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Abstract Background The changes over time of the annual incidence of lower urinary tract stones in Japan from 1965 to 1995 were analyzed. Methods Data on lower urinary tract calculi were abstracted from the past three nationwide surveys of urolithiasis, which covered nearly all major hospitals and urologists in Japan and enumerated all outpatient visits diagnosed as urolithiasis in the years 1965, 1975, 1985 and 1995. Chronological changes in the sex- and age-related annual incidences of lower urinary tract stones and stone composition were estimated. Results Lower urinary tract stones were predominant in men 60 years of age or older. Between 1965 and 1995, the annual incidence has significantly decreased in men ≥ 60 years of age from 37.2 to 27.0 per 100 000 and significantly increased in women ≥ 60 years of age from 2.4 to 4.8 per 100 000. In men, an increased proportion of uric acid and calcium stones as well as a decreased frequency of infection stones is a phenomenon common to upper urinary tract stones. However, infection and calcium stones have been two major stone types in women. Conclusions In contrast to upper urinary tract calculi, the incidence of lower urinary tract stones has decreased over the last 30 years in men ≥ 60 years of age predisposed to this disease. [ABSTRACT FROM AUTHOR]

Abstract: Task instructions have traditionally been communicated orally in many fields. However, recently more and more wearable displays, such as the see-through head mounted displays (HMDs) have been developed, and some studies have provided ideas on applying visual instruction using these new interfaces to particular situations. However, in some cases, where instructions are communicated amongst the workers, the data is not sufficient for field workers to choose the best way of communicating instructions depending on the situation. Thus, this study aims to clarify the cases in which it is effective to apply visual instructions with HMDs, and to provide information that suggests the applicability of such visual instructions instead of or in addition to the traditional auditory instructions in different situations. These suggestions will be a useful reference for workers in safety-critical fields, helping them make better decisions about whether, when, and where to introduce the new method of instructions. It will also address some of the unsolved problems in the field, such as errors, low efficiency, and discomfort in communication. [ABSTRACT FROM AUTHOR]

Objective: To examine the antitumor activity of zoledronic acid (ZA) combined with androgen deprivation therapy (ADT) for men with treatment-naive prostate cancer and bone metastasis. Methods: We enrolled 227 men with treatment-naive prostate cancer and bone metastasis. Participants were randomly assigned (1:1 ratio) to receive combined androgen blockade alone (CAB group) or ZA with combined androgen blockade (CZ group). Time to treatment failure (TTTF), time to the first skeletal-related event (TTfSRE), and overall survival (OS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using the Cox proportional hazards model. Median follow-up duration was 41.5 months. Results: Median TTTFs were 12.4 and 9.7 months for the CZ and CAB groups, respectively (HR 0.75; 95 % CI 0.57-1.00; p = 0.051). For men with baseline prostate-specific antigen levels <200 ng/mL, median TTTFs were 23.7 and 9.8 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.35-0.93; p = 0.023). Median TTfSREs were 64.7 and 45.9 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.38-0.88; p = 0.009). OS was similar between the groups. Conclusions: This study failed to demonstrate that combined use of ZA and ADT significantly prolonged TTTF in men with treatment-naive prostate cancer and bone metastasis. However, it generates a new hypothesis that the combined therapy could delay the development of castration resistance in a subgroup of patients with low baseline prostate-specific antigen values <200 ng/mL. The treatment also significantly prolonged TTfSRE but did not affect OS. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the potential suitability of calreticulin (CRT) as a urinary marker for bladder cancer. Methods: Urine specimens were collected from patients with histologically confirmed bladder urothelial carcinoma (Group 1; n = 109), urological patients without urothelial carcinoma (Group 2; n = 60), and non-urological patients (Group 3; n = 40). We developed an enzyme-linked immunosorbent assay (ELISA) procedure using commercially available anti-CRT mono/polyclonal antibodies, and then measured the concentration of urinary CRT. Results: Urinary CRT concentration of group 1 was significantly higher than group 2 and 3 (Mann–Whitney U-test, P < 0.001). Groups 2 and 3 were joined together and considered as a non-bladder cancer group ( n = 100), and a cutoff value (2.85 ng/mL) was determined using receiver operating characteristic (ROC) analysis. The sensitivity, specificity, and the area under the curve were 67.9%, 80.0%, and 0.742, respectively. The overall sensitivity of voided urine cytology (VUC) was 39.0% ( n = 105), and the sensitivity of urinary CRT was significantly superior to VUC (McNemar test, P < 0.001). Higher sensitivity was observed especially in Ta, G1-2, and ≤3 cm tumors. Conclusions: Urinary CRT may be useful for diagnosis of bladder urothelial cancer. However, given that its specificity is relatively low, further evaluation in larger series is needed to define its clinical usefulness. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To retrospectively compare the long-term functional outcomes of ileal and sigmoid orthotopic bladder replacements after radical cystectomy. Methods: From 1990 to 2004, 123 male patients underwent orthotopic neobladder reconstruction after cystectomy; 75 underwent ileal neobladder (IN) and 48 sigmoid neobladder (SN) procedures. The observation period was 12.3 to 151.6 months (median 61.1). The voiding function of each patient was evaluated at three different observation periods: time 1, less than 5 years; time 2, 5 to 10 years; and time 3, more than 10 years after surgery. Results: Almost every SN patient could void without assistance throughout the observation period. In contrast, the rate of spontaneous voiders was significantly low for the IN patients. Daytime continence was significantly worse in the SN than in the IN patients at time 2 (P <0.01), and the difference in nighttime continence between the two groups was even larger during the first 10 years after surgery (P <0.01). The postvoid residual urinary volume at time 2 was significantly larger in the IN than in the SN patients (P <0.01). No significant change in neobladder capacity was observed for either procedure throughout the observation period. The mean serum creatinine level was stable for both groups throughout the follow-up period. Conclusions: The IN and SN procedures result in different outcomes. The rate of spontaneous voiders was better in the SN group than in the IN group. The IN tends to provide better continence than the SN. In choosing a neobladder procedure, a proper understanding of the prospects of voiding functions is required. [Copyright &y& Elsevier]

Aim: We report the 5-year interval change in voiding function of orthotopic ileal neobladder. Methods: Voiding function was evaluated at two points with an interval of 5 years in 49 patients with orthotopic ileal neobladder. The first and second surveys were performed in May, 1998 (1998 survey) and in April 2003 (2003 survey), respectively. Median age at operation was 67 years, ranging 47–77. Median follow-up times at the first and the second surveys were 19.5 months (range, 3–87) and 67.5 months (range, 62–145), respectively. Results: There was no significant change in daytime continence status between the 1998 and 2003 surveys. More than 95% never or only occasionally suffered daytime incontinence in the two surveys. On the other hand, 15 (34.1%) and 14 (31.8%), respectively, experienced night-time incontinence, despite regular voiding during the night. When voiding patterns were analysed, 11 patients (23.4%) sometimes or often performed catheterization because of difficulty in urinating or incomplete emptying of the neobladder in the 1998 survey. Three patients (6.4%) were unable to void and required regular catheterization. In the 2003 survey, however, such poor voiders increased to nine (19.1%), although the difference was not significant. During the study period of 5 years, there was no change in renal function. Conclusions: Continence status, either at daytime or at nighttime, was stable during the study period. The number of the patients who needed regular catheterization tended to increase, suggesting deterioration of voiding function with time. Careful long-term follow up is warranted. [ABSTRACT FROM AUTHOR]

High-dose chemotherapy (HDCT) with peripheral blood stem cell (PBSC) support has been investigated as a first-line treatment in patients with poor risk germ cell cancer. However, effective management of patients with residual cancer after HDCT has not been well addressed, and the outcome in such patients is poor. Here, we report a case of disseminated germ cell cancer successfully treated with intensive conventional chemotherapy after HDCT. A 31-year-old man presented with a bulky mass at the retroperitoneum, which had invaded the lumbar and sacral vertebra, and multiple lung and liver metastases. The patient's serum beta subunit of human chorionic gonadotrophin (β-hCG) was elevated to 2600 IU (cut-off value <0.1 IU). At the time of diagnosis of poor risk germ cell cancer of extragonadal origin, he underwent two cycles of BEP (bleomycin, etoposide, and cisplatin) chemotherapy and PBSC harvest followed by three cycles of HDCT with PBSC transplantation. The liver metastases disappeared. The retroperitoneal bulky mass and multiple lung metastases shrank but were still present, and the serum β-hCG level was not completely normalized. An additional three courses of BEP and five courses of VIP (cisplatin, ifosfamide, etoposide) normalized the β-hCG level. Pathological evaluation of the residual masses revealed no viable cancer cells at either site. The patient is alive without disease recurrence 5 years after completion of chemotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Cutaneous ureterostomy is the simplest and safest method of all permanent urinary diversions. However, the procedure does carry a risk of stomal stenosis. We describe a simple technique for improving tubeless cutaneous ureterostomy. Technical Considerations: Between June 1991 and June 2003, the Toyoda cutaneous ureterostomy was performed in 54 patients (102 renal units) with a minimum of 6 months of follow-up. Since 1998, we introduced a new technique, consisting of fixation between the anterior and posterior rectus sheath by four interrupted sutures to maintain the stability of the abdominal wall tunnel for the ureters. The ureteral patency rate was reviewed. Of the 79 renal units (77.5%) that achieved a tubeless condition, 70 (68.6%) had no hydronephrosis. The catheter-free rate improved from 60.5% (26 of 43 renal units) to 89.8% (53 of 59 renal units) with the introduction of the new surgical stabilization step for the abdominal wall tunnel. Conclusions: This surgical modification is an effective and simple procedure that improves tubeless cutaneous ureterostomy performed with the Toyoda method. [Copyright &y& Elsevier]

The mainstay in the management of invasive bladder cancer continues to be radical cystectomy. With regard to improvement of quality of life, however, therapies that preserve the bladder are desirable. We investigated the use of intravesical PLK-1 small interfering RNA (siRNA) against bladder cancer. Patients with bladder cancers expressing high levels of PLK-1 have a poor prognosis compared with patients with low expression. Using siRNA/cationic liposomes, the expression of endogenous PLK-1 could be suppressed in bladder cancer cells in a time- and dose-dependent manner. As a consequence, PLK-1 functions were disrupted. Inhibition of bipolar spindle formation, accumulation of cycin Bi, reduced cell proliferation, and induction of apoptosis were observed. In order to determine the efficacy of the siRNA/liposomes in vivo, we established an orthotopic mouse model using a LUC-labeled bladder cancer cell line, UM-UC-3LUC. PLK-1 siRNA was successfully transfected into the cells, reduced PLK-1 expression, and prevented the growth of bladder cancer in this mouse model. This is the first demonstration, to our knowledge, of inhibition of cancer growth in the murine bladder by intravesical siRNA/cationic liposomes. We believe intravesical siRNA instillation against bladder cancer will be useful as a therapeutic tool. [ABSTRACT FROM AUTHOR]

The increased risk of several types of cancer in Klinefelter syndrome (47XXY) suggests that the extra X chromosome may be involved in the tumorigenesis associated with this syndrome. Here, we show that cancer cells (PSK-1) derived from a patient with Klinefelter syndrome (47XXY) showing loss of an inactive X chromosome subsequently gained active X chromosomes. We found that this abnormal X chromosome composition in PSK-1 is caused by a loss of an inactive X chromosome followed by multiplication of identical active X chromosomes, not by reactivation of an inactive X chromosome. Furthermore, we extended the characterization of loss-of-inactive X in a series of 22 female-derived cancer cell lines (eight breast cancer cell lines, seven ovarian cancer cell lines, and seven cervical cancer cell lines). The data demonstrate that loss-of-inactive X in the female-derived cancer cells is mainly achieved by loss of an inactive X chromosomes followed by multiplication of an identical active X chromosomes. However, distinctive pathways, including reactivation of an inactive X chromosome, are also involved in the mechanisms for loss-of-inactive X and gain-of-active X in female-derived cancer cells. The biological significance of the loss-of-inactive X and gain-of-active X in the oncogenesis of Klinefelter syndrome and female-derived cancer cells are discussed.Oncogene (2004) 23, 6163-6169. doi:10.1038/sj.onc.1207808 Published online 14 June 2004 [ABSTRACT FROM AUTHOR]

Three patients suffered from renal pelvic, ureteral and bladder cancers that were treated with both standard surgical treatments and two adjuvant cycles of cisplatin-based combination chemotherapy. Metastases of interaortocaval lymph nodes were detected in all patients between 9 and 33 months from the surgery for primary lesions. All patients received three cycles of cisplatin-based combination chemotherapy and retroperitoneal lymph node dissection (RPLND). The chemotherapy achieved partial response (62–98%). Two patients with viable cancer cells died with hepatic metastases; the first 15 months and the second 25 months from the date of diagnosis of distant lymph node metastasis. The third patient, who had no viable cancer cells, remains alive and disease-free 36 months later. Therefore, RPLND after chemotherapy provides prognostic information that helps to define patients who might benefit from additional systemic chemotherapy. [ABSTRACT FROM AUTHOR]

: ObjectivesTo analyze the methylation status and expression profiles of multiple tumor suppressor genes in renal cell carcinoma-derived cell lines. Aberrant promoter methylation is commonly found in human cancers. Nonetheless, it is challenging to demonstrate that methylation of a specific gene results in gene inactivation.: MethodsWe simultaneously analyzed methylation and expression profiles of five putative tumor suppressor genes (p15, p16, Rb, BRCA1, and E-cadherin) in 14 different cell lines using bisulfite genomic sequencing and reverse transcriptase-polymerase chain reaction. We also used multiplex polymerase chain reaction to identify homozygous deletions at the p15 and p16 loci.: ResultsExpression of p16, BRCA1, and E-cadherin was maintained in 4 (29%) of 14 cell lines, regardless of the presence of methylation. Aberrant methylation of p16 was observed in 2 (14%), of BRCA1 in 1 (7%), and of E-cadherin in 9 (64%) of 14 cell lines. Concurrent methylation was observed among p16 and BRCA1 (1 [7%] of 14 cell lines) and among p16 and E-cadherin (1 [7%] of 14 cell lines). We detected homozygous deletion of p16 and p15 in 11 (78%) and 6 (43%) cell lines, respectively.: ConclusionsThe present data shows the presence of methylation does not always contribute to the loss of expression of tumor suppressor genes. Therefore, we must be cautious in interpreting the results of methylation assays—in particular, detection of methylation by nonquantitative methods. The data also demonstrated that multiple tumor suppressor genes are simultaneously inactivated in renal cell carcinoma-derived cell lines by distinctive mechanisms. [Copyright &y& Elsevier]

The family of neurotrophins, encompassing nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3) and neurotrophin-4/5 (NT-4/5), is important in the regulation of neuronal development and function. We examined the expression of neurotrophin messenger RNAs (mRNAs) in the rat urinary bladder during pre- and postnatal development using competitive reverse transcription-polymerase chain reaction. The mRNA levels showed a biphasic pattern of expression; one peak was at prenatal ages (embryonic day (E)15–E18) and the other peak was at postnatal ages (postnatal day (P)14–P28). NT-4/5, BDNF and NGF mRNA levels were greatest at E15, E16 and E18, respectively. In contrast, NT-3 mRNA levels were significantly highest at P14. These data suggest that neurotrophins are involved in the mechanisms of bladder nerve growth for the prenatal period and reorganization of bladder reflex pathways during the second to the fourth postnatal week. [Copyright &y& Elsevier]

We report a case of advanced childhood testicular yolk sac tumor with bone metastasis, which was successfully treated by multimodal treatment. Optimal management of bone metastases from testicular yolk sac tumor in childhood is discussed. [ABSTRACT FROM AUTHOR]

National trend of the incidence of urolithiasis in Japan from 1965 to 1995. Background. A nationwide survey of urolithiasis in Japan was made in order to evaluate the chronological trend of upper urinary tract stones in the Japanese. It succeeded previous studies done in 1955, 1966, 1979, and 1990. Methods. All outpatient visits to urologists that resulted in a diagnosis of first-episode upper urinary tract stones in the years 1990 and 1995 were enumerated, irrespective of admission and treatment. The study enrolled all of the Japanese Board of Urology-approved hospitals, thereby covering nearly all urologists practicing in Japan. The annual incidence by sex and age was estimated and compared with the incidences in the previous nationwide surveys. Results. The age-adjusted annual incidence of first-episode upper urinary tract stones in 1995 was estimated as 68.9 per 100,000 (100.1 in men and 55.4 in women), a steady increase from 54.2 in 1965. The annual incidence has increased in all age groups, except in those of the first three decades. The peak age for both sexes has shifted in toward the older population's direction. Estimations of longitudinal changes between 1965 and 1995 showed that the annual incidence has more than doubled for the cohort of the 1965 census population (from 43.7 in 1965 to 110.9 in 1995) and that younger generations have had progressively higher annual incidences. Conclusions. The annual incidence of upper urinary tract stones in Japan has increased steadily over the past 30 years and will continue to do so in the near future, but it still is lower than in the United States. [ABSTRACT FROM AUTHOR]

AbstractBackground: Orthotopic urinary diversion has become the preferred form of bladder reconstruction after cystectomy. We report on our experience with 66 male patients undergoing this procedure from November 1990 to February 1998. Methods: A neobladder was constructed using an ileal segment with a Hautmann type bladder. Complications were assessed and subdivided into early and late types. Voiding function was evaluated in terms of voiding pattern and continence. Median follow up was 19.5 (range 3.5–87.7) months. Results: There was one (1.5%) perioperative death. The most frequent pouch-related and unrelated early complications were persistent urine leak (7.6%) and prolonged ileus (16.7%), respectively, the majority of cases of which were managed conservatively. Analysis of late complications revealed 6.2% ureteroileal stenosis and 1.5% urethrointestinal stenosis rates, but no case of bladder stone formation. Of the 61 patients in whom voiding function was evaluable, 95.1% achieved excellent daytime continence, while only 67.2% had night-time continence. With regard to posture at voiding, 23 (37.7%) voided in a sitting position. Three of the patients (4.9%) were unable to void and required regular intermittent catheterization. Conclusions: An orthotopic neobladder can be constructed with acceptable morbidity and excellent functional results. We believe that orthotopic urinary diversion offers an attractive alternative to a bladder substitute when cystectomy is required. [ABSTRACT FROM AUTHOR]

Background: Uroplakins (UP), urothelium-specific transmembrane proteins, are present only in urothelia and may be good candidates as tumor markers specific for transitional cell carcinomas (TCC). We investigated the expression of UP-Ia and UP-II genes in the tissues and peripheral blood of patients with TCC. Methods: We investigated UP-Ia and UP-II gene expression in tissues from 12 patients with TCC by reverse transcription–polymerase chain reaction (RT-PCR). HT1197, a TCC cell line, was used as an indicated cell line to assess a detection system for the UP-II gene-expressing cancer cells by nested RT-PCR. We also investigated UP-II gene expression in the peripheral blood of 12 other patients with TCC by nested RT-PCR. Results: Prior to the investigation of UP-Ia and UP-II gene expression, a partial nucleotide sequence of human UP-II gene cDNA was determined to prepare the primers for RT-PCR. Uroplakin genes were expressed in both cancerous and non-cancerous urothelia taken from all patients examined by RT-PCR. The detection sensitivity of our assay showed that one cancer cell could be detected in 5 mL peripheral blood. UP-II gene-expression was detected in the peripheral blood from all three patients with metastatic TCC but not from the nine patients with non-metastatic TCC nor the three healthy volunteers. Conclusions: Uroplakins may be employed as tumor markers for transitional cell cancer, because they are highly conserved and well expressed, not only in non-cancerous cells but also in cancer cells. Furthermore, detection of UP-II gene expression in blood by nested RT-PCR may provide helpful information in the diagnosis and management of TCC. [ABSTRACT FROM AUTHOR]

Presents a study on the association of renal pseudotumor with chronic pachymeningitis. Demonstration of a solitary space-occupying lesion in the left kidney; Revelation of a sclerotic fibrous lesion by pathological examination; Manifestations of multifocal fibrosclerosis.

We report a rare case of stage I non-seminomatous testicular germ cell tumor with malignant transformation. The patient received two cycles of chemotherapy (cisplatin, bleomycin and etoposide) tailored to testicular germ cell tumors as an adjuvant therapy after orchiectomy. However, 22 months later, the patient developed a metastasis in the occipital region that consisted of solely rhabdomyosarcoma through malignant transformation of a teratoma component. This case highlights an issue related to adjuvant chemotherapy for testicular germ cell tumors with components of malignant transformation. [ABSTRACT FROM AUTHOR]

We report a rare case of multiple schwannomas presenting with scrotal mass. In the present case, a scrotal schwannoma developed in a 66-year-old man with a history of brain tumor surgery. Investigating the patient's past history lead to the diagnosis as probable schwannomatosis. Patients with schwannomatosis are at increased risk of developing multiple schwannomas and these patients need regular surveillance. In this regard, the present case highlights the importance of thorough history taking in patients with scrotal schwannoma. [ABSTRACT FROM AUTHOR]

Crossed renal ectopia with fusion is a rare anomaly of the kidney. The present case report describes a 67-year-old man with renal tumor who had been diagnosed as having a crossed ectopic kidney with fusion for 25 years. The pathological diagnosis of the primary tumor specimen was Wilms' tumor with favorable histology. Upon tumor recurrence, molecular detection of SYT-SSX2 fusion transcripts lead to the diagnosis of synovial sarcoma of the kidney. To our knowledge, this is the first case of primary synovial sarcoma arising from a crossed ectopic kidney with fusion. [ABSTRACT FROM AUTHOR]

Renal hypothermia using ice slush for retroperitoneal laparoscopic partial nephrectomy was performed in 2 patients. A cylindrical device was secured in the enlarged port site. Through the device, ice slush was introduced and placed around the kidney. The nadir renal temperature under renal ischemia in the 2 patients was 18.4°C and 25.8°C. [Copyright &y& Elsevier]

Background: A 14-year-old boy was admitted because of lumbago and high fever. Methods/Results: Computed tomography scans revealed psoas, piriformis and gluteal abscesses as well as right iliac vein thrombus. A right femoral venogram demonstrated compression from the psoas abscess and thrombosis of the common iliac vein. Appropriate surgical drainage, administration of antibiotics and anticoagulant therapy were effective in the present case. Conclusions: This is the first report of primary psoas abscess associated with vein thrombosis and is also unique in that abscesses were multiple without predisposing diseases or trauma. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article about tuberculosis in patients with end-stage renal disease undergoing hemodialysis, by Abdelrahman et al.

The mouth of a LapSac was opened horizontally using a guidewire and, thereafter, the kidney was moved onto the center of the mouth. Forceps lifted the mouth and the specimen entered into the sack automatically under its own weight. Use of this technique facilitated kidney entrapment. [Copyright &y& Elsevier]

Torsion of a spermatocele on its pedicle is an extremely rare clinical condition that mimics acute testicular torsion. This rare condition has not been well characterized. Here, we report a case of torsion of a spermatocele. The present case is the 5th case of torsion of a spermatocele and the first report in a patient with a history of scrotal trauma. A tender cystic mass adjacent to the normally appearing testicle in the scrotum is highly significant for the differentiation from other types of acute scrotum. Torsion of a spermatocele should be considered a differential diagnosis of acute scrotum in adolescents and adults.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The incidence of an ectopic ureter in male patients is low. The ectopic ureter in men often ends at the seminal tract in association with renal dysgenesis. Malignant transformation of this closed, nonfunctional urothelial system has been reported only once. To our knowledge, we report the first case of primary transitional cell carcinoma in a single ectopic ureter with a dysplastic kidney that terminated in the ejaculatory duct. [Copyright &y& Elsevier]