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A 54-year-old female underwent open left adrenalectomy for a left adrenal tumor in 2013. The pathology showed metastatic poorly differentiated adenocarcinoma. Despite a close examination, the primary tumor could not be identified. During the follow-up, a computed tomographic scan showed a hyper vascular tumor in the left breast in2015. A left mastectomy was performed for diagnosis and treatment. The pathology showed invasive ductal carcinoma of the breast. Comparing the histopathology and immunohistochemistry of the breast tumor with the adrenal tumor, the adrenal tumor was finally confirmed as metastatic invasive ductal carcinoma. Adrenal gland metastasis from invasive ductal carcinoma is said to be extremely rare. To our knowledge, there have been no reports of cases in which metastatic invasive ductal carcinoma of the adrenal gland was found before the primary site. We report this case with some literature review.

A 67-year-old female, with a past medical history of IgG4-related Mikulicz disease, was referred to our department for a periurethral mass revealed by contrast-enhanced computed tomography. She presented with weak urine flow a half year before the first consultation. Magnetic resonance imaging (MRI) revealed a periurethral mass, 39×39×29 mm, extending from the bladder neck to the urethral meatus. Serum IgG4 level was elevated to 580 mg/dl. Histological examination by the transvasinal biopsy revealed a lymphocytic infiltrate with IgG4-positive plasmacytoid predominance, leading to the diagnosis of IgG4-related disease arising in the periurethra. She was treated with prednisolone for 4 months, and urinary disturbance disappeared. MRI showed that the periurethral mass decreased in size.

A 12-year-old girl was found to have decending colon diverticulum perforation and retroperitoneal abscess on computed tomography (CT) carried out to determine the cause of fever and stomachache. CT-guided drainage tube placement was performed. She was suspected of having MEN2B from her specific facial appearance, Marfan-like body shape and lingual mucosa neuroma. Cervical ultrasonography and serum tumor marker revealed medullary thyroid carcinoma and metastasis to cervical lymph node. Genetic examination revealed a mutation of RET gene codon 918. Therefore, she was diagnosed as having MEN2B. Laboratory data showed elevated urinary catecholamines. Metaiodobenzylguanidine (MIBG) adrenal scintigraphy showed bilateral adrenal uptake and a definitive diagnosis of bilateral adrenal pheochromocytomas was made. Discharge from the drainage tube persisted and it was difficult to continue conservative treatment. Therefore, laparoscopic bilateral adrenalectomy and transverse colon colostomy were performed. Subsequently, total thyroidectomy and cervical lymph node dissection were performed. At five years of follow up, bilateral lung metastases were observed, but the serum calcitonin level was normal and the patient is under observation.

A 55-year-old male was referred to our hospital for left lower back pain. Computer tomography suggested a left ureteral stone and two left renal tumors at ventral and lateral sites. The ventral tumor measured 7 mm, and it showed intense early enhancement. On the other hand, the lateral tumor measured 22 mm, and it was enhanced weakly. We performed a single-stage robot-assisted partial nephrectomy, because he had chronic renal insufficiency and the two tumors appeared to be different types of renal cell carcinoma. Pathological examination revealed the ventral tumor was clear cell renal cell carcinoma, while the lateral tumor was papillary renal cell carcinoma. He is free of recurrence 1 year and 2 months after operation.

We report a case of perivascular epithelioid cell tumor (PEComa) of the uterus associated with tuberous sclerosis complex discovered as a result of intraabdominal bleeding. A 54-year-old woman visited the department of obstetrics and gynecology with chief complaints of genital bleeding and abdominal pain lasting three weeks. Abdominal computed tomography (CT) revealed intraabdominal bleeding from the uterine corpus. She had a history of bilateral renal angiomyolipoma, which was treated with partial bilateral nephrectomy at age 25. Moreover, pulmonary lymphangioleiomyomatosis was diagnosed at age 43. Both conditions were detected by the CT scan during this hospitalization. Immediately after the CT scans, the patient entered a state of hemorrhagic shock, and we performed an emergency simple total hysterectomy. Histopathological examination on the resected specimen yielded a diagnosis of uterine perivascular epithelial cell tumor (PEComa). After making a definitive diagnosis of tuberous sclerosis complex (TSC), systemic evaluation was performed. As a result, multiple skin and intracranial lesions characteristic of TSC were identified and we stated administration of everolimus.

A 62-year-old man had been treated for urethral stricture developed after his right kidney was harvested for donation to his sister 34 years ago. Transurethral biopsy was performed because of positive urinary cytology and squamous cell carcinoma was detected from the site of urethral stricture. The patient with the desire to preserve the penis was referred to our department. Magneticresonanc e imaging showed no evidence of invasion to subepithelial tissue. Re-biopsy from the site of urethral stricture revealed squamous cell carcinoma in situ. Under the diagnosis of urethral carcinoma cTisN0M0, urethrectomy of anterior urethra with perineal urethrostomy was performed. Histopathological diagnosis was squamous cell carcinoma of the urethra pTis and surgical margins were negative. The patient reported complete urinary continence, normal erections and ejaculation from his urethrostomy. He showed no evidence of recurrence at 28 months after surgery.

A 38-year-old man had a right lower retroperitoneal mass found by abdominal echography in a medical examination, and he consulted the internal medicine of Sumitomo Hospital. On the suspicion of malignant lymphoma, he received a laparotomy with biopsy. Pathological examination revealed that the tumor was either benign lymphadenopathy or low-grade malignant lymphoma, and he was follow-up. Two years later, he was introduced to our department because the follow-up computed tomography revealed signs of a tumor and a mass of adjunctive adipose tissue that increased markedly. Thus, we suspected that the tumor was liposarcoma before the operation, and performed retroperitoneal tumor resection. However, we found that the tumor was pathologically a hyaline vascular type of Castleman's disease and the pathological examination showed no malignant cells in the peritumoral adipose tissue. Since Castleman's disease lacks the characteristic symptoms or image findings, the preoperative diagnosis is generally difficult. Cases with growth of the peritumoral adipose tissue are rare, and the differentiation from the liposarcoma is usually difficult. We discussed how to perform the differential diagnosis of Castleman's disease, and especially about the differential diagnosis of liposarcoma.

A 48-year-old female was referred to our hospital for further urological examination of primary amenorrhea. She had been suffering from amenorrhea since 12 years old. Although she had normal female external genitalia, she had a blind-ended vagina with complete absence of the uterus.Laboratory tests showed high testosterone level and the 46 XY karyotype. Thus, our diagnosis was androgen insensivity syndrome. Magnetic resonance imaging showed bilateral intra-abdominal testes. We performed laparoscopic bilateral gonadalectomy. Pathological diagnosis was seminoma in the right gonad. She is free of recurrence 6 months after operation.

Renal angiomyolipoma (AML) and aneurysm are common in tuberous sclerosis complex (TSC) and represent the main causes of morbidity in adults with TSC. Herein, we report a 22-year-old woman with TSC-associated AMLs and renal aneurysms. She was referred to our hospital for the treatment of multiple renal aneurysms larger than 5 mm in diameter. The previous hospital considered that transcatheter arterial embolization (TAE) of bilateral renal aneurysms would cause deterioration of renal function. To estimate the impact of TAE on renal function, we superimposed contrast enhanced computed tomography (CT) over single-photon emission CT (SPECT)-CT. This fusion image, referred to as functional kidney mapping image, revealed the location of renal arteries and aneurysms, and normal renal parenchyma simultaneously. Functional kidney mapping image was useful to distinguish the AML region from the normal renal parenchyma, and revealed that the planned embolization site was a non-functioning parenchyma. Therefore, TAE for her multiple renal aneurysms was successfully performed without deterioration of her renal function.

A 40-year-old man presented to our institution with a few-month history of increased urinary frequency, urgency and voiding difficulty. He had severe lower urinary tract symptoms with an International Prostate Symptom Score of 28 and quality of life score of 6. The mean urinary frequency and voided volume was 20 times per day and 150 ml, respectively. Abdominal ultrasonography and pelvic magnetic resonance imaging revealed the prostate measuring 15 cm3 with a 3 cm midline cyst which compressed the posterior of the bladder wall. A subsequent examination indicated that his lower urinary tract symptoms could be attributed to the cystic mass which mainly affected his storage symptoms. The patient underwent transurethral unroofing of the prostate cyst. Immediately after the surgery, his storage symptoms were improved greatly. The voiding volume was increased to 250 ml, and the frequency of urination was decreased to 8 times. No recurrent symptoms were found for seven months after the surgery.

A 61-year-oldman presentedwith a chief complaint of abdominal pain. Enhancedcomputed tomography andmagnetic resonance imaging showeda left adrenal mass with a diameter of 7 cm with heterogeneous enchancement. He was referredto our hospital for further treatment. No endocrinological abnormality was detected. The tumor showed abnormal uptake on fludeoxyglucose positron emission tomography scan. Preoperative diagnosis was left adrenocortical carcinoma (cT2N0M0). Tumor excision was performedandpathological findings on the resectedspecimen revealedleiomyosarcoma of the left adrenal grand. The patient has been followed up for 16 months with no additional treatment. No evidence of local recurrence or metastasis was seen.

Microscopic subinguinal varicocelectomy has a recurrence of less than 1%, and varicocele recurrence is supposed to be an uncommon post-surgery adverse event. At present, no guidelines exist for the management of recurrent varicoceles after surgery. In this report, we present two cases of post-surgery recurrent varicocele of the testis. Case_1 : A 23-year-old male patient who had undergone microscopic subinguinal varicocelectomy for a grade 3 varicocele was referred to our hospital because of recurrent varicocele. Retrograde venography revealed the persistence of dilated spermatic veins. The former surgeon preserved the dilated vas deferens vein, and this was considered a possible cause of persistence of dilated spermatic veins. The vein considered as vas deferens vein was actually an internal spermatic vein. Case_2 : A 28-year-old male patient complained of recurrence of varicocele two months after the original operation for a grade 3 varicocele. Internal spermatic vessels were slightly visualized on retrograde venography. The possible cause of persistence in this case was insufficient ligation of the internal spermatic vessels. We performed embolization in both cases of recurrent varicocele. Both cases were successfully treated, and there has been no recurrence. Our findings suggest that percutaneous transcatheter embolization of the testicular vein may be effective in the management of postsurgical recurrent varicocele of the testis.

We report a case of nonischemic priapism following brachytherapy. A 63-year-old man presented 22 days after brachytherapy for prostate cancer. He suffered painless sustained incomplete erection for a few days. The patient was diagnosed with nonischemic priapism by cavernosal blood gas analysis. Right internal pudendal arteriography showed blood pooling in the cavernosum caused by arteriovenous fistula. Selective arterial embolization with gelatin sponge particles was performed and detumescence achieved. To our knowledge,this is the first case of high flow priapism caused by brachytherapy for prostate cancer. In addition,we reviewed the mechanism of high flow priapism.

We report a case of recurrent renal cancer in the autografted kidney, treated with percutaneous cryoablation. A 59-year-old man who had bilateral renal tumors underwent radical left nephrectomy, ex vivo right partial nephrectomy and auto-transplantation at the right ileal fossa in our hospital 11 years ago. Histopathological examination showed clear cell renal cell carcinoma in bilateral kidneys (pT1bN0M0). He had been followed at another hospital without tumor recurrence for 11 years. In 2014, an enhanced CT scan revealed a renal tumor with a diameter of two centimeters in the autografted kidney, which was thought to be a recurrence of the initial renal cancer. He was referred to our hospital for further evaluation and treatment. He underwent percutaneous renal tumor biopsy, which confirmed renal cancer recurrence, followed by percutaneous cryoablation. Three months after cryoablation, an enhanced CT showed that the enhancement lesion in the autografted kidney had disappeared, and these findings were confirmed pathologically by absence of malignancy by a subsequent needle biopsy. The level of serum creatinine (sCr) was 1.16 md/dl immediately before cryoablation and 1.46 mg/dl at three months after cryoablation. Nine months after cryoablation, the patient had no reccurence and renal function was stable (sCr 1.43 mg/dl).

A 63-year-old male with a past history of left nephrectomy due to clear cell renal cell carcinoma at the age of 57 was admitted for further evaluation. Enhanced abdominal computed tomography revealed that there were several hypervascular tumors in the pancreas and a single hypervascular tumor in the gallbladder. Laparoscopic cholecystectomy was performed to obtain pathological diagnosis. Microscopically, the tumor in the gallbladder was filled with clear cells and was diagnosed as metastatic gallbladder cancer from the previous clear cell renal cell carcinoma. Metastatic renal cell carcinoma to the gallbladder is extremely rare, with reported frequencies of less than 0. 6% in 687 autopsies. We herein report a case in which cholecystectomy enabled a successful diagnosis and review the reported 22 cases in Japanese patients.

We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the possibility of sigmoid colon cancer. Eleven days after hospitalization, bilateral scrotal contents had swollen rapidly to the size of a goose egg. CT suggested urethral fistula with scrotal abscess formation. Drainage of scrotal abscess and colostomy were performed. Intraoperatively, the fistula of the bulbar urethra was revealed. Because increased serum CA19-9 suggested a diagnosis of sigmoid colon cancer, cystectomy and sigmoid colectomy with right nephrectomy were performed. Pathological examination revealed adenocarcinoma of sigmoid colon with bladder invasion. His condition was improved with rehabilitation 6 months after operation.

A 46-year-old man was found to have a mass in the pelvic cavity on computed tomography (CT) carried out for an examination for lower abdominal pain. Abdominal magnetic resonance imaging showed a mass which appeared to have hyposignals on both T1- and T2-weighted images. A positron emission tomography CT showed that the mass had a low maximum standardized uptake value (＝1.4). Biopsy of the mass showed tumoral cells demonstrating a 'patternless pattern' characterized by a haphazard, storiform arrangement of short spindle or ovoid cells. Immunohistochemistry disclosed CD34 positivity and desmin and alfa-smooth muscle actin (SMA) negativity which supported the diagnosis of solitary fibrous tumor. Tumorectomy was performed. Grossly, the tumor was a large encapsulated mass with well limited margins weighing 67.7 g. Histology revealed a mass with no necrotic or hemorrhagic degeneration. On immunohistochemistry, the tumor cells were strongly positive for CD34 and they were negative for desmin and alfa-SMA. At six months of follow up, the patient was well and he had no signs of recurrence.

A 53-year-old man presented to our hospital with a few-month history of fatigue and anorexia. His aging male's symptoms (AMS) score was 57, and the free testosterone value was low (6.5 pg/ml). He was diagnosed with severe late-onset hypogonadism indicative of androgen replacement therapy (ART). His serum prostate specific antigen was 8.7 ng/ml, and pelvic magnetic resonance imaging showed a low intensity area in the peripheral zone of the prostate. A systematic 10-core prostate biopsy revealed one core of adenocarcinoma with a Gleason score of 3 + 3=6. Imaging examination revealed organ-confined prostate cancer that was cT2aN0M0. Given his desire for ART for the treatment of hypogonadism, the patient underwent open radical prostatectomy. Pathologic examination demonstrated prostate adenocarcinoma that was pT2aN0, and Gleason score of 3 + 3=6. After confirming that the prostate specific antigen value was under 0.01 ng/ml for three years after prostatectomy, the patient received 125 mg methyltestosterone monthly. His hypogonadism-related symptoms diminished and AMS score dropped to 48. During a three-year follow-up of ART, no biochemical recurrence was found.

A 67-year-old man visited an urological clinic with a chief complaint of urination pain. Cystourethroscopy and magnetic resonance imaging (MRI) examination revealed a bladder tumor (cT3bN0M0). Marked leukocytosis and respiratory distress with pleural effusion appeared. Pulse steroid therapy improved the general condition partially. The patient was sent to our hospital for further examination. Serum granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6) were high and the pathological findings of bladder tumor obtained by transurethral resection (TUR) revealed an urothelial carcinoma that produced G-CSF and IL-6. Neoadjuvant systemic chemotherapy was performed along with use of steroid and sivelestat, which ameliorated the respiratory distress. After three courses of systemic chemotherapy, serum G-CSF and IL-6 normalized and cystoprostatectomy was performed. The patient has been in good health at 20 months after the surgery with no evidence of recurrence.

A 70-year-old man visited a urological clinic with a chief complaint of pollakiuria, which was refractory to various medications. Pelvic magnetic resonance imaging (MRI) revealed a mass 6 cm in diameter immediately next to the left side of the bladder. The patient was referred to our hospital for further examination. Since he had a past history of neurofibroma of cauda equina, we suspected neurofibromatosis type 1. (18)Fluorodeoxyglucose (FDG)-positron emission tomography (PET) demonstrated a high accumulation of FDG in the pelvic mass. Under a diagnosis of neurogenic tumor, surgery was performed. As an examination of frozen section during the surgery led us to suspect a sarcoma, the tumor was excised radically. The pathological examination demonstrated diffuse large B cell lymphoma.

A 79-year-old man presented with a mass lesion under the left kidney that was revealed by abdominal ultrasonography. The retroperitoneal tumor was removed by transabdominal exploration. Histopathological diagnosis was a leiomyosarcoma. Seven years after the first operation, he presented with left flank pain. Computed tomography showed a mass lesion in the abdominal wall. Tumor resection was performed. The pathological diagnosis was recurrence of leiomyosarcoma. The patient remains free from disease recurrence 1 year after the second surgery.

A 20-year-old woman referred to our hospital for further examination of primary amenorrhea with high levels of testosterone (998 ng/ml). Inspite of having normal female external genitalia, she had 5 cm deep blind-ending vagina, absence of uterus and ovaries with the karyotype of 46,XY. Abdominal magnetic resonance imaging localized bilateral intra abdominal structures, which indicated bilateral testes. Thus, she was diagnosed with androgen insensitivity syndrome(AIS) based on both clinical and karyotypic evidence. She underwent laparoscopic bilateral gonadalectomy through a single incision at the navel and histological examination showed intratubular germ cell neoplasia (ITGCN). Her postoperative course was uneventful with less pain and a small surgical wound was only at the navel. Laparoendoscopic single site surgery (LESS) can be considered a surgical procedure for gonadalectomy in AIS patients.

A case of retrocaval ureter associated with right ureteral tumor in a 70-year-old male is reported. The diagnosis was confirmed by CT and RP. Retroperitoneoscopic nephroureterectomy was performed. The histology of the tumor was urethelial carcinoma. After 20 months, there was neither evidence of recurrence nor metastasis. To our knowledge, this is the 11th case of retrocaval ureter associated with upper urinary tract tumors.

Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominant disorder characterized by an excess of extracolonic malignancies including those of the urinary tract. We report two cases of bladder tumor associated with HNPCC. The reported cases were compatible for Amsterdam criteria II for HNPCC. It is important to obtain a family history of cancer in patients with urothelial carcinoma. A patient with a strongly positive cancer history must be carefully examined for HNPCC and HNPCC associated cancers.

A 60-year-old woman presented at another hospital with a complaint of voiding difficulty. She had had left nephrectomy and bladder augmentation using the sigmoid colon for treatment of urinary tract tuberculosis 38 years ago. Left ovarian tumor was found by computed tomography and she was referred to our hospital. Another tumor which involved the uterus, bladder, and urethra was revealed by magnetic resonance imaging. An anterior pelvic exenteration was performed with preoperative diagnosis of left ovarian cancer with peritoneal dissemination. Histopathological examination revealed a clear cell adenocarcinoma of the left ovary and a sigmoid cancer arising in the augmented bladder. The sigmoid cancer arose from the anastomotic site between the bladder and sigmoid segment. This is the 34th case of neoplasms following augmentation enterocystoplasty reported in Japan.

A 76-year-old female presented with edema in the bilateral lower legs and computed tomography (CT) subsequently revealed a tumor under the right side of the kidney that extended to the inferior vena cava. Under suspicion of a right renal sarcoma or malignant teratoma, we performed a right nephrectomy and tumor thrombectomy. Histopathological features of the resected specimen were compatible with a leiomyosarcoma originating from either extrarenal blood vessels or muscle fibers of the renal pelvis. Immunohistological findings showed that the tumor cells were spindle-shaped, arranged in bundles, and stained positive for α-smooth muscle actin and desmin. The patient was free from recurrence 10 months after surgery. The prognosis of patients with a renal leiomyosarcoma with venous thrombus has been considered to be poor. Herein, we provide details of our case and conclude that radical tumor resection is necessary for a long-term cure.

A 67-year-old man had undergone a right ureteronephrectomy because of a right ureter tumor, but the pathological diagnosis was inflammatory tissue with plasma cells, lymphocytes, and fibrosis. About 3 years later, abdominal computed tomography (CT) revealed a solid tumor at the left renal hilus. We resected the tumor and the pathological diagnosis was the same as before. More than 2 years later, because of elevated pancreatic enzymes, immunoglobulin G (IgG) and IgG4, more detailed examinations ware done, and he was diagnosed with IgG4-related autoimmune pancreatitis. We believe that the retroperitoneal tumor was retroperitoneal fibrosis associated with IgG4-related sclerosing disease. Now, he is being treated with steroid therapy. IgG4-related sclerosing disease is a systemic disease whose concept is now being established. Much more work is needed to understand this disease.

We report a case of bladder cancer with pelvic lymph node metastasis effectively treated by chemotherapy followed by radiotherapy. The patient was a 65-year-old man who had undergone radical cystectomy. Histological findings showed urothelial carcinoma, G3 > G2, pT1b. After 31 months, computerized tomography (CT) revealed a bulky tumor (7.0 x 5.6 cm) along the left pelvic wall, indicating pelvic lymph node metastasis. Five courses of chemotherapy consisting of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) was performed. The size of the tumor was reduced to 1.5 x 1.0 cm. Then, external beam radiotherapy (50 Gy) was added to the residual tumor. He has been alive with no evidence of disease progression for 31 months since the radiotherapy.

A 14-year-old girl was referred to our hospital for examination of a right adrenal tumor, incidentally found by abdominal ultrasound sonography. Computed tomographic scan and magnetic resonance imaging showed a 44 x 20 mm solid tumor in the right adrenal region. Endocrinological examination were within normal limits except for slightly increased serum aldosterone. Laparoscopic adrenalectomy was performed and the tumor was histologically diagnosed as ganglioneuroma originated from the right adrenal medulla.

We present a 60-year-old female who underwent living unrelated renal transplantation from her 62-year-old husband. The primary immunosuppression consisted of tacrolimus, mycophenolate mofetil and steroid. We did not recognize any rejection in a histopathological study. The total ischemic time to carry out anastomosis of the two renal arteries was 121 minutes. After hemodialysis 5 times for acute tubular necrosis, her renal function improved. She was discharged on the 33rd postoperative day when her serum cretinine level was 1.0 mg/dl. The graft function was stable at 6 months after transplantation. We discussed living unrelated renal transplantation in the elderly population in Japan.

A 46-year-old man had undergone radical high orchiectomy because of a tumor of the right spermatic cord. Pathological diagnosis was atypical lipomatous tumor. Six years later, he had asymptomatic swelling in his right groin. Local recurrence was suspected, and surgical resection of the tumor with a sufficient surgical margin was performed. Pathological diagnosis was well-differentiated liposarcoma, sclerosing type. Ten cases of recurrent spermatic cord liposarcoma, including the present case, have been reported in Japan. Because of the possibility of local recurrence, spermatic cord liposarcoma needs strict and long-term follow up.

A 39-year-old man whose chief complaints were general fatigue and bloody phlegm was diagnosed with testicular cancer and underwent left high orchiectomy at an affiliated hospital. The histopathologic diagnosis was chorio carcinoma. Several imaging examinations revealed the metastases in the lung, liver, brain, stomach, kidneys and skin. In spite of various chemotherapies, he died 17 months after the operation. Skin metastasis of testicular cancer is very rare and this is the twelfth case reported in the world, to our knowledge. The significance of skin metastasis in testicular cancer is discussed.

Two cases of ureteral polyp resected by a transurethral approach are presented. Case 1: A 70-year-old woman was referred to our clinic because of hydronephrosis incidentally found. Excretory urography demonstrated a filling defect with a long and round smooth contour in the left lower ureter without hydroureter. Urine cytology was negative for malignant cells. Under the clinical diagnosis of left ureteral polyp, polyp was resected transurethrally. The pathological diagnosis was fibroepithelial polyp. Case 2: A 59-year-old woman was referred to our clinic with a chief complaint of macroscopic hematuria. Excretory urography revealed a filling defect with a long and round smooth contour in the left upper ureter. Because urine cytology was negative for malignant cells, left ureteral polyp was suspected. After the operation by tranthurethral approach, the pathological diagnosis was fibroepithelial polyp. No intraoperative complication was observed in either case. Ureteral polyps resected by a transurethral approach are relatively rare. We reviewed and discussed 46 cases of ureteral polyp resected transurethrally, reported in Japan including our two cases.

Clear cell adenocarcinoma of the female urethra is extremely rare. We herein describe the 33rd case of clear cell adenocarcinoma of the female urethra in Japan. A 54-year-old female who presented with pollakisuria was referred to our department. Transvaginal examination showed a walnut-sized firm mass on the anterior vaginal wall. Computed tomography, magnetic resonance imaging (MRI), cystourethroscopy and the histopathological findings of the biopsied specimen revealed adenocarcinoma of the urethra. Anterior pelvic exenteration and ileal conduit urinary diversion were performed and the final pathological diagnosis was clear cell adenocarcinoma of the urethra, pT3, pN2. No further adjuvant therapy was conducted. She remains alive 6 months after surgery in spite of paraaortic and inguinal lymph node metastases.

A 78-year-old woman had disregarded pneumaturia since April 1998. In March 1999, computed tomography and barium enema were done to examine anemia and positive fecal occult blood, revealing a left renocolic fistula and bilateral renal stones. Intravenous pyelography revealed a left staghorn calculus, non-functioning kidney, and right partial staghorn calculus. Urinalysis showed pyuria and the culture grew Proteus vulgaris and Klebsiella oxytoca. Smear and culture of the urine were negative for acid-fast bacilli. In consideration of the patient's age and conservation of right renal function, right pyelolithotomy was performed first. Three weeks later, left nephrectomy and partial colectomy were done. The postoperative course was uneventful. A renocolic fistula is relatively rare and to our knowledge there have been 37 cases reported in Japan, including our case. Surgery is the main therapy and was performed in 31 patients. Among them, surgery was not curative in 1 and 5 died of postoperative complications. Thus, surgery is not safe in all cases. However, despite her age and bilateral renal dysfunction, our patient was successfully operated on.

A retrospective study was conducted on the duration of pyuria after transurethral resection of the prostate (TURP) and the factors affecting the duration in 273 patients, who were diagnosed as having benign prostatic hyperplasia (BPH) with postoperative resolution of pyuria among those who underwent TURP over the last ten years at our clinic. In the 273 patients, the mean (+/- SD) weight of the resected prostate was 13.2 +/- 10.2 g (range : 1-52 g), the mean operating time was 74.3 +/- 29.8 min (25-215 min), the duration of pyuria was 110.6 +/- 38.3 days (23-273 days), and the resected weight to operating time ratio was 0.172 +/- 0.093 g/min (0.018-0.500 g/min). There was a significant correlation between the duration of pyuria and the patient's age, resected weight, operating time, or resected weight/operating time ratio, resected weight being the most important factor. The surgeon, the postoperative antibiotics used, and the preoperative existence of pyuria did not have any significant effect on the duration of postoperative pyuria. Investigation after stratification by the resected weight in 10 g increments suggested that a shorter operating time was important to reduce the duration of postoperative pyuria, particularly in BPH patients with a resected weight of 20-29 g.

Accumulation in the tumor of the RCS-1 monoclonal antibody, which recognizes the cell surface antigen of renal cancer cells was examined. The antibody purified by affinity chromatography (protein-A column) and gel fractionation was labeled with technetium-99m (99mTc) by a direct method. High labeling efficiency (> 98%) could be routinely obtained. However, the 99mTc labeling of the antibody did not reduce the reactivity of the RCS-1 antibody. The labeled antibody was injected into nude mice transplanted with human renal and gastric tumors, and the accumulation of the antibody in each tumor and various tissues was compared at 48 hours after injection. The highest accumulation of radiolabeled RCS-1 antibody was observed in the AM-RC-3 renal tumors; at 8.0% of the injected dose per gram and a tumor-to-blood ratio of 1.05, respectively. However, the radiolabeled RCS-1, did not show specific accumulation in the gastric tumor nor in any tissues tested. The xenografted tumor, AM-RC-3 was successfully visualized with the radiolabeled RCS-1 antibody by scintigraphy.

Twenty-four patients suffering from prostate hyperplasia were given venous injections of CDZM of either 1 or 2 g at specific intervals (30 min, 1, 2 and 4 hr) before surgery. Blood samples from the injected vein and tissue samples from the prostate were subsequently taken. In this study, the concentrations of CDZM in the prostate tissue (P) and in serum (S), as well as the ratio of the tissue to serum concentrations (P/S) were determined. In patients given 1 g injections, P ranged from 5.26-48.10 micrograms/g, while S ranged from 25.40-130.00 micrograms/ml and P/S ranged from 12.6-37.0%. In the patients given 2 g injections, P ranged from 9.40-49.20 micrograms/g, S ranged from 62.30-234.00 micrograms/ml and P/S ranged from 9.3-29.1%. CDZM exhibited excellent transmigration to the prostate tissue. Inflammatory bacteria present in prostatitis and urinary tract infections are generally those of E. coli, Proteus sp., but because the P range was much higher than the ratio of MIC, CDZM is expected to be useful against infections in the field of urology.

Previously, we reported the effects of human lymphoblastoid interferon (HLBI), using a transplantable human renal cell carcinoma strain (AM-RC-3) in nude mice established in our laboratory. An overall anticancer effect was found from its combination with UFT (Ft-207t uracil). In the present investigation, we examined the clinical effectiveness when HLBI was administered alone or in combination with UFT to the patients. Seventy-three patients who had undergone curative surgery were divided into 3 groups, according to the type of adjuvant therapy. The HLBI group consisted of 38 patients, including those administered the agent alone over 50 times for more than six months, and or those to whom it was given in combination with UFT. The second group of 23 patients had been treated with hormones, radiotherapy, or with an anticancer drug (Fluoride pyrimidine group), while the last group of 17 patients underwent no postoperative adjuvant therapy. The survival rate calculated by the Kaplan-Meier method revealed no significant effects of HLBI on the survival period, but a significant difference (p < 0.05) was found in the HLBI group compared to the other groups in terms of much higher non-recurrence rate. When HLBI was administered alone or in combination with UFT, a definite anticancer effect was seen in 6 (complete response 3, partial response 2, minor response (MR) 1, no change 5, progression of disease 14) of the 25 treated patients. Fourteen of the 25, treated patients had postoperative recurrence, and 11 patients had distant metastases, at the time of diagnosis which were considered to be progressive and measurable lesions. In 6 patients the response was better than MR, with the effective rate being 24%. Four of the 6 patients had received HLBI in combination with UFT, which suggests a clinical effect in this combination. However, the effectiveness was limited to the lung lesions, more effective treatment of the lesions in other sites is required.

Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.

Sultamicillin, a new semisynthetic oral beta-lactam antibiotic, was evaluated for its antibacteria susceptibility and clinical efficacy against urinary tract infection (UTI), and the following results were obtained. The sensitivity of sultamicillin (SBTPC) on 518 strains of clinical isolates from the urine were tested and compared to ampicillin (ABPC). S. aureus, S. epidermidis, Enterococcus sp., Streptococcus sp., E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, M. morganii and Acinetobacter sp. showed high sensitivity to SBTPC. The antibacterial activity of SBTPC was superior to that of ABPC in most strains and especially more superior in beta-lactamase producing strains. The clinical effectiveness rate on a total of 15 patients with acute uncomplicated cystitis was 93.3% and the eradication rate of causative organisms was 93.3%. On 15 patients with chronic complicated UTI, the clinical effectiveness rate was 73.3% and eradication rate was 76.5%. Side effects (diarrhea) were observed in 3 cases, but this symptom was not severe and soon disappeared. Abnormal laboratory data due to the drug were not observed.

Fifty six patients with transitional cell carcinoma of the urinary bladder were treated by total cystectomy from January, 1979 through December, 1988. A retrospective study was conducted on 52 patients on whom prognosis could be followed up. There were 40 men and 12 women (male to female ratio: 3.3: 1), between 32 and 79 years old (mean age, 64.1 years old). The overall 1-, 3- and 5-year survival rates were 65.8%, 54.1% and 43.0%, respectively. The 5-year survival rates for patients with low grade (G, I, II) and high grade (G. III) were 41.9% and 42.7%, respectively: with no significant difference in the survival curves between the two groups. The 5-year survival rates according to histopathological stage were 78.9% for patients in low stage, 24.7% in high stage, and the difference in the survival curves between the two groups was statistically significant (P less than 0.001). The mortality in the 21 cases of the 33 high stage cases in which cisplatin was used was 42.9%, with 3- and 5-year survival rates were 53.1% and 36.8%, respectively. In the remaining 12 cases in which cisplatin was not used for post-operative chemotherapy, the mortality in the 12 cases was 83.3%, with 3- and 5-year survival rates of 25.1% and 12.3%, respectively. Thus, the patients who received post-operative chemotherapy showed a better survival rate than those who did not with a significant difference (P less than 0.05). The results of the present study suggest the usefulness of post-operative adjuvant chemotherapy in the high stage case.

A total of 518 bacterial strains isolated from the urine of patients with various urological diseases in our Urological Department between November, 1987 and February, 1989 were studied for their beta-lactamase production and susceptibility to various antimicrobial agents was determined. beta-lactamase activity was determined by the acidometry disc method. There were 241 gram-positive cocci, 276 of gram-negative rods and 1 Neisseria gonorrhoeae. Thirty-four percent of the gram positive and 76.3% of gram negative rods produced beta-lactamase. S. aureus (81.3%), S. epidermidis (65.1%) in gram-positive cocci, E. cloacae (100%), S. marcescens (100%), C. freundii (100%), P. aeruginosa (97.2%), P. Rettgeri (88.9%), E. gergoviae (85.7%), K. oxytoca (84.6%), M. morganii (81.8%) and E. coli (69.0%) in gram-negative rods produced beta-lactamase at a higher rate. beta-lactamase produced by gram-positive cocci was entirely penicillinase, and that produced by gram-negative rods only penicillinase in 4.0%, only cephalosporinase in 44.2% and both in 25.4%. In S. aureus and S. epidermidis, the isolated rate of strains resistant to ampicillin (p less than 0.01) and piperacillin (p less than 0.05) in the beta-lactamase producing strains was significantly higher than that in the beta-lactamase non-producing strains. In E. coli, the isolation rate of strains resistant to ampicillin and piperacillin in the penicillinase-producing strains was significantly higher than in the penicillinase non-producing strains (p less than 0.01). But both cephalosporinase-producing strains and beta-lactamase non-producing strains showed high susceptibility to cephalothin. These results suggest that the penicillinase might present a clinical problem in the treatment of urinary tract infections by S. aureus, S. epidermidis and E. coli.

The tumor line in nude mice is one of the most important experimental animal models for oncodevelopmental studies. We implanted a human ureteral tumor into nude mice, established the tumor line, AM-UT-1, and maintained it by serial transplantation. The characteristics of this tumor line in nude mice are reported. Histologically, the original tumor was a transitional cell carcinoma (grade II, stage B). The transplanted tumor grew locally and had a constant growth pattern during serial passage until the 13th passage in nude recipients and maintained the basic histological, immunohistochemical findings of the original tumor. Both original tumor and serial transplanted tumor had carcinoembryonic antigen (CEA)-producing activity. A high level of serum CEA was also recognized in nude mice.

Statistical studies were performed on bacterial strains isolated from the urine of patients with various urological disease in our Urological Department between January, 1983 and December, 1987. In 1987, sensitivity tests of antibiotics to various pathogens were carried out. From the outpatients, 5,725 bacterial strains were isolated. S. epidermidis was isolated most frequently (23.8%), followed by Enterococcus species (16.5%), E. coli (14.7%), Streptococcus species (12.6%), Proteus species (5.3%), other GNR (4.6%), P, aeruginosa (4.5%), Klebsiella species (4.4%), and others. From the inpatients, 4,747 bacterial strains were isolated. Enterococcus species was isolated most frequently (23.1%), followed by S. epidermidis (18.7%), Fungi (12.9%), P. aeruginosa (8.0%), other GNR (6.8%), Streptococcus species (5.4%), Enterobacter species (4.8%), E. coli (4.1%), S. aureus (4.1%) and others. Annual change of distribution of organisms indicated that S. aureus from outpatients had a tendency to increase and Streptococcus species had a tendency to decrease. Whereas from inpatients, E. coli, other GNR, Pseudomonas species and Enterobacter species had a tendency to increase, and Streptococcus species, P. aeruginosa, Proteus species and Klebsiella species had a tendency to decrease. S. epidermidis showed a high sensitivity to minocycline and cephalothin, and Enterococcus showed a high sensitivity to ampicillin and minocycline, but did not show good sensitivity to cefoperazone and latamoxef. E. coli showed a high sensitivity to all drug we tested. P. aeruginosa showed a high sensitivity to gentamycin and norflaxacin, but did not show good sensitivity to other many drugs we tested.

Thomsen Friedenreich antigen (T-ag), ABH isoantigen (ABH-ag) in 106 cases with bladder tumor (all transitional cell carcinoma) of various histological grades and stages were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method. There was a correlation between histological grade, stage and deletion of the antigenicity (T-ag and ABH-ag). In a follow-up study of 45 patients with low grade and low stage tumor, the recurrence rate after surgery of the cases with abnormal antigenicity (T-ag and ABH-ag) was significantly higher than that of the cases with the normal antigenicity. Combination of two markers (T-ag and ABH-ag) was significantly more effective than the single marker.

A 67-year-old man was admitted for complaint of gross hematuria on April 9, 1986. Cytoscopic examination was revealed broad-base tumor, its size was thumb's head, at the right lateral wall of the bladder. Ultrasonography and computed tomographic scan of the bladder demonstrated no evidence of invasion to adjacent organs. The biopsy showed signet-ring cell carcinoma. Radiography of the digestive organs showed no abnormality. A partial cystectomy was performed. Histologically the tumor was limited up to submucosa, that is pT1b. The localization of carcinoembryonic antigen (CEA) on tissue of our case, using the peroxidase-antiperoxidase (PAP) method, was evidenced.

The clinical effectiveness and safety of T-2588 were evaluated in 21 patients with complicated urinary tract infections. Six hundred mg of T-2588 per day was administered orally in three divided doses for 14 days. The results were excellent in 7 cases (33.3%), moderate in 8 cases (38.1%) and poor in 6 cases (28.6%), and the effectiveness rate was 71.4%. The effectiveness rates of the single infection group and mixed infection group were 91.7% and 44.4%, respectively. The overall bacteriological eradication rate obtained was 77.1%, and those of gram-positive cocci and gram-negative rods were 62.5% and 81.5%, respectively. None of the 21 cases, had any significant side effects and abnormal laboratory findings. From the above results, T-2588 is considered to be a useful antibiotic in the treatment of complicated urinary tract infections.

ABH-isoantigen (ABH-Ag) and Thomsen-Friedenreich antigen (T-Ag) were investigated by the Avidin-Biotin-Peroxidase Complex (ABC) method on 47 patients with epithelial tumor of the upper urinary tract (all patients underwent nephroureterectomy including the cuff of the bladder; 30 patients were diagnosed as transitional cell carcinoma of renal pelvis and 17 ureteral organs). The correlations between ABC expression for ABH-Ag and T-Ag with histological grade, stage and prognosis (5 year survival rate) were studied. A correlation was observed between grade (p less than 0.05) and deletion of the antigenicity of ABH-Ag, but no correlation was evident with stage and prognosis. A high correlation was evident, however, between grade (p less than 0.01), stage (p less than 0.01) and prognosis (p less than 0.01) and deletion of the antigenicity of T-Ag. The analysis of ABC expression for ABH-Ag and T-Ag may therefore be valuable for predicting the malignant potential in transitional cell carcinoma of the upper urinary tract. T-Ag determination in particular may provide a useful prognostic probe should it find clinical application.

ABH isoantigens in 82 cases with bladder tumor of various grades and stages were investigated by the avidin-biotin-peroxidase complex (ABC) method. Correlation of ABC expression for isoantigens with pathological findings on the grading and staging system of the bladder tumors were as follow: Of 60 cases of low grade tumors, 34 (56.7%) were positive and of 22 cases of high grade tumors, 21 (95.5%) were negative. Of 63 cases of low stage tumors, 35 (55.6%) were positive and all 19 cases of high stage tumors, (100%) were negative. The isoantigens in the tissue of the bladder tumors tended to disappear as the histologic anaplasia of the tumor progressed. There was a high correlation between the histological grade, stage and ABC expression (p less than 0.01). In a follow-up study of 38 patients with low grade, low stage, initial transitional cell carcinoma, 9 of the 24 patients positive for ABC expression (37.5%) showed recurrence during the 1 to 6 year follow-up period, whereas 10 of the 14 patients negative for ABC expression 10 (71.4%) did. There was a high correlation between the recurrence rate and ABC expression (p less than 0.05). Therefore, the analysis in the bladder tumors may be valuable for prediction of malignant potential, especially for the low grade, low stage tumors.