bluuebunny/crossref_metadata_2025 huggingface dataset:
Differential Diagnosis of Primary Benign and Malignant Retroperitoneal Tumors
Authors: Nakashima Jun , Ueno Munehisa , Nakamura Kaoru , Tachibana Masaaki , Baba Shiro , de Guchi Nobuhiro , Tazaki Hiroshi , Murai Masaru
Published: July 2007

Background:

Clinical differential diagnosis between malignant and benign tumors is important in order to select a therapeutic strategy for a primary retroperitoneal tumor.

Methods:

The clinical findings and radiological features of 25 patients with primary retroperitoneal tumors were retrospectively evaluated to find those signs that might contribute to the preoperative distinction between benign and malignant tumors.

Results:

Of 25 primary retroperitoneal tumors, 15 were benign. This may reflect the increased number of incidentally found small benign tumors. There were significant associations between the presence of symptoms and malignancy (P< 0.05), between irregular margins on imaging and malignancy (P< 0.05) and between the absence of calcification and malignancy (P< 0.05). Malignant tumors were significantly larger than benign tumors (11.45 ± 1.90 cm vs. 5.31 ± 0.43 cm). A retroperitoneal tumor scoring system was developed to distinguish primary retroperitoneal benign tumors from their malignant counterparts based on the: 1) maximum diameter equal to or larger than 5.5 cm, 2) presence of symptoms, 3) absence of calcification, 4) presence of irregular margins, and 5) presence of cystic degeneration or necrosis. A significant correlation was found between the incidence of malignant tumors and the total retroperitoneal tumor score (P < 0.05).

Conclusion:

This study suggests that the size of tumor, the presence of symptoms, irregular margins, and the absence of calcification may be valuable predictors of primary retroperitoneal malignant tumor.
Histologic Characteristics of Renal Cell Carcinomas with Lymph Node Metastasis
Authors: Kanamaru Hiroshi , Mori Hirotaka , Sasaki Miharu , Fujikawa Keita , Akino Hironobu , Miwa Yoshiji , Okada Kenichiro
Published: July 2007

Background:

This study was conducted to determine if there are any specific histologic features that are associated with lymph node metastasis in renal cell carcinoma (RCC).

Methods:

TNM classification, histologic grade, mean nuclear volume, cell type, and histologic architecture of the tumors were evaluated in 66 patients who had undergone nephrectomy and lym‐phadenectomy for RCC. In the 18 patients with positive lymph node metastasis, both primary lesions and metastatic lymph nodes were evaluated.

Results:

Lymph node status was correlated with primary tumor stage, venous involvement, and distant metastasis. The tumor grade was higher, and the mean nuclear volume was larger, in both primary and metastatic lesions of RCCs with lymph node metastasis than in tumors with no metastasis. In primary lesions of RCCs with lymph node metastasis, clear cell, alveolar, or cystic patterns were observed less frequently, and granular or spindle/pleomorphic cells and papillary or solid patterns, were observed more frequently, as compared to those lesions without metastasis. Comparison between primary and metastatic lesions in individual patients revealed no significant difference in grade or mean nuclear volume. The development of new cell types or histologic architectures, which was not noted in the primary lesions, was also a rare event in the metastatic lesions.

Conclusion:

Several characteristic histologic features, which may reflect the increased metastatic potential of the tumor, were observed in both primary and metastatic lesions in cases of RCC with lymph node metastasis. No substantial difference in histologic features was observed between the primary or metastatic lesions of individual patients.
Influence of Intravesical Bacillus Calmette‐Guerin Therapy on Systemic Immunological Status
Authors: Yoshimura Koji , Yamauchi Tamio
Published: July 2007

Background: Intravesical bacillus Calmette‐Guérin (BCC) therapy for superficial bladder cancer induces obvious local immunological responses. The purpose of this study was to examine the systemic immunological influences induced by intravesical BCG therapy.

Methods: We measured peripheral blood lymphocyte subsets (PBLS) and monocyte counts in 30 patients with superficial bladder carcinoma by two‐colored flow cytometry before, during, and after intravesical BCG treatment. Comparisons were made between 24 good treatment responders and 6 poor responders.

Results: From 3 to 12 months after the beginning of treatment, PBLS and monocyte counts changed, as evidenced by an increase of suppressor T cells and a decrease of helper T cells. The good responders had higher cell counts than the poor responders, with differences in cell counts between good and poor responders more marked 1 month after beginning treatment, particularly of natural killer cells, cytotoxic T cells, and inducer T cells. These differences disappeared 3 months after the onset of treatment.

Conclusion: Intravesical BCG therapy caused a marked and persistent alteration of the systemic immunological status.
Usefulness of Preoperative MRI Diagnosis in Prostatic Adenocarcinoma
Authors: Totsuka Yoshihiro , Ishizaka Hiroshi , Suzuki Keiji , Yamanaka Hidetosi
Published: July 2007

Background:

We examined the reliability of an MRI diagnosis prior to radical prostatectomy for prostate cancer.

Methods:

A radical prostatectomy was performed in 24 patients with prostate cancer. Resected specimens were fixed and 5 mm step sections vertical to the urethra were prepared to resemble MRI images. We compared this pathological map with the preoperative MRI diagnosis which included capsular or seminal vesicle invasion and tumor localization in the prostate. We defined a new criterion for the presence of capsular invasion as a chemical shift that occurred on the rectal side on T1 ‐weighted images 5 minutes after gadolinium (Gd) enhancement and the periprostatic venous plexus was not serial. We also examined 4 diagnostic factors of tumor localization including a low‐signal intensity area detected in the peripheral zone on T2‐weighted images, the presence of an enhanced area on Gd‐enhanced T1‐weighted images, and a low T2 with either Gd‐enhanced or nonenhanced T1‐weighted images.

Results:

The accuracy of a preoperative MRI diagnosis of capsular invasion was 16.7% using the conventional criteria, but 88.9% adding the new criterion. The accuracy of predicting seminal vesicle invasion was 63.2% in a group using a body surface coil compared to 75% in the group using an endorectal surface coil. The accuracy, positive predictive value, sensitivity and specificity of diagnosing tumor localization were 69%, 74.4%, 35.1%, and 91.8%, respectively.

Conclusion:

This new criterion proved superior for diagnosing capsular invasion in prostate cancer patients. Also, analysis of tumor localization in the peripheral zone demonstrated that cancer detection is increased if the low‐signal intensity area is enhanced by Gd.
Therapeutic Efficacy of Clenbuterol for Urinary Incontinence after Radical Prostatectomy
Authors: Noguchi Masanori , Eguchi Yoshiro , Ichiki Junji , Yahara Junro , Noda Shinshi
Published: July 2007

Background:

Urinary incontinence is one of the most common complications occurring after radical prostatectomy. We evaluated the efficacy of clenbuterol, a selective β2‐adrenoceptor agonist, in the treatment of incontinence occurring after radical prostatectomy, using urodynamic assessment.

Methods:

Fourteen men (mean age, 68 years) with post‐radical‐prostatectomy incontinence were treated with 20 mg of clenbuterol twice a day for 1 month. The urodynamic assessment was performed on all patients before and after the administration of clenbuterol. A pad scoring system was used to gauge the severity of incontinence before and after treatment.

Results:

At 1 month after administration of clenbuterol, 9 of the 14 patients (64%) had dramatic improvement in pad scores. Treatment failed in 5 patients (36%) with severe incontinence. The results of urodynamic studies showed that the mean functional urethral length of the patients with post‐radical‐prostatectomy incontinence increased significantly after treatment.

Conclusion:

These results suggest that clenbuterol can be used as an effective agent for treating mild‐to‐moderate stress incontinence after radical prostatectomy.
Renal Fossa Recurrence of a Renal Cell Carcinoma 13 Years after Nephrectomy: A Case Report
Authors: Takashi Munehisa , Hibi Hatsuki , Ohmura Masaharu , Sato Keiji , Sakata Takao , Ando Masashi
Published: July 2007

Between 1980 and 1995, we performed a nephrectomy with curative intent on 183 patients with renal cell carcinoma at Nagoya University Hospital. Among these patients, 5 (2.7%) developed renal fossa recurrence (median follow‐up, 65 months). We report a case of such a recurrence found 13 years after a nephrectomy for renal cell carcinoma (stage pT3a, pNO, MO). A 62‐year‐old female presented with a nodule on her back. Computed tomography and magnetic resonance imaging revealed a mass in the right back and retroperitoneum, and a biopsy revealed the tumor to be a renal cell carcinoma. Complete resection was performed, followed by administration of a‐interferon. The patient is doing well 16 months after the operation. The case illustrates that very long‐term follow‐up after a nephrectomy is mandatory for patients with perinephric invasion of a renal cell carcinoma due to the risk of renal fossa recurrence.
Extravesical Tumor Implantation Caused by Perforation during Transurethral Resection of a Bladder Tumor: A Case Report
Authors: Ohguchi Naoki , Sakaida Noriko , Okamura Akiharu , Kawakita Shigenari , Kawamura Hiroshi , Matsuda Tadashi
Published: July 2007

We report a case of invasive bladder cancer in which cancer dissemination occurred through a perforation of the vesical wall during transurethral resection of the tumor. A radical cystectomy was performed 1 month later and several clusters of viable cancer cells were histologically identified in a fibrous foreign body granuloma in the paravesicular adipose tissue of the lymphadenectomy specimen. The patient received adjuvant chemotherapy, but developed right inguinal lymph node metastasis 21 months after cystectomy.
Glioblastoma Multiforme after Radiotherapy for Metastatic Brain Tumor of Testicular Cancer
Authors: Saiki Shigeru , Kinouchi Toshiaki , Usami Michiyuki , Nakagawa Hidemitsu , Kotake Toshihiko
Published: July 2007

A patient with left testicular cancer and metastases to retroperitoneal lymph nodes, lung, and brain was treated by chemotherapy, radiotherapy and surgery, and obtained the state of no evidence of disease, but 10 years after radiotherapy, a glioblastoma multiforme tumor appeared in the brain. This is the first report of a glioma appearing after radiotherapy in a testicular cancer patient.
Testicular Microlithiasis Associated with Teratocarcinoma and Intratubular Germ Cell Neoplasia: A Case Report
Authors: Tüzel Emre , Yörukoĝlu Kutsal , Gümü Bahri , Kirkali Ziya
Published: July 2007

Testicular microlithiasis is a rare condition that has characteristic sonographic and histologic features. It is often associated with premalignant changes and malignant neoplasms of the testes. We report a case of testicular microlithiasis associated with teratocarcinoma and intratubular germ cell neoplasia. Three previously reported cases documented development of malignant germ cell tumor during the clinical follow‐up period of patients with testicular microlithiasis. We think that testicular microlithiasis is strongly associated with testicular neoplasms, and that coexistence of intratubular germ cell neoplasia and malignant germ cell tumors with testicular microlithiasis is common.
Nuclear p53 Overexpression in Bladder, Prostate, and Renal Carcinomas
Authors: Sinik Zafer , Alkibay Turgut , Ataoglu Oumür , Biri Hasan , Sözen Sinan , de Niz Nuri , Karaoglan Uustünol , Bozkirli Ibrahim
Published: July 2007

Background:

The aim of this study was to examine nuclear p53 overexpression in transitional cell carcinoma of the bladder, adenocarcinoma of the prostate, and renal cell carcinoma.

Methods:

Forty‐four pathologic specimens from 39 bladder cancer patients, 41 prostatic adenocarcinoma, and 39 renal cell carcinoma specimens were analyzed immunohistochemically with D07 monoclonal antibody to detect the expression of the mutant p53 gene. Overexpression was said to occur when the number of positively‐stained tumor nuclei were≥ 10% in each specimen. p53 overexpression was correlated with the clinical and histopathological features of these cancers.

Results:

Nuclear p53 overexpression occurred in 18.2% of transitional cell bladder cancer specimens, 12.2% of prostate cancer specimens, and 17.9% of renal cell cancer specimens. Statistical analyses showed that grade, vascular invasion, and necrosis in bladder cancer, a high Gleason score in prostate cancer, and the 1‐year mortality rate in renal cancer were significantly related with p53 nuclear overexpression (P<0.05).

Conclusion:

Using the D07 monoclonal antibody, nuclear p53 overexpression is relatively uncommon in urologic malignancies, and moderately correlates with several histopathological and clinical features of urologic malignancies.
Significance of the BTA Test in Bladder Cancer: A Multicenter Trial
Authors: Miyanaga Naoto , Akaza Hideyuki , Kameyama Shuji , Hachiya Takahiko , Ozono Seiichiro , Kuroda Masao , Koga Hirofumi , Koiso Kenkichi
Published: July 2007

Background:

The BTA test is a latex agglutination assay for the qualitative detection in the urine of analytes that are associated with bladder tumor. We compared the results of the BTA test with those of voided urine cytology (VUC) in patients with bladder cancer.

Methods:

A multicenter trial was performed at 6 institutions. A total of 132 patients with histologically diagnosed bladder cancer were enrolled. Urine samples were split for BTA and VUC testing.

Results:

The sensitivities of the BTA test and VUC were 57.6% and 37.9%, respectively; this difference was significant (P< 0.001). The BTA test had much higher sensitivity for small, solitary, superficial tumors than did VUC.

Conclusion:

The BTA test is simple to perform, gives rapid results, and is far more sensitive than VUC for detection of bladder cancer. The BTA test has the potential to become an additional tool for detecting bladder cancer.
Relationship between Prostate‐Specific Antigen, Clinical Stage, and Degree of Bone Metastasis in Patients with Prostate Cancer: Comparison with Prostatic Acid Phosphatase and Alkaline Phosphatase
Authors: Akimoto Susumu , Furuya Yuzo , Akakura Koichiro , Shimazaki Jun , Ito Haruo
Published: July 2007

Background:

The study was designed to examine the relation of the levels of prostate‐specific antigen (PSA), prostatic acid phosphatase (PAP), and alkaline phosphatase (ALP) to clinical stage and bone metastasis in prostate cancer patients.

Methods:

Serum PSA, PAP, and ALP levels were evaluated in 272 patients with prostate cancer. The relation of the level of PSA, PAP, and ALP to clinical stage and to degree of bone metastasis were examined by a multiple comparison method using ranks. The superiority of a marker in the rate of detection of bone metastasis was evaluated with receiver operating characteristic (ROC) curves. The correlation coefficients of the order of the extent of bone metastasis with PSA, PAP, and ALP were examined with Spearman's rank order correlation coefficient test.

Results:

The levels of PSA showed significant differences among 8 pairs of clinical stages, in contrast, the levels of PAP showed significant differences among 6 pairs, and the levels of ALP showed significant differences among only 4 pairs. The area under the ROC curves of PSA, PAP, and ALP for revealing bone metastasis was 84.9%, 81.4%, and 77.3%, respectively. The correlation coefficients of the order of extent of disease (EOD) with log (PSA), log (PAP), and log (ALP) were 0.346, 0.394, and 0.618, respectively, and the levels of ALP showed the most significant differences regarding the extent of bone metastasis.

Conclusion:

PSA was the best marker for differentiating clinical stages, but showed limited reliability for stratifying the extent of bone metastasis.
Effects of α‐Interferon on Sperm Production, Concentration, and Motility in the Rat
Authors: Hibi Hatsuki , Yokoi Keisuke , Yamamoto Masanori
Published: July 2007

Background:

We evaluated possible effects of α‐interferon (α‐IFN) on testicular spermatogenesis and epididymal sperm quality in the nude rat.

Methods:

Nude male rats were administered subcutaneous injections of human α‐IFN daily for 3 months. The luminal content of the cauda epididymidis was collected by micropuncture. Daily sperm production was determined by Amann's method and sperm concentrations were determined by microassay. Progressive motility was judged by evaluating the linear distance traveled by the sperm in a diluent. Serum levels of testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were also measured at the end of the experiment.

Results:

Daily sperm production and epididymal sperm concentrations were significantly increased after administration of α‐IFN, while progressive motility of the spermatozoa was not altered. α‐IFN significantly increased serum testosterone levels, while it decreased serum LH levels and left serum FSH levels unchanged.

Conclusion:

α‐IFN may improve testicular spermatogenesis and increase the epididymal sperm concentration in the rat. These promising results with α‐IFN may pave the way for a new approach to treating male infertility.
A Case of Adrenal Cavernous Hemangioma
Authors: Oh Bong‐Ryoul , Jeong Yong‐Yoen , Ryu Soo‐Bang , Park Yang‐ll , Kang Heoung‐Keun
Published: July 2007

Adrenal hemangiomas are rare tumor. Only 29 surgical cases have been reported. Although rare, adrenal hemangiomas should be included in the differential diagnosis of adrenal neoplasms. We report an additional case of adrenal hemangioma that was removed surgically, and the pertinent literature is reviewed.
Frequent Recurrence of Superficial Bladder Tumors in the Periorificial Region: Possible Predictor for Delayed Appearance of Invasive Intramural Ureteric Cancer
Authors: Kato Haruaki , Kiyokawa Hideo , Igawa Yasuhiko , Toguri Allan G. , Nishizawa Osamu
Published: July 2007

Two cases of invasive lower ureteric cancer developed following frequent recurrence of superficial bladder tumors in the region of the ureteral orifice. The cancer focus could not be identified in the intramural ureter prior to intravenous urography which revealed hydronephrosis. When bladder tumors repeatedly develop near the ureteric orifice, careful investigations such as ureteral catheterization with a small brush for cytology or ureteroscopy are necessary for the early detection of invasive disease.

bladder neoplasms,

ureteral neoplasms
Circumvention of Multidrug Resistance in Genitourinary Tumors
Authors: Brussel Jérôme P. van , Mickisch Gerald H. J.
Published: July 2007

Chemotherapy is the principal strategy to systemically challenge metastasized cancers of genitourinary origin. Unfortunately, the efficacy of chemotherapy is often hampered by multidrug resistance, the resistance to a variety of structurally and functionally distinct cytotoxic agents. Multidrug resistance can be either intrinsic or acquired, and can be caused by several mechanisms. The so‐called classical multidrug resistance, mediated by the MDR1 gene product P‐glycoprotein, has been held mainly responsible for inferring the multidrug resistance phenotype on urologic malignancies. However, several other multidrug resistance pathways have been identified. Multidrug resistance can be caused by the membrane‐bound multidrug‐resistance‐associated protein, the detoxifying glutathione metabolism, the antiapoptotic protein BCL2, and changes in levels or activity of the topoisomerase enzymes. Strategies to overcome multidrug resistance of genitourinary tumors have arisen from the better understanding of the biologic and molecular mechanisms of multidrug resistance, and have been studied in experimental and clinical settings. However, attempts to modulate multidrug resistance in clinical renal cell, bladder, prostate, and testicular cancer have not been very rewarding so far, despite the optimism that had arisen from experimental data. Nevertheless, application of novel therapies to reverse multidrug resistance and to increase efficacy of chemotherapy for urologic cancers should be further pursued, within the setting of controlled clinical trials, to improve on current strategies.
Construction and Voiding Functions of Three Types of Orthotopic Neobladders Using Colonic Segments: The Kobe University Experience
Authors: Okada Hiroshi , Yamanaka Nozomu , Oh‐Oka Hitoshi , Gotoh Akinobu , Nakamura Ichiro , Hara Isao , Fujisawa Masato , Gohji Kazuo , Arakawa Soichi , Kamidono Sadao
Published: July 2007

Background At Kobe University Hospital we have created orthotopic neobladders since 1988 by using several colonic segments. Various types of neobladders were compared and a detailed description of these procedures and the voiding function outcome is presented.

Methods Thirty‐two men with invasive bladder carcinoma or recurrent carcinoma in situ underwent a radical cystectomy followed by orthotopic neobladder replacement using a right colonic, ileocolic or sigmoid colonic segment. The functional capacity, percentage of residual urine volume, configuration of the neobladder, and location in the pelvis were evaluated 1 year after surgery. Voiding function was evaluated using a questionnaire which included questions on diurnal and nocturnal continence, and by uroflowmetric analysis.

Results Operative time, blood loss, and functional neobladder capacity did not differ for the 3 types of neobladders. The configuration of the right colonic and ileocolic neobladders resembled the shape of a rugby ball. The configuration of the sigmoid neobladder was oval. The right colonic and ileocolic neobladders tended to be located along the right side wall of the pelvis. The sigmoid neobladder was located in the center of the pelvis. Daytime and nocturnal continence was not affected by either the type of neobladder or its configuration or position. Neobladders located in the center of the pelvis exhibited a better maximum flow rate than those located along the right wall of the pelvis.

Conclusion The technical difficulty in constructing the 3 types of neobladders was approximately the same. For better voiding a neobladder should be located in the center of the pelvis.
Clinical Evaluation of Random Biopsy of Urinary Bladder in Patients with Superficial Bladder Cancer
Authors: Taguchi Isao , Gohji Kazuo , Hara Isao , Gotoh Akinobu , Yamada Yuji , Yamanaka Kazuki , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao
Published: July 2007

Background Superficial bladder cancer has a tendency to recur in the urinary bladder. One reason for recurrence is the presence of concomitant carcinoma in situ (CIS) or dysplasia. However, the usefulness of random biopsy of the urinary bladder has been unclear.

Methods Between September 1990 and March 1996, 83 patients with superficial bladder cancer underwent mucosal biopsy of 6 different sites in the urinary bladder with macroscopically normal findings (random biopsy). The relationship between a positive biopsy (CIS or dysplasia) and the tumor characteristics was examined. The disease‐free survival of the patients according to the biopsy results was determined.

Results The positive biopsy rate was 24.1% (CIS, 14.5% dysplasia, 9.6%). The incidence of positive biopsy in patients with high‐grade (C3), pT1 tumors, 3 or more and non‐papillary wide‐based tumors was significantly higher than that in patients with 1 or 2 tumors, low‐grade (G1, G2), pTa tumors and papillary tumors (P< 0.05). In patients with a single papillary tumor, positive biopsy was found in 9.5%. The disease‐free survival in patients with a positive biopsy did not differ from that in patients with a negative biopsy, because intravesical bacillus Calmette‐Guérin was instilled in patients with a positive biopsy.

Conclusion Our results indicate that random biopsy is useful for detecting concomitant CIS or dysplasia and in the choice of drugs for intravesical instillation.
Vesicourethral Dysfunction Following Radical Surgery for Rectal Carcinoma: Change in Voiding Pattern on Sequential Urodynamic Studies and Impact of Nerve‐Sparing Surgery
Authors: Mitsui Takahiko , Kobayashi Shinya , Matsuura Shinobu , Kakizaki Hidehiro , Mori Tatsuya , Minami Shigemasa , Koyanagi Tomohiko
Published: July 2007

Objectives Urodynamic studies were performed to clarify vesicourethral dysfunction and recovery after rectal surgery for cancer.

Materials and Methods At 1, and 6 to 12 months after rectal surgery interviews and urodynamic studies (UDS) were performed on 51 consecutive patients, all without a prior history of voiding disorder (40 males and 11 females; median age, 60 years). Patients were divided into 2 groups, either with (preserved group, n = 17) or without (nonpreserved group, n = 34) preservation of the bilateral pelvic plexus during surgery. Comparisons of voiding status and urodynamic parameters were made between the 2 groups.

Results By 1 and 6 months after the operation normal voiding was achieved in 71 % (12/17) and 100% (13/13) of patients in the preserved group, and 6% (2/34) and 30% of patients (9/30) in the nonpreserved group, respectively (P< 0.001). Attainment of normal voiding in the nonpreserved group was preceded by the recovery of bladder sensation, while UDS demonstrated increases in vesical compliance and the disappearance of vesical denervation supersensitivity.

Conclusion A nerve‐sparing procedure during radical surgery for rectal carcinoma preserved vesicourethral function. The urodynamic parameters relevant to postoperative recovery of voiding function were improved vesical compliance, disappearance of vesical denervation supersensitivity, and recovery of a bladder filling sensation.
Persistent Vesicourethral Dysfunction Following Radical Surgery for Rectal Carcinoma: Urodynamic Features and Potential Abatement with Modified Sphincterotomy (Radical Transurethral Resection of the Prostate)
Authors: Mitsui Takahiko , Shinno Yuichiro , Kobayashi Shinya , Matsuura Shinobu , Shibata Takashi , Ameda Kaname , Koyanagi Tomohiko
Published: July 2007

Background Vesicourethral function returns after radical rectal surgery during the first year but rarely progresses after 1 year. We examined the urodynamics of patients whose voiding dysfunction remained after 1 year, and treated several with a modified sphincterotomy procedure similar to radical transurethral resection of the prostate.

Methods We analyzed the urodynamic features of vesicourethral dysfunction in 16 male patients with persistent voiding dysfunction for more than 1 year following radical surgery for rectal carcinoma. Seven patients elected to undergo radical transurethral resection of prostate (radical TUR‐P) for the relief of their persistent voiding dysfunction.

Results The mean bladder volume at the first desire to void was 210 mL, the mean maximal bladder capacity was 343 mL, and the mean vesical compliance (Cves) was 27.1 mL/cm H2O. All patients demonstrated either vesical denervation supersensitivity (Vds) or uninhibited contraction. The mean maximal urethral closure pressure was 43.9 cm H2O, and urethral denervation supersensitivity was found in 77.8% (7/9), and sphincter dyssynergia in 66.7% (6/9) of patients. After radical TUR‐P, 5 patients became free from the use of self‐catheterization, 1 patient had a reduced residual urine rate, and 1 patient was unchanged, but no patient noted a change in urinary control.

Conclusion Urethral dysfunction after radical rectal surgery was caused by failure of the bladder to empty along with an underactive detrusor. Radical TUR‐P was effective in restoring voiding function in a selected group of these patients.
Testicular Findings, Endocrine Features and Therapeutic Responses of Men with Acquired Hypogonadotropic Hypogonadism
Authors: Tachiki Hitoshi , Ito Naoki , Maruta Hiroshi , Kumamoto Yoshiaki , Tsukamoto Taiji
Published: July 2007

Background Men with acquired hypogonadotropic hypogonadism (AHH) who desire restoration of fertility are treated with exogenous gonadotropin. However, gonadotropin (Gn) therapy does not always restore testicular function. It is unknown whether the therapeutic responses to Gn therapy correlate with their testicular histological findings. Thus, we analyzed factors influencing testicular dysfunction and therapeutic responses in AHH.

Methods Of 21 men with AHH, 11 had no postmeiotic germ cells and were classified as the severe spermatogenic failure group. These were compared with the other 10 patients who had postmeiotic germ cells and comprised the mild spermatogenic failure group.

Results: Testicular volume and tubular diameter were significantly smaller, and the basement membrane and tunica propria were significantly thicker in the severe failure group. The gonadotropin basal level and response to exogenous gonadotropin‐releasing hormone, and the testosterone response to exogenous human chorionic gonadotropin were significantly lower in the severe failure group of patients. Also, the recovery of spermatogenesis and testosterone secretory potentials was poor in the cases with a duration between diagnosis and treatment of 2 years or more.

Conclusion Longer periods without treatment may be responsible for irreversible testicular dysfunction in AHH. Gn therapy should be initiated very soon after the diagnosis of AHH if fertility is desired.
Cirsoid Arteriovenous Malformation of Kidney Presenting as a Mass Suggestive of Malignancy
Authors: Turkeri Levent N. , Daudi Imbesat , Abraham Jerrold L. , Wojtowycz Andrij R. , Haas Gabriel P.
Published: July 2007

This paper reports a rare case of cirsoid renal arteriovenous malformation (AVM) that showed radiological characteristics of a renal malignancy. Using only conventional procedures such as computerized tomography, the present case was misdiagnosed as a solid tumor mass and therefore radical nephrectomy was indicated. Angiographic analysis is expected to improve the accuracy of diagnosis of AVM, thus reducing the need to resort to invasive techniques.
Evaluation of the Prognostic Significance of Microvessel Count and Tumor Size in Renal Cell Carcinoma
Authors: Yoshino Shuji , Kato Mikio , Okada Koichi
Published: July 2007

Background:

We analyzed the significance of tumor microvessel count and tumor size as prognostic factors for renal cell carcinoma (RCC).

Methods:

T criteria (local invasion), M criteria (distant metastasis), macrovenous invasion, histological grade, cell type, tumor size, and tumor microvessel count were investigated as prognostic factors in 62 patients with RCC. Microvessel density was evaluated by immunohistochemical staining of the endothelial cells.

Results:

No significant correlation was found between tumor size and the other prognostic factors. Analysis of the survival rate based on tumor size revealed that patients with a small tumor tended to show a good prognosis, but no significant difference was found in the prognosis between medium‐sized and large‐sized tumor groups. Analysis of all patients revealed that M criteria, macrovenous invasion, cell type and microvessel count were significant factors and that in 37 patients with low‐stage tumors, the only significant prognostic factor was microvessel count (P= 0.003).

Conclusion:

Tumor size cannot be readily justified as a determinant of prognosis in patients with medium‐or large‐sized tumors. In patients with low‐stage tumors, microvessel count served as the only significant determinant for prognosis. When the patients were considered as a whole, microvessel count, M criteria, macrovenous invasion and histological grade were significant prognostic factors.
Combined Treatment of Staghorn Calculi by Fiberoptic Transurethral Nephrolithotripsy and Extracorporeal Shock Wave Lithotripsy
Authors: Mugiya Soichi , Suzuki Kazuo , Ushiyama Tomomi , Fujita Kimio
Published: July 2007

Background:

Although various strategies have been proposed, the treatment of staghorn calculi is still controversial. We report on the treatment of 27 staghorn calculi using fiberoptic transurethral nephrolithotripsy (f‐TUL) combined with extracorporeal shock wave lithotripsy (ESWL).

Methods:

Stones were initially disintegrated by f‐TUL as an inpatient procedure. For stone fragmentation, we originally used an electrohydraulic lithotriptor (EHL) but changed to a pulsed‐dye laser in 1993. After the stones were disintegrated as much as possible, a double‐J ureteral stent was inserted and the patient was discharged. ESWL for the residual fragments was begun on an outpatient basis at 1 or 2 weeks after f‐TUL and repeated until the residual fragments were smaller than 4 mm.

Results:

Since 1989, 27 staghorn calculi in 26 patients have been treated. Among them, 21 were successfully fragmented using this combined treatment regimen. From 3 to 26 ESWL sessions (mean, 8.4 sessions) were required to disintegrate the staghorn calculi. Auxiliary percutaneous endourological procedures were necessary in 2 cases due to ureteral obstruction. The other 4 patients are still receiving ESWL for residual fragments. Urinary tract injury occurred in 2 patients early in this series when an EHL was used, but was managed without any surgical procedures. A fever greater than 38°C developed in 9 patients.

Conclusion:

Combining f‐TUL with ESWL provides an alternative treatment option for staghorn calculi. The use of a small caliber fiberscope (2.6 mm in diameter) and a laser for fragmentation decreased the risk of complications.
Familial Prostate Cancer in Japan
Authors: Ohtake Nobuaki , Hatori Motoaki , Yamanaka Hidetoshi , Nakata Seiji , Sada Masaharu , Tsuji Takayuki
Published: July 2007

Background:

Familial prostate cancer has been studied in Europe and the United States. This study was conducted toclarify the clinical features and incidenceof the human leukocyte antigen (HLA) in familial prostate cancer in patients seen at hospitals in Japan.

Methods:

The age at diagnosis, clinical stage, histologic differentiation, prognosis, cause of death and family history were compiled from 43 patients from 20 families with familial prostate cancer (group F) and compared in patients with sporadic prostate cancer (group S). In addition, HLA class II gene typing was performed in 17 patients from 11 families with familial prostate cancer (group F') and their healthy family members (15 males and 25 females).

Results:

The age at diagnosis was significantly lower in group F patients (P < 0.001), but neither clinical stage nor prognosis differed between group F and group S, yet the incidence of moderately differentiated adenocarcinoma was significantly higher in group F (P& 0.01). There were no historical factors that were specific for group F patients. The frequency of HLA‐DRB1 *0901 and *1201 alleles was significantly higher in group F' patients than in group J (the frequency of alleles in 1216 Japanese people attending the 11th Japan HLA Workshop), but not between group F' and their healthy male family members.

Conclusion:

There were no significant differences in clinical parameters between group F and group S, except that the age at diagnosis was lower in group F patients, and that the frequency of several HLA class II alleles was significantly higher in patients with prostate cancer. In men with a family history of prostate cancer, examinations for early detection of prostate cancer should begin at a young age.
Detrusor Areflexia in a Patient with Myasthenia Gravis
Authors: Sandler Paula M. , Avillo Christine , Kaplan Steven A.
Published: July 2007

Myasthenia gravis (MG) is a common neuromuscular disorder, however, voiding dysfunction in conjunction with MG is rare. A review of the literature yielded only 7 prior reports of such a combination. Most of the reported cases involved incontinence in males which developed after a transurethral resection of the prostate. Only 3 cases described de novo voiding dysfunction. We report a fourth patient. In all 4 cases of de novo dysfunction, the voiding problem either heralded a new diagnosis of MG or an exacerbation of the disease process. It is hypothesized that autonomic dysfunction in patients with MG might indicate a unique subset with a worse prognosis.
Use of Systematic Biopsy Results to Predict Pathologic Stage in Patients with Clinically Localized Prostate Cancer: A Preliminary Report
Authors: Goto Yasuki , Ohori Makoto , Scardino Peter T.
Published: July 2007

Background: The purpose of this study was to determine the ability of clinical tests to predict advanced pathologic stage (seminal vesicle invasion, pT3c, or pelvic lymph node metastases, pN+).

Methods: T stage, PSA, PSA density, and pathologic features in systematic biopsy specimens were correlated with pathologic stage in 190 consecutive patients with clinically localized (T1‐3) prostate cancer detected by systematic needle biopsies and treated with radical prostatectomies.

Results: Thirty‐three patients (17%) had an advanced pathologic stage cancer (pT3c or pN+). In logistic regression analysis, the total length of cancer in all biopsy cores (P < 0.0005), the percent of poorly‐differentiated cancer in each specimen (P < 0.021), and serum PSA (P < 0.028) were the only significant predictors of advanced stage. A model was constructed to predict advanced stage: if the PSA was 6 ng/mL and 4 or more biopsy cores were positive and the total length of cancer in all cores was 20 mm and at least 10% of the cancer was poorly‐differentiated, then 14 (93%) of 15 patients had an advanced pathologic stage cancer compared to 11% of the remaining 175 patients (P < 0.0005). Conclusion: The pathologic features of cancer in systematic needle biopsy specimens more accurately predicts which patients have advanced stage cancer than standard clinical tests alone.
Simultaneous Presentation of Malignant Lymphoma of the Kidney and Multiple Myeloma of the Bone Marrow
Authors: Hayakawa Masamichi , Asano Tomohiko , Nakajima Fumio , Tamai Seiichi , Nakamura Hiroshi
Published: July 2007

We report a case of coexisting renal lymphoma and multiple myeloma. A 77‐year‐old man was referred to our hospital with a diagnosis of cancer in his right kidney. Biopsies of the renal mass and bone marrow were performed because of hyperproteinemia and biclonal gammopathy. Immunohistochemical staining and Southern blot analysis of the tumor's DNA were diagnostic for renal lymphoma. To our knowledge, this is the first time the coexistence of malignant renal lymphoma and multiple myeloma has been reported.
Neonatal Urinary Ascites Caused by Urinary Tract Obstruction: Two Case Reports
Authors: Sakai Kiyohide , Konda Ryuichiro , Ota Shozo , Takeda Atsushi , Orikasa Seiichi
Published: July 2007

Two cases of neonatal urinary ascites are reported, one (case 1) caused by posterior urethral valves associated with right vesicoureteral reflux, and the other (case 2) secondary to bilateral obstructed megaureter–a very rare cause. Abdominal distension, electrolyte imbalance, and an elevated BUN/ serum creatinine ratio were noted at the time of hospitalization in both cases. These laboratory values promptly returned to normal after the establishment of appropriate urinary drainage, accomplished through bladder catheterization in case 1 and bilateral percutaneous nephrostomy in case 2. In case 1, transurethral resection of the posterior urethral valves was followed by resumption of normal urination. In case 2, bilateral ureteroneocystostomy with ureteral tapering was performed successfully. These are only the fifth and sixth cases of neonatal urinary ascites reported in the Japanese literature.
Familial Prostate Cancer in Four Brothers
Authors: Ohtake Nobuaki , Nakata Seiji , Hatori Motoaki , Ohi Masaru , Matsui Hiroshi , Tokunaga Takashi , Ono Yoshihiro , Fukabori Yoshitatsu , Yamanaka Hidetoshi , Suzuki Keiji , Tari Kiyonobu , Sada Masaharu , Tsuji Takayuki
Published: July 2007

We identified a family of 4 brothers with prostate cancer. The proband was the second son who was seen at the Department of Urology, Gunma University, Gunma, Japan, in May 1995, with a chief complaint of dysuria. The serum level of PSA was high, and a prostate needle biopsy revealed a moderately‐differentiated adenocarcinoma. Subsequently, a total prostatectomy was performed. The family history revealed that the fourth son had been under treatment at the Saitama Cancer Center Hospital for prostate cancer since 1994. Therefore, the other 2 brothers became healthy male family members of the familial prostate cancer line, and their serum PSA levels were examined after obtaining their informed consent. Both had a high serum PSA level and biopsies revealed moderately‐differentiated adenocarcinomas in both. Human leukocyte antigen class II gene typing was conducted on 3 of 4 brothers and 4 healthy family members who gave informed consent, and revealed the DRB1 *0901 ‐DQB1 *0303 haplotype in the first, second and third sons. Familial prostate cancer is well documented in Europe and the US where the incidence of prostate cancer is high, but this is the first report of prostate cancer in 4 brothers in Japan.
Secondary Treatment Failure without Anti‐human Chorionic Gonadotropin Antibody in a Patient with Kallmann Syndrome
Authors: Kitahara Satoshi , Yoshida Ken‐ichiro , Ishizaka Kazuhiro , Higashi Yotsuo , Takagi Kentaro , Oshima Hiroyuki
Published: July 2007

A 29‐year‐old man with Kallmann syndrome suddenly developed decreased semen volume, azoospermia, and facial hair loss after 11 years of successful human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) treatment. Anti‐hCG antibody was not detected in the patient's serum. A high serum level of luteinizing hormone (LH) with nasal LH‐releasing hormone analogue administration failed to increase serum testosterone to a sufficient level. Testosterone injection after cessation of hCG and hMG therapy was able to improve semen volume, but not azoospermia. Resumption of hCG and hMG therapy after 6 months cessation partially restored spermatogenesis. The secondary failure of hCG and hMG therapy suggests a decrease of testicular sensitivity to LH as well as hCG.
Significant Prognostic Factors for 5‐Year Survival after Curative Resection of Renal Cell Carcinoma
Authors: Masuda Hiroaki , Kurita Yutaka , Fukuta Ken , Mugiya Soichi , Suzuki Kazuo , Fujita Kimio
Published: July 2007

Background: Renal cell carcinoma (RCC) patients occasionally die of RCC even after curative resection. In this study, we investigated prognostic factors between survivors for more than 5 years and patients who died within 5 years after curative resection.

Methods: We retrospectively studied 111 patients who underwent RCC curative resection and were followed for more than 5 years. Patient survival at 5 years after curative resection was regarded as the end‐point of this analysis. Statistical differences of 19 prognostic factors between surviving and deceased patients were determined using logistic regression analysis.

Results: Eighteen of the 111 patients died of RCC during the 5‐year follow‐up period. Of the 19 prognostic factors evaluated, univariate analysis showed significant differences in the body temperature, hemoglobin, erythrocyte sedimentation rate(ESR), α2‐globulin, C‐reactive protein (CRP), fibrinogen, tumor size, Robson's stage, T classification (renal capsular involvement), pathological grade, and mode of tumor infiltration. Five significant variables (body temperature, ESR, α2‐globulin, fibrinogen, and tumor size) were excluded from multivariate analysis because greater than 10% of the data was missing. The TNM staging system was selected as the representative variable for stage for multivariate analysis. Using the remaining 5 significant variables (hemoglobin, CRP, T stage, pathological grade, and mode of tumor infiltration), multivariate analysis showed that CRP (P=0.01 26) and T stage (P=0.0490) were the most important prognostic factors.

Conclusion: From this analysis, CRP and renal capsular involvement were the most important factors predicting survival for greater than 5 years after curative resection of RCC.
Immunological Analysis of Rat Renal Transplant Recipients Exhibiting Long‐term Survival Following Treatment with 15‐Deoxyspergualin in the Early Postoperative Phase
Authors: Takeuchi Ichiro , Chikaraishi Tatsuya , Seki Toshimori , Kanagawa Kouichi , Koyanagi Tomohiko
Published: July 2007

Background: We previously reported that short‐term administration of 15‐deoxyspergualin (DSG), 5 mg/kg/day on postoperative days 4 through 7, prolonged survival of rat renal allografts indefinitely. We now report the immunologic environment of DSG‐treated recipients in the early postoperative phase.

Methods: TO (RT1u) rat kidneys were transplanted into WKAH (RT1k) rats. Peripheral blood lymphocytes (PBL), splenocytes (SPC) and graft infiltrating lymphocytes (GIL) were harvested from rejecting (untreated) recipients on day 7 (group AR) and from DSG‐treated recipients on days 7 (Group DSG7) and 14 (group DSG14). Flow cytometric analysis was done to determine characteristics of these cells. Mixed lymphocyte culture reactions (MLRs) were also studied to examine suppressive activities of sera, SPC, and GIL of each group by adding them to TO/WKAH MLRs.

Results: In all groups, the proportions of CD8‐and interleukin2 receptor (IL‐2R)‐positive cells were higher for GIL than for either PBL or SPC. The CD4/CD8 ratio was lowest in GIL. Comparing groups DSG7 and DSG14, significant decreases in the proportion of CD8‐ and IL‐2R‐positive cells were found only in GIL. Sera of all groups nonspecifically suppressed MLRs, independent of DSG‐administration. GIL of all groups also nonspecifically suppressed MLRs, while these suppressive activities were not observed with SPC. Suppressive activities of GIL remained unchanged in the first 2 postoperative weeks.

Conclusions: Differences in the immunologic environment were reflected primarily in GIL. DSG seemed to decrease CD8‐ and IL‐2R‐positive cells in allografts. In the presence of DSG, this model may feature a predominance of nonspecific suppressor T cells over cytotoxic T cells during the first 2 postoperative weeks.
Ileal Pouch with an Umbilical Stoma: A Continent Mechanism Created by the Extramural Tunnel Technique
Authors: Kato Haruaki , Igawa Yasuhiko , Nishizawa Osamu
Published: July 2007

We present an initial experience of creating an extramural continent valve in the ileal pouch in 4 patients who required continent urinary diversion. Using the appendix or a tapered ileal segment, the continent valve was created by the extramural tunnel technique along the anterior suture line of the pouch to facilitate the umbilical anastomosis. All patients were continent postoperatively with easy catheterization. This technique can provide a simple and effective continent pouch formed entirely from the ileum.
Erythropoietin‐Producing Renal Cell Carcinoma Arising from Acquired Cystic Disease of the Kidney
Authors: Hanada Toshikatsu , Mimata Hiromitsu , Ohno Hitoshi , Nasu Nobuyoshi , Nakagawa Masayuki , Nomura Yoshio
Published: July 2007

A 49‐year‐old woman had been on hemodialysis for 18 years. She presented with left back pain and macrohematuria. Radiologic studies demonstrated a left renal tumor with acquired cystic disease of the kidney. Her serum erythropoietin (EPO) level was 78.4 U/L despite no history of EPO supplementation. Left radical nephrectomy was performed. Pathologic examination revealed EPO‐producing renal cell carcinoma. After surgery, the patient's serum EPO level decreased markedly to 15.1 U/L. The measurement of serum EPO levels may be useful for detecting and monitoring a recurrence of renal cell carcinoma with acquired cystic disease of the kidney in patients on long‐term hemodialysis.