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A 59-year-old male with a complaint of gross hematuria was found to have a pedunculated and non-papillary tumor on the prostatic urethra. The tumor was resected transurethrally. The pathological finding was inverted papilloma. Although the majority of the cases of inverted papilloma have been found in the bladder, we reported the 32nd case located on the prostatic urethra in Japan.

A 68-year-old male was admitted to our hospital with the complaint of left painless mass of extratesticular scrotal content. Laboratory examinations were unremarkable. The tumor was resected by operation. The removed specimen was solid, 15 x 15 x 20 mm in size. Histopathological findings revealed leiomyoma. Other cases from the Japanese publications, together with our case, are reviewed.

A 74-year-old man was admitted for asymptomatic macroscopic hematuria. He had undergone transurethral resection of bladder tumor (TURBT) due to transitional cell carcinoma 30 years ago. Pelvic CT showed two invasive bladder tumors. A 5 cm tumor was on the dome and a 1 cm tumor was on the left lateral wall. TURBT was performed. Pathological examination revealed that they were leiomyosarcoma and transitional cell carcinoma. Radical cystectomy plus bilateral cutaneousureterostomy was performed. He died of lung metastases and local recurrence after 6 months.

We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1,700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.

We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.

A 61-year-old woman, who had undergone total right pneumonectomy 22 months before due to lung cancer (adenosquamous cell carcinoma) was admitted for macroscopic hematuria. Abdominal CT showed two renal tumors in the right kidney. Right radical nephrectomy was performed, because no imaging study showed any other metastasis. Pathological examination revealed adenosquamous cell carcinoma, which was the same pathology as the lung cancer had been. She died of the left lung metastasis 24 months after right radical nephrectomy. Her prognosis was thought to have been prolonged by the operation of right radical nephrectomy.

A 37-year-old man was admitted with a painful mass in his left inguinal region. He had an undescended testis on the left side. Six months earlier, he had noted that his left inguinal testis was larger, and he had suddenly developed pain in the left inguinal region. The levels of AFP, hCG beta and LDH were normal. We diagnosed a left undescended testicular tumor and torsion of the left testis. Left inguinal high orchiectomy showed a torsion of the left testis and histopathological examination of the specimen revealed seminoma.

A 14-year-old male patient was admitted with the chief complaint of macroscopic hematuria. Abdominal ultrasonography demonstrated a tumor of the anterior wall of the bladder. Further, cystoscopic examination confirmed a papillary tumor. Transurethral resection of the bladder tumor was performed. Histopathology of the excised tumor showed transitional cell carcinoma (G1, pTa). Recurrence has not been observed for 9 months postoperatively.

A 72-year-old male was admitted with a chief complaint of anuria. Clinical examinations showed that he was in uremic state and had bilateral hydronephroses. An endoscopic examination revealed a left ureteral tumor and a bladder tumor. Left nephroureterectomy with partial cystectomy and transurethral resection of the bladder tumor were performed. Pathological examinations showed an invasive left renal pelvic tumor (pT3, G3), an invasive left ureteral tumor (pT4, G3), and a bladder tumor (pTis, G3). Following the operation, roentgenological and urinary cytological findings showed a right ureteral carcinoma. He died of multiple liver and bone metastases and local recurrence at 5 months postoperatively.

A 59-year-old man was referred to our clinic with a complaint of frequent urination, voiding pain, and macroscopic hematuria. He had undergone total gastrectomy for mucinous adenocarcinoma, 21 months earlier. Pelvic computed tomography revealed a thick bladder wall all around. There were no other metastatic sites except for paraaortic lymph nodes. Transurethral resection of the bladder tumor was performed. The specimen showed signet ring cell carcinoma and revealed the same pathological findings as the primary gastric cancer. We diagnosed him with metastastic bladder tumor lymphogenously disseminated from gastric cancer. Such lymphogenous metastases from gastric cancer at the entire bladder wall without other apparent lesions have rarely been reported in the Japanese literature.

A 67-year-old male was admitted with a three-month history of voiding difficulty. Prostate specific antigen remained within the normal limit. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of prostate was performed. Pathological examination of the resected specimens of the prostate revealed transitional cell carcinoma. Two courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) chemotherapy were performed, followed by cystoprostatourethrectomy, pelvic lymphadenectomy, and ileal conduit construction. Now one year has elapsed, with no clinical signs of recurrence.

A 72-year-old male was admitted to our hospital with the complaint of right painless swelling of extratesticular scrotal content. Laboratory examinations were unremarkable. Under the diagnosis of an intrascrotal lipoma, the tumor was resected. The removed specimen weighed 115 g. Histopathological findings revealed lipoma. Other cases from the Japanese publications, together with our case, are reviewed.

A 32-year-old woman in the 36th week of pregnancy was admitted to obstetrics with a complaint of left flank pain. Magnetic resonance imaging demonstrated a left perinephric hematoma before the cesarean section. Spontaneous rupture of renal angiomyolipoma was suspected by computed tomographic scan and renal angiography after the cesarean section. We attempted partial nephrectomy, but performed nephrectomy because of perinephric adhesion. This is the 11th case of spontaneous rupture of renal angiomyolipoma during pregnancy in the Japanese literature.

A 56-year-old man visited our hospital with the complaint of painless swelling of right scrotal contents. Right orchiectomy was performed. Histopathological diagnosis was malignant lymphoma of the epididymis, without involvement of the testis. Bone marrow biopsy and Ga scintigram showed a normal pattern, while a swollen retroperitoneal lymph node (3 cm) was found by computed tomography (CT). The CT also showed a small mass lesion in the left upper lung field. After 2 courses of chemotherapy for malignant lymphoma, left upper lobectomy was performed at another clinic. Pathological diagnosis of the surgical specimen was moderately differentiated adenocarcinoma. The patient died without known causes, 8 months after the orchiectomy.

Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

Sixty-six patients with renal pelvic and ureteral tumors were treated in our hospital between June 1974 and June 1991. These cases consisted of 27 renal pelvic tumors, 31 ureteral tumors and 8 renal pelvic and ureteral tumors. Their ages ranged from 43 to 86 years old (average: 65). There were 46 males and 20 females. The surgical method involved total nephroureterectomy with a cuff for 44 patients, nephroureterectomy for 3, nephrectomy for 9, total nephroureterectomy with total cystectomy for 5 and partial ureterectomy for 2. Histologically, there were 60 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC) and 4 TCC with SCC. As for the pathological stage, 13 were pTa, 16 pT1, 12 pT2, 11 pT3, 13 pT4 and 1 pTX. Subsequent bladder tumors were found in 13 patients (19.7%). The overall survival rate at 1, 3 and 5 years were 80%, 68% and 52%, respectively according to the Kaplan-Meier's method. In this series, the pathological staging was the most important prognostic factor.

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.

The combination of carumonam (CRMN) and cefotiam (CTM), expected to have a broader spectrum of coverage in connection with urinary tract infections, was evaluated for its effectiveness and safety at the Department of Urology, Osaka University Hospital and 17 affiliated hospitals. CRMN and CTM were given together to 109 patients with complicated urinary tract infections (UTI), of whom 65 cases satisfied the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data for women. CRMN and CTM were administered by drip or one-shot infusion at a total daily dose of 4 g (equally mixed 1 g plus 1 g each, twice a day) for 5 consecutive days or longer. The overall clinical efficacy rate in the 65 cases of complicated UTI was 72%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 72% for the 29 patients in the 1st group, 100% for the 1 patient in the 2nd group, 100% for the 7 patients in the 3rd group, 83% for the 6 patients in the 4th group, 50% for the 14 patients in the 5th group and 75% for the 8 patients in the 6th group. The disappearance rate of both urinary Gram positive cocci and Gram negative bacilli was 83.3%. Fifteen strains appeared after the treatment, only 4 of which were Gram positive cocci. Among the 109 patients treated with CRMN+CTM, no subjective side effects were recorded and the abnormalized laboratory findings observed were: eosinophilia in one patient, increases in both GPT and GOT in one patient, and lowered creatinine clearance in one patient. With a broader spectrum and safe regimen, the combination of CRMN/CTM is recommended as the first choice against complicated UTI.

Aztreonam (AZT, Azactam) was given to 176 patients with complicated urinary tract infections (UTI), of whom 110 cases satisfied with the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data in cases of women. Aztreonam was administered by drip infusion at a daily dose of 1 to 4 grams (mostly 2 grams) for at least five days long. The overall clinical efficacy rate of AZT in the 110 cases with the complicated UTI was 64%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 66% for the 38 patients in the 1st group, 33% for the 3 in the 2nd group, 79% for the 19 in the 3rd group, 85% for the 21 in the 4th, 47% for the 19 in the 5th and 42% for the 12 in the 6th group. The disappearance rate of Gram negative bacilli was 87.1%. Especially 15 strains of Pseudomonas aeruginosa were eliminated out of 25 (60%) after AZT administration. Forty-six strains appeared after AZT treatment, 36 (76%) of which were Gram positive cocci. Subjective side effects and abnormal laboratory findings in a total 176 cases were: diarrhea in one, upper abdominal discomfort in one, increases in glutamic pyruvic transaminase in 8, increases in glutamic oxaloacetic transaminase in 5 and eosinophilia in 1. All of these disappeared after termination of the drug. AZT might therefore be a useful and safe antibiotic for the first choice use against complicated UTI.

A case of bilateral asynchronous ureteral tumors in a 58-year-old man associated with a horseshoe kidney was reported. First, left heminephrectomy with total left ureterectomy had been performed because of the left ureteral carcinoma. Three years and 8 months later, he was admitted and an emergency right nephrostomy was made on account of false anuria. Then, right ureterectomy with total cystectomy was the choice of treatment against the ureteral tumor on the right side. This case of bilateral ureteral tumors associated with a horseshoe kidney appears to be the first one reported in the Japanese literature.

Two cases of malignant lymphoma arising from the testis are reported. One was 45 years of age, with the complaint of left scrotal swelling with dull pain and the other was 68 years of age, with the complaint of painless swelling of right scrotal contents. Microscopic findings were both malignant lymphoma of the testis, large cell and immunoblastic type in case 1 and diffuse mixed, small and large cell type in case 2 (Working Formulation, 1982). Biomedical and radiographic examinations revealed no apparent involvement otherwise. For the period of 6 months in case 1 and 2 months in case 2 following radical orchiectomy with postoperative irradiation (Lineac 4,000 rad), the patients have been doing quite well without any clinical evidence of recurrence. The literature is also reviewed briefly.

A case of synchronous contralateral renal cell carcinoma and ureteral transitional cell carcinoma is reported. A 56-year-old man, who had been incidentally found to have an abnormal mass in the upper pole of the right kidney on ultrasound sonography, was admitted on January 8, 1985. CT scanning and renal arteriography revealed right renal malignancy. Right radical nephrectomy was performed and histological examination showed adenocarcinoma, granular cell type of the right kidney. He was discharged on February 3, 1985. Two months postoperatively, he was rehospitalized for macroscopic hematuria. Left retrograde pyelogram showed obstruction at middle ureter and cytology of urine from left ureter was positive. So a left ureteral tumor was suspected, and partial resection of left ureter and ureteroureterostomy were performed. Histological examination revealed ureteral transitional cell carcinoma. He is now doing well at 6 months following the lat surgery, without any evidence of recurrence.

We have experienced a case of retroperitoneal plasmacytoma. A 47-year-old man was admitted to our hospital with the chief complaints of right lumbago and lower abdominal dull pain. Roentgenography revealed retroperitoneal tumors, and right nephrectomy and excision of left pararenal tumors were performed. The histological examination and urine immunoelectrophoresis showed retroperitoneal plasmacytoma. No signs or symptoms of multiple myeloma were recognized postoperatively. The literature is reviewed briefly concerning the diagnosis and treatment of retroperitoneal plasmacytoma.

Cefixime (CFIX, Cefspan), a new oral cephem, was used in the treatment of urinary tract infections, and was evaluated for its therapeutic effectiveness and safety at the Department of Urology, Osaka University Hospital and 16 affiliated hospitals. A total of 238 patients were administered daily doses of 200 or 400 mg. Clinical efficacy was assessed on 92 female patients with acute uncomplicated cystitis and 42 patients with complicated UTI according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd ed.) recommended by the Japan UTI Committee, to which we added our own minimum modification. Clinical efficacy was evaluated as excellent in 57 of the acute uncomplicated cystitis cases, moderate in 33 and poor in 2, with an overall clinical effectiveness rate of 98%. Clinical efficacy was evaluated as excellent in 12 of the complicated UTI cases moderate in 12 and poor in 18, with an overall clinical effectiveness rate of 57%. In one case of uncomplicated pyelonephritis, CFIX showed an excellent efficacy. Of the total of 102 bacterial strains isolated from uncomplicated UTIs, 95 (93%) were eradicated by CFIX, while 36 (72%) eradicated in 50 strains isolated from complicated UTIs. Subjective adverse reactions were seen in 4 cases (1.7%) of the 236 patients, as generalized pruritus and upper gastrointestinal discomforts. Abnormal laboratory findings were recorded in 6 out of 141 cases. They were increases in serum GPT, GOT, alkaline phosphatases, total bilirubin, as well as increases in peripheral leukocytes. These adverse symptoms and abnormal laboratory findings disappeared after the termination of CFIX administration. CFIX might therefore be considered as a clinically useful oral antibiotic in the treatment of UTI.

Four males with ectopic ureteral opening are reported herein. Case 1 was a 17 year old who complained of miction pain and macroscopic hematuria. Cystoscopy and radiological examinations showed left ectopic ureteral opening into the seminal vesicle associated with left renal agenesis. The left ureter and seminal vesicle were extirpated. Case 2 was a 21 year old who complained of lower abdominal pain. On physical examination, a child's head sized mass was palpable in the midline of the lower abdomen. Operation was performed under diagnosis of intrapelvic tumor, but the mass was cystic dilatation of left ureter which opened into the seminal vesicle. Case 3 was a 19 year old who complained of right CVA colic pain. On cystoscopy, the right ureteral orifice was absent. During the operation, right ureter was found to open into the posterior urethra. Case 4 was a 57 year old who complained of fever. Plain X-ray on the pelvic cavity showed a 82 X 10 mm calcified shadow. CT revealed a right ectopic ureteral opening into the posterior urethra with a ureteral stone in it. On cystoscopy, the right ureteral orifice was identified and pus discharge was observed to flow out of it. Operative exploration demonstrated that the right ureter was inverted Y duplication; one opened into the posterior urethra and the other into the trigone. Seventy nine males with ectopic ureteral opening and 3 with inverted Y ureteral duplication from the Japanese literature are reviewed briefly.

We have experienced 3 cases of retroperitoneal ganglioneuroma. One case was in a 5-year-old boy with the chief complaint of abdominal mass. The preoperative diagnosis was neuroblastoma due to excessive urinary excretion of vanillylmandelic acid. The other two cases were in adults, 40 and 28 years old, and were found incidentally. All three cases were doing well without any clinical signs of recurrence almost 10 years, 5 years, and 6 months, postoperatively. The literature is reviewed briefly concerning some cases in children under 5 years of age whose ganglioneuromas were sometimes confused with neuroblastoma because of excessive catecholamines.

Two cases of secondary penile tumor are reported. The first was a 69-year-old man with the complaint of continuous painful penile erection. He had been diagnosed to have left lung cancer, squamous cell carcinoma, and was treated with chemotherapy as well as irradiation 10 months previously. He underwent amputation of penis and histopathologically diagnosed to have penile metastasis from the lung cancer. The second was a 60-year-old man who had been treated by Miles' operation due to rectal cancer, adenocarcinoma, 24 months previously. Autopsy demonstrated continuous invasion in a corpus cavernosum of rectal cancer which had locally recurred. We reviewed and discussed briefly 74 cases with secondary penile tumor collected from the Japanese literature.

Three cases of metastatic renal tumor are reported. The first case was of a 61-year-old man, who had a Miles' operation for rectal adenocarcinoma 30 months before, and suffered from high fever and right flank pain. Right nephrectomy was carried out and the kidney was found to contain an adenocarcinoma identical to the one previously removed from the rectum. He died 1 year after nephrectomy. The second case was of a 35-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One month later, he was readmitted with cloudiness of consciousness and high fever. Investigations revealed right kidney, adrenal gland and brain malignancies, and which were ectomized totally. On pathological examination all ectomized tissues were metastatic squamous cell carcinoma. He died 1 month after the second operation. The third case was of a 48-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One year after pneumonectomy, abdominal CT showed a left renal tumor. Right nephrectomy was performed and pathological examination revealed a metastatic squamous cell carcinoma. He is now alive 4 months after nephrectomy without any sign of recurrence. A total of 136 cases of metastatic renal tumors including 38 cases from the Japanese literature, are reviewed.

A 21-year-old man, who had had normal sexuality, noticed a decrease in libido and potency as well as loss of ejaculation. Endocrinological evaluation showed normal serum levels of gonadotropins but a low testosterone level. The response to clomiphene citrate was poor while the response to luteinizing hormone-releasing hormone and human chorionic gonadotropin were within normal limits. By the examination of brain computerized tomography a tumor was detected in the septum pellucidum and was resected. Histologically it proved to be a mixed tumor composed of astrocytoma and oligodendroglioma. Two months after the operation the patient had recovered normal sexual functions and the endocrinological functions, including the responsiveness to clomiphene citrate, had been restored. This case suggests the existence of some stimulatory fiber for the secretion of luteinizing hormone in the septum pellucidum.

A 47-year-old man was admitted with chief complaints of macroscopic hematuria and bone pain. Hypercalcemia still remained after three small papillary tumors on the left retrotrigonal wall of the bladder were resected transurethrally. Some biochemical as well as X-ray examinations thereafter pointed out an association with primary hyperparathyroidism. An adenoma arising from right upper parathyroid gland was found and excised. Then his symptoms, both subjective and objective, were normalized. Six documented cases of primary hyperparathyroidism associated with urological malignancy including our own were found in the Japanese literature.

The therapeutic efficacy of Pivmecillinam (PMPC) against urinary tract infections after prostatectomy was investigated. PMPC was orally administered at the dose of 300 mg/day for 2-14 weeks after initial intravenous postoperative chemotherapy with other antibiotics for 0-24 days (average 5.7 days). Thirty patients underwent retropubic prostatectomy and the other 59 patients received TUR-P. The chemotherapeutic efficacy for 19 patients who had over 10(3) CFU/ml of microorganisms was as follows: The effective rate was 48.4% after 2 weeks, 53.8% after 4 weeks, 66.7% after 5-6 weeks and 100% after 7-9 weeks. The prophylactic efficacy for 70 patients who had no or less than 10(3) CFU/ml of microorganisms was 64.3% after 2 weeks, 79.6% after 4 weeks, 86.7% after 5-6 weeks and 90.0% after 7-9 weeks. The overall clinical efficacy of PMPC for 89 patients was 60.7% after 2 weeks, 74.2% after 4 weeks, 83.3% after 5-6 weeks, 90.0% after 7-9 weeks and 100% after 10-14 weeks. No severe side effects were found in these 89 cases. In conclusion, PMPC is a useful drug for the long term treatment after prostatectomy.

The efficacy and safety of long-term administration of oxybutynin hydrochloride in patients with neurogenic bladder and unstable bladder, who complained of urinary frequency, urgency and incontinence, and whose bladder was proved to be uninhibited, reflex, and/or low compliant, were studied at the multi-center hospitals, and the following results were obtained. This study comprised 149 cases but 8 of them were excluded because of the incomplete protocol. Thus, 141 cases (104 neurogenic bladder patients, 33 unstable bladder patients and 4 others) were investigated. The daily dosage of Oxybutynin hydrochloride ranged from 1 to 18 mg, and averaged at 6.6 mg. Since a small daily dosage of 3 mg was administered in 32 cases to examine the minimum effective dosage of the drug, the low average dosage possibly resulted. The clinical optimal dosage seemed to be more than 6.6 mg. The average period of administration in all cases was 161.7 days (1-336 days), and the drug was discontinued in 46 cases (33.6%) on average 62.1 days (1-141 days). The rate of global improvement by this drug estimated at the time of completion was found to be 65.6% with excellent and good and 87.8% with excellent, good and fair. The efficacy of this drug was stable and not decreased during the long-term test period. As to the objective findings studied before, during and after the drug administration, cystometric bladder capacity was significantly increased both first desire to void and the total capacity. Voided volume and residual urine were also increased, but there was no change in the rate of residual urine. Side effects were observed in 37 (26.2%) of 141 cases, and mainly gastrointestinal signs such as dry mouth and constipation. Urological signs such as dysuria and urinary retention were experienced in 8 cases. Regarding the findings of laboratory tests, there were no abnormality except for small changes of some items in normal range. Six children who were younger than 15 years old were subjected to this study. The results of evaluation were similar to those obtained on adults and no side effects were observed. From these findings, oxybutynin hydrochloride is considered an effective and useful drug in patients suffering from neurogenic bladder and unstable bladder with over active bladder condition.

A case of primary signet ring cell carcinoma of the urinary bladder is reported. A 52-year-old man was admitted with the complaint of gross hematuria. Cystoscopy showed non-papillary tumor on the right lateral wall. Abdominal CT, Ga scintigraphy, upper gastrointestinal series and barium enema, revealed no signs of a tumor other than the bladder carcinoma. The routine hematologic and chemistry profiles showed no abnormalities except for the serum level of carcinoembryonic antigen elevated to 210 ng/ml. Total cystectomy and right nephroureterectomy with left cutaneous ureterostomy was performed and the surgical specimen showed adenocarcinoma of the bladder. The patient died 5 months after the operation, and autopsy was performed. No tumors were found on the mucosa of the whole digestive tracts or pancreas. This case might be of primary adenocarcinoma originated from the bladder. The literature on the differential diagnosis of the cases reported as bladder adenocarcinoma are reviewed briefly.