 0.75.

Function: (post‐pre of Qmax) ≥ 10 mL/s, ≥ 5 mL/s, ≥ 0.25 mL/s, < 0.25 mL/s.

Anatomy: (post/pre ratio of prostate volume) ≤ 0.5, ≤ 0.75, ≤ 0.9, > 0.9.

QOL: (pre‐post of QOL index) ≥ 4, 3, 2 and 1, ≤ 0.

The overall efficacy grade was defined as the median of efficacy grades of 3 domains: symptom, function and QOL. The agreement rates between the criteria and physicians' judgement on the dichotomous efficacy (either excellent plus good, or fair plus poor) were approximately 80% in individual domains and overall estimate, and consistent among various treatments.

Conclusion: The proposed criteria are fairly accurate, simple, and practical, and thus may be useful as a standard method for assessing the clinical efficacy of BPH treatments.
Relationship between Grade of Varicocele and the Response to Varicocelectomy
Authors: Takahara Masanobu , Ichikawa Tomohiko , Shiseki Yoshio , Nakamura Takeshi , Shimazaki Jun
Published: July 2007

Background: Although several studies indicate that larger varicoceles are associated with greater impairment of spermatogenesis, others suggest that the response to surgery is independent of varicocele size. In order to elucidate these seeming contradictions, correlations between the preoperative evaluation of varicoceles and improvement in semen quality after varicocelectomy were investigated.

Methods: Forty men with left unilateral varicocele, followed for at least 6 months after varicocelectomy, were included in this study. The relationships between the grade of varicocele by palpation, Doppler examination, ultrasound, or scintigraphy were correlated with a postoperative improvement in sperm density or sperm motility.

Results: Greater improvement in sperm density was observed in the patients with a large varicocele graded by palpation or measured by ultrasound, and greater improvement in sperm motility was observed in the patients with high uptake of radioactivity in the left side by scrotal scintigraphy.

Conclusion: An improvement in semen quality after varicocelectomy is greater in patients with a large varicocele than in the patients with a small one. The significance of surgical repair of a small varicocele should be reconsidered.
Metenkephalin in Seminal Plasma of Infertile Men
Authors: Fujisawa Masato , Kanzaki Masanori , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao
Published: July 2007

Background: Enkephalin is one of the opioids, which is expressed widely in reproductive organs. However, the function of enkephalin in male reproduction is not completely understood. The effect of metenkephalin on sperm motility remains especially controversial. In this study we examined the level of metenkephalin in seminal plasma from men with normal sperm production and patients with asthenospermia, oligospermia, and azoospermia to investigate the role of metenkephalin in seminal plasma on sperm function. We also investigated the effect of metenkephalin on sperm motility in vitro.

Methods: Sixty nine infertile patients (31 oligospermic, 21 asthenospermic, and 17 azoospermic) were included in this study. The level of metenkephalin in seminal plasma of these men was measured and the effect of the peptide on the motility of human sperm was examined in vitro. Seventeen men with normal seminograms were a control group.

Results: The level of metenkephalin in the seminal plasma of semen from asthenospermic men was significantly lower than that from the controls (P< 0.05). No significant correlations between the level of metenkephalin and the mean pathing or progressive velocity of sperm, or serum hormone levels were observed. In the in vitro study, which used semen from the controls, treatment of sperm with metenkephalin (50–200 pg/mL) maintained sperm motility for 4 hours. On the other hand, motility of sperm incubated without metenkephalin began to decrease at 3 hours. Metenkephalin levels of 50 pg/mL in seminal plasma is considered to be necessary for maintaining sperm motility.

Conclusion: These results suggest that metenkephalin in seminal plasma is an important clue in the investigation of decreased sperm motility.
Giant Retroperitoneal Cyst in an Adult Male
Authors: Egawa Shin , Satoh Takefumi , Suyama Kazuho , Uchida Toyoaki , Iwabuchi Keiichi , Koshiba Ken
Published: July 2007

This paper presents a case of a symptomatic giant retroperitoneal cyst in an adult male. The unilocular cyst was excised successfully with resolution of the attendant symptoms. Histological findings of the cyst wall suggested a lymphangiomatous etiology. Any good risk patient found to harbor such a cyst should undergo complete excision in view of the potential for the development of symptoms and complications.
Bulky Transitional Cell Carcinoma of Bladder with Inverted Proliferation
Authors: Terai Akito , Tamaki Masahiro , Hayashida Hideshi , Tomoyosh Tadao , Takeuchi Hideo , Yoshida Osamu
Published: July 2007

Two women, aged 51 and 62 years, had unusual transitional cell carcinomas of the urinary bladder which were > 5 cm and had a structural resemblance to inverted papilloma or Brunn's nest. They were treated by bladder‐preserving surgery with no evidence of recurrence after 30 and 1 03 months follow‐up, respectively. Our cases show some hitherto unrecognized aspects of transitional cell carcinoma with inverted proliferation because the tumors are usually found in males and tend to be aggressive.
The Protective Effect of Methylprednisolone against Cisplatin‐Induced Nephrotoxicity in Patients with Urothelial Tumors
Authors: Uozumi Jiro , Koikawa Yasuhiro , Yasumasu Tetsuo , Tokuda Noriaki , Kumazawa Joichi
Published: July 2007

Background: Many attempts have been made to reduce the nephrotoxicity of the anticancer agent cisplatin but the number of clinically useful modalities is very limited. Our previous experiments demonstrated that in rats methylprednisolone significantly reduces the nephrotoxicity caused by cisplatin. The present clinical study was conducted to confirm the protective effects of methylprednisolone against cisplatin nephrotoxicity.

Methods: Fourteen patients with urothelial tumors were injected with cisplatin according to the methotrexate, vinblastine, adriamycin, cisplatin (MVAC) therapy. Methylprednisolone was not administered during the first course of chemotherapy to provide a control, but was given in a dose of 2000 mg 2–3 hours before cisplatin during the second course of chemotherapy (treatment period) in each patient. Urinary excretion of N‐acetyl‐β‐D‐glucosarninidase (NAG) and γ‐glutamyltranspeptidase (CGTP), serum creatinine, and creatinine clearance (Ccr) were determined as indicators of the nephrotoxicity of cisplatin. Results were statistically analyzed by a paired t test to compare the nephrotoxic effects of cisplatin during the first course of chemotherapy (control period) with those during the second course of chemotherapy (treatment period).

Results: Methylprednisolone did not significantly inhibit the elevation in urinary enzyme excretion or serum creatinine levels following the cisplatin injection. However, the Ccr level after cisplatin infusion in the treatment period was significantly highter than that observed in the control period.

Conclusion: The protective effects of methylprednisolone against cisplatin nephrotoxicity were indicated in this prospective clinical study.
Transition Zone Ratio and Prostate‐Specific Antigen Density: The Index of Response of Benign Prostatic Hypertrophy to an Alpha Blocker
Authors: Kurita Yutaka , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio , Kawabe Kazuki
Published: July 2007

Background: The aim of the present study was to determine whether the indices of transrectal ultrasonography (TRUS) are related to the clinical response to tamsulosin, a long‐acting selectiveα1‐blocker.

Methods: Sixty patients with symptomatic benign prostatic hypertrophy (BPH) were treated with tamsulosin hydrochloride (0.2mg/day) for 2 months. The findings on TRUS and uroflowmetry and the AUA symptom score before treatment were compared with those obtained at the end of the 2 month treatment period. For the indices of TRUS, transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and prostate specific antigen density (PSAD) were calculated.

Results: There was a significant correlation between the pretreatment TZ ratio and the residual urine volume (r= 0.421, P= 0.0005). Patients with a lower TZ ratio and/or PSAD responded well to the treatment. The correlation between the PSAD value and the percent change in peak urinary flow rate was statistically significant (r= ‐0.432, P = 0.0009).

Conclusion: TRUS provides simple parameters of PSAD that can be used to predict the response of patients to tamsulosin hydrochloride.
Clinical Applicability of a New Tactile Sensor for Evaluating Rigidity of the Penis: A Comparative Study with Rigiscan
Authors: Kaneko Shigeo , Mizunaga Mitsuhiro , Yachiku Sunao , Yamaguchi Osamu , Omata Sadao
Published: July 2007

Background: A new tactile sensor was developed for detecting hardness of living tissue by Omata et al. in 1992. This paper reports applicability of the sensor for evaluation of penile rigidity.

Methods: Nine patients from a group of 12 patients with penile erectile dysfunction were selected as subjects of this study. All patients agreed to artificial erection and monitoring of penile rigidity by a new tactile sensor and the Rigiscan system. The 9 patients selected all developed more than 1 cm circumferential expansion of the penis after an injection of smooth muscle relaxant into the corpus cavernosum.

The sensor equipment consisted of a piezoelectric element that vibrated, and a pickup that detected vibration frequency. When the end of the sensor was pressed against a surface of the penis, the resonance frequency of the sensor changed and indicated rigidity of the organ. Rigidity of the penile shaft was simultaneously monitored with the sensor and the Rigiscan system before and after an injection of 40mg papaverine or 20μg prostaglandin E1. The sensor's measurements of rigidity were compared with those of Rigiscan.

Results: Reproducibility of rigidity measured with the tactile sensor was satisfactory. Statistical analysis was made on 85 simultaneous pairs of rigidity values from the tactile sensor and Rigiscan. The analysis indicated significant correlation between the values.

Conclusion: The tactile sensor as well as Rigiscan will be of use for evaluating rigidity of the penis.
Comparison of the Equil2 Program and Other Methods for Estimating the Ion‐Activity Product of Urinary Calcium Oxalate: A New Simplified Method Is Proposed
Authors: Ogawa Yoshihide , Hatano Tadashi
Published: July 2007

Background: We aimed to develop a new simplified method to determine the urinary calcium‐oxalate saturation.

Methods: The ion‐activity product (AP) of urinary calcium oxalate was estimated in 345 clinical urine specimens (all 2.5 hour collections) using the Equil2 computer program and several other methods, and the results were compared. A new index using 4 parameters was created using multiple regression analysis.

Results: Our new simplified method (the AP(CaOx) index EQ2) provided a better approximation to the Equil2 method (r= 0.9897) than other conventional methods.

Conclusion: This new method requiring 4 factors (urinary calcium, magnesium, oxalate, and citrate concentrations) is simple and clinically usable.
Laparoscopic Nephropexy: A Case Report
Authors: Matsuda Tadashi , Uchida Junji , Ashida Makoto , Mikami Osamu
Published: July 2007

The laparoscopic approach is an ideal method for nephropexy because it produces less postoperative pain and allows an early recovery. We report a case of symptomatic renal ptosis treated laparoscopically with good success.
Anterior Urethral Diverticulum Produced by Cowper's Gland Duct Cyst
Authors: Shintaku Ichiro , Ono Yoshinari , Katoh Norio , Takeda Akihisa , Ohshima Shinichi
Published: July 2007

A case of congenital urethral diverticulum is presented. The patient was a 16‐year‐old boy with the chief complaint of dribbling urine since he was 14 years old. A retrograde urethrogram revealed a diverticulum of the bulbar urethra, which had been produced by a cystic dilation of the Cowper's gland duct. The walls of the diverticulum were resected endoscopically.
Effect of Surgical Stress on Immune Function in Patients with Urologic Cancer
Authors: Mizutani Youichi , Terachi Toshiro , Okada Yusaku , Yoshida Osamu
Published: July 2007

Background: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer.

Methods: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma.

Results: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte‐associated HLA‐DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes.

Conclusions: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.
Bladder Dysfunction in Patients with Benign Prostatic Hyperplasia: Relevance of Cystometry as Prognostic Indicator of the Outcome after Prostatectomy
Authors: Akino Hironobu , Gobara Masaru , Okada Kenichiro
Published: July 2007

Background: We correlated cystometric findings to the clinical features of benign prostatic hyperplasia (BPH) and compared them in terms of outcome after prostatectomy.

Methods: Cystometric findings obtained from 78 patients who underwent prostatectomy were correlated with clinical features in BPH patients. In 41 consecutive patients of this group, prospective periodical cystometry was also performed.

Results: Low bladder compliance correlated significantly with an increase in age and prostate volume, detrusor instability and impaired contractility. Low compliance also correlated with irritative symptoms, decreased maximum flow rate, increased post‐void residual urine and an increase in the American Urological Association symptom score. Postoperative persistent incontinence was associated with low bladder compliance and detrusor instability. In a prospective study, bladder dysfunction was not completely restored in 53% of patients examined at a mean interval of 7.7 months after prostatectomy.

Conclusions: Among the cystometric parameters investigated, low compliance was the most relevant to the clinical features of BPH and had some predictive value for the outcome after prostatectomy. In about half of the BPH patients with bladder dysfunction preoperatively, this condition was irreversible for a significant period of time after prostatectomy, in spite of surgical relief of the infravesical obstruction.
Recommended Dose of Flutamide with LH‐RH Agonist Therapy in Patients with Advanced Prostate Cancer
Authors: Akaza Hideyuki , Isaka Shigeo , Usami Michiyuki , Kanetake Hiroshi , Kotake Toshihiko , Koiso Kenkichi , Aso Yoshio
Published: July 2007

Background: In a recent study by the Casodex Combination Study Group, USA, patients in a flutamide (750mg/day) plus LH‐RH agonist group showed a high treatment failure rate, mainly due to flutamide‐induced diarrhea and hepatotoxicity. Our current study was conducted to determine the optimal dose of flutamide for use in this type of Combination therapy.

Methods: In a randomized, multicenter study, 30 patients (hormone untreated; stage C or D) were divided into 2 groups: flutamide 250mg (125mg × 2; 14 patients) and flutamide 375mg (125mg × 3; 16 patients), and each dose combined with either goserelin acetate (3.6 mg every 4 weeks) or leuprolide acetate (3.75 mg every 4 weeks). Goserelin and leuprolide were administered to patients in a 1:1 ratio. Flutamide monotherapy at a daily dose of 375 mg was determined to be the optimal dose in Japan in our previous phase II study. The endpoints of this pilot study were the objective response and adverse events during the 12‐week treatment.

Results: The objective response rate was 83.3% in the flutamide 250mg group and 85.7% in the flutamide 375 mg group according to the Japanese response criteria for prostate cancer. Elevated PSA levels fell to within the normal range in 83.3% of the patients in the former group and in 93.3% of the patients in the latter group. One patient administered 250 mg of flutamide experienced diarrhea, while the serum GOT and/or GPT were elevated in 3 patients administered 250 mg of flutamide and 4 patients administered 375 mg of flutamide.

Conclusions: Based on the findings of this pilot study of maximal androgen‐depletion therapy for advanced prostate cancer, 375mg/day of flutamide is recommended in combination with an LH‐RH agonist. Assessment of the effects of our recommended regimen on longer term survival, quality of life and antiandrogen withdrawal syndrome of patients treated requires additional patients and time for foIIow‐up.
Bilateral Deoxycorticosterone‐Secreting Adrenocortical Adenoma
Authors: Nitta Toshikazu , Kumamoto Yoshiaki , Itoh Naoki , Tachiki Hitoshi , Mikuma Naohito , Tsukamoto Taiji , Limura Osamu , Shimamoto Kazuaki
Published: July 2007

A case of a 58‐year‐old man with bilateral deoxycorticosterone (DOC)‐secreting adrenocortical adenoma is reported. Before surgery, plasma levels of DOC and corticosterone were markedly elevated, but both adrenal hormone levels normalized after the surgical removal of the bilateral adrenal tumors. The histologic examination revealed bilateral adrenocortical adenoma, but curiously, the tissue concentrations of DOC and corticosterone were elevated only in the right adrenal gland.
Diagnosis and Treatment of Renal Hydatid Disease: Presentation of Four Cases
Authors: Baykal Kadir , Önol Yavuz , Içeri Cüneyt , Kalci Erdal , Kizilkaya Eçref , Inal Haluk , Erden Dogan
Published: July 2007

Hydatid disease of the urinary tract is uncommon, accounting for only 2% to 3% of all hydatid diseases. We report 4 patients with hydatid cystic disease of the kidney. Nephrectomy was performed on 1 patient because of the destruction of renal parenchyma by the hydatid cyst. The other 3 patients were treated by cystectomy to preserve the normal renal parenchyma. In these cases, Casoni's intradermal test and indirect hemagglutination (IHA) test were not found to be helpful in the diagnosis, and eosinophilia was not significant. Diagnostic features of hydatid cysts were mixed echogenicity on ultrasonography, and multivesicular cyst with mixed density on computerized tomography (CT). CT was the most useful and specific investigation. No complications were noted during the first 3 months of the follow‐up. Despite its rarity, hydatid disease should be considered in the differential diagnosis of space‐occupying lesions of the urinary tract. Parenchyma‐sparing surgery (cystectomy, partial nephrectomy) or nephrectomy are the main treatment modalities.
Acute Thrombosis in a Contralateral Kidney after Radical Nephrectomy: Successful Treatment by Thrombolytic Therapy Using a Tissue‐Type Plasminogen Activator
Authors: Tsutsumi Masakazu , Kasaya Shunya , Sakurai Junichi , Maruyama Tsunehiko , Akaza Hideyuki
Published: July 2007

A 67‐year‐old male became anuric immediately after a right radical nephrectomy tor renal cell carcinoma. The patient was diagnosed with an acute arterial thrombosis of the remaining kidney within 4 hours after surgery by both CT scan and angiography. Thrombolytic therapy was started by a transcatheteral infusion of tissue‐type plasminogen activator (TPA) resulting in a complete recanalization. Hydration and systemic administration of heparin followed, and renal function recovered within 3 weeks. This is the first report of acute thrombosis in a contralateral renal artery immediately after a radical nephrectomy which was successfully treated with TPA. It is probable that compression of the contralateral renal artery by the retractor for an extended period of time during surgery led to this unfavorable condition.
Papillary Cystadenocarcinoma of the Prostate
Authors: Kojima Keiji , Uehara Hisanori , Naruo Sei‐ichi , Kanayama Hiro‐omi , Kagawa Susumu
Published: July 2007

We report a papillary adenocarcinoma with cystic formation in the prostate of a 64‐year‐old man, who presented with gross hematuria and pollakisuria. lmmunohistochemically, the origin of this tumor was considered to be the prostate gland. Interestingly, this tumor grew into the muscle layer of the bladder with large glandular formation but no stromal changes.