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The continence self-management programme fee (CSPF) for hospitalized patients was revised in 2020 to include those receiving consistent care on an out-patient basis. We extracted candidate patients for CSPF on an out-patient basis (out-patient candidates hereafter) from those for whom-CSPF had been calculated during hospitalization at our hospital, and defined those who had undergone a medical examination related to continence care as out-patient calculation candidates. Of the 956 patients for whom CSPF had been calculated during hospitalization, 482 patients (50%) were out-patient candidates ; 275 (54%) and 169 (33%) of whom were seen in the urology and neurosurgery departments, respectively. Of the 482 out-patient candidates, 238 (49%) were out-patient calculation candidates ; 197 (83%) and 14 (6%) of whom were seen in the urology and neurosurgery departments, respectively. Forty-two and 41 of the calculation candidates were cases of benign prostatic hyperplasia and bladder cancer, respectively. The CSPF was actually processed 93 times for 78 of the 482 out-patient candidates (16%). There were various obstacles in the current system of calculating the fees to realize consistent care from hospitalization to out-patient care.

We evaluated the impact of tumor shrinkage (TS) induced by molecular targeted therapy as the first-line systemic therapy on the survival of patients with metastatic renal cell carcinoma (mRCC). A total of 67 patients with mRCC who received first-line molecular targeted therapy were included in this study. Sixty patients were evaluable by response evaluation criteria in solid tumors. Patients underwent the first evaluation at 8-12 weeks after the start of the therapy. Twenty patients had TS ≧30%, 32 from 30% to -20%, and 8 ≦-20%. The median overall survival periods of patients who achieved TS ≧30%, from 30% to -20%, and ≦-20% at first evaluation were 41.0, 35.0, and 11.5 months, respectively. Univariate and multivariate analyses showed that TS of≧0%, in addition to negative C-reactive protein and the absence of bone metastasis were good predictors of overall survival. The patients who achieved 0% or more at the initial evaluation had longer survival than those who had no tumor reduction (40.0 months vs 12.0 months, p<0. 001). These findings suggest that early TS affects overall survival in real practice. We should consider alternative therapies for patients who have not achieved tumor reduction at the initial evaluation.

We examined the postoperative urinary continence rate, and preoperative and postoperative factors predicting postoperative urinary continence for patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) at our hospital. In all, 122 patients who received RARP were retrospectively analyzed. All patients answered a questionnaire to evaluate the urinary condition and also had a follow-up period of 6 months or longer after surgery. We defined urinary continence to be the use of 1 pad per day or less, including a safety pad. Membranous urethral length (MUL) was measured using sagittal sections of T1-weighted MRI. Postoperative urinary incontinence rates were 48.7, 72.4, 82.6 and 86.8% at 3, 6, 12 and 24 months after surgery, respectively. MUL was a significant predictive factor of urinary continence at 6 months after surgery (p<0.01). We examined the factors predicting the urinary continence recovery at 6 months after surgery, including only patients who did not obtain urinary continence at 1 month after surgery. Two factors, MUL of 11 mm or longer and two pads per day at 1 month after surgery, were significant predictive factors of urinary continence recovery at 6 months after surgery (P=0.02, P=0.04). Patients who had a long MUL could easily obtain urinary continence after RARP compared to those with a short MUL. Most patients with a long MUL and with use of 2 pads per day at 1 month after surgery could obtain urinary continence at 6 months after surgery, even if they had urinary incontinence at 1 month after surgery.

A 72-year-old man was referred to our hospital for examination of a right adrenal tumor incidentally found by computed tomography for close inspection of lumbago. The computed tomography scan and magnetic resonance imaging showed a 51×54×43 mm solid tumor in the right adrenal region. Endocrinological examinations were within normal limits. Because we could not diagnose his condition due to atypical radiographic findings preoperatively and exclude a malignant tumor, laparoscopic right adrenalectomy was performed. The tumor was histologically diagnosed as ganglioneuroma originating from the right adrenal glands.

A 60-year-old man presented at our hospital with gross hematuria. He had been treated for nephrotic syndrome with cyclophosphamide and steroids since he was in his 20s. We detected diffuse hemorrhagic cystitis on cystoscopy and diagnosed him with cyclophosphamide-induced hemorrhagic cystitis. He was hospitalized due to clot retention. We treated him with blood transfusion for severe anemia and conducted continuous bladder irrigation. We performed hyperbaric oxygen therapy and transurethral electric coagulation, and increased the steroid dose. However, we could not control the hematuria. Finally, we performed cystectomy, and he is now well without hematuria. Although cystectomy is the final option, it is important to decide it in a timely manner because a delay decreases the quality of life.

We assessed the outcomes of high-risk prostate cancer patients who received radical prostatectomy (RP), external beamradiation therapy (EBRT) or androgen deprivation therapy (ADT). Two hundred nineteen patients who were diagnosed with pathologically confirmed high-risk prostate cancer as defined by D'Amico between 2005 and 2011 were included in this study. Of them, 74 patients underwent RP. The 5-year cancer-specific survival (5yCSS) and 5-year PSA recurrence-free survival (5yPRFS) rates were 100 and 67.2%, respectively. A positive surgical margin and Gleason score≧8 were risk factors for PSA recurrence. The 5yPRFSs were 100, 74.4% and 'unmeasurable' for patients with 0, 1 and 2 risk factors, respectively. Ninety patients underwent EBRT. The 5yCSS and 5yPRFS rates were 95.2 and 74.2%, respectively. Fifty-five patients underwent ADT alone. Their 5yCSS and 5yPRFS rates were 93. 3 and 64. 3%, respectively. There was no significant difference in 5yCSS and 5yPRFS rates among the treatment groups. These results show that RP can be a treatment option for high-risk prostate cancer patients.

A 51-year-old man received 2 courses of intravesical bacillus Calmette-Guerin (BCG) therapy for carcinoma in situ of the bladder. Two years after the therapy, he underwent left radical nephroureterectomy, cystectomy, urethrectomy and construction of an ileal conduit because of left renal pelvic cancer and severe atrophic bladder. The histopathological diagnosis was carcinoma in situ of the left pelvis and ureter, and epithelioid cell granuloma of left kidney, prostate and bladder. After the operation, he developed extensive surgical site infection (SSI) by BCG, the diagnosis of which was delayed. He recovered from the SSI soon after anti-tuberculosis chemotherapy was begun. We discuss the requirements for more prompt diagnosis of SSI by BCG by analysis of this case.

The definition of malignant fibrous histiocytoma (MFH) was modified and simplified in the new WHO-Soft Tissue and Bone Tumor Classification published in 2002. We reviewed the clinical courses of 7 patients with MFH of the retroperitoneum treated in our hospital from 1985 to 2005 and reexamined their pathological diagnoses according to the new classification. All pathological specimens were reviewed again by an expert pathologist (TH) and were confirmed as MFH. Median follow-up was 5 months (0.5 to 44 months). Five patients were diagnosed as having the pleomorphic type, and 2, the inflammatory type. The tumor was located in the retroperitoneal space in 6 patients and around the left spermatic cord in 1. Radical surgery was the primary treatment for 6 patients. The disease recurred locally in 5 patients and distant metastasis developed in 3. The lung and liver were the principal locations of distant metastases. The 2-year disease-specific survival rate was 30% and 2 patients have been alive for more than 3 years. Our experience and those of others reported in the literature suggested that the factors for long-term survival in MFH are pleomorphic-type histology, superficial location, small tumor size and intensive wide excision, although most patients with MFH might have a poor prognosis. Because the tumor size of MFH tended to be large, especially that in the retroperitoneal cavity, wide excision with sufficient tumor-free margin is hard to guarantee.

A 65-year-old woman was admitted for the treatment of malignant lymphoma. Computed tomography revealed a right renal tumor. After 3 cycles of CHOP (cyclophosphamide, adriamycin, vincristine, prednisone) chemotherapy, we performed right radical nephrectomy. The histopathological diagnosis was renal cell carcinoma. After nephrectomy she was treated with 3 cycles of CHOP chemotherapy and radiation therapy. She received no adjuvant therapy for renal cell carcinoma and had no recurrence after 8 months from the nephrectomy.

Between 1988 and 1996, we treated 11 poor-risk patients with non-seminomatous germ cell tumors (NSGCT) at Nagoya University Hospital. "Poor-risk" was defined as i) advanced disease equal to or greater than class 7 of the Indiana University Classification (7 patients), ii) primary mediastinal extragonadal NSGCT (2), iii) tumor markers not normalized by the induction chemotherapy (1) or iv) primary retroperitoneal NSGCT with multiple lung metastases (1). Two patients with mediastinal tumors died during the chemotherapy. The minimal volume of fluid must be administered to patients with giant mediastinal tumors. The tumor marker normalized during the induction chemotherapy in only three patients. Three patients, whose tumor markers elevated during or one month after the induction chemotherapy, eventually died of cancer. The tumor markers in five of the seven patients which had not normalized during the induction chemotherapy, had decreased to the normal range during the salvage chemotherapy and two of the five subsequently achieved the status of "no evidence of disease" (NED). Six patients with and two without normalized tumor markers underwent retroperitoneal lymph nodes dissection and/or resection of residual tumors. Pathological examination of the resected tumors showed necrosis/fibrosis in five patients and two had elevated tumor markers immediately after the surgery and eventually died of the disease. Overall, eight (73%) of 11 poor-risk patients achieved a complete response but only five (45%) eventually achieved a NED status that was maintained (6.6 +/- 3.0 years). Our results were not satisfactory, and we believe that new strategies, such as early high-dose chemotherapy, are required for poor-risk patients, who are not likely to respond well to the induction chemotherapy.

A 77-year-old man presented with a painless swelling of the right testis. A high inguinal orchiectomy was done under the diagnosis of testicular tumor. Histologic diagnosis was carcinoid with teratoma. Computerized tomography revealed multiple lung and retroperitoneal lymph node metastases 4 months after orchiectomy. Chemotherapy had no effect on metastases. He died of lung metastasis 3 months after the recurrence.

We earlier demonstrated that simultaneous administration of EHEN and uracil for 3 weeks resulted in enhancement of renal carcinogenesis in F344 female rats. Therefore, to establish a model of renal carcinogenesis in rats that can induce advanced renal carcinoma at a high incidence, differences in the susceptibility to N-ethyl-N-hydroxyethylnitrosamine (EHEN) and uracil of the kidneys in male and female rats of two strains were examined. Group 1 (male Wistar rats), group 2 (female Wistar rats), group 3 (male F344 rats), and group 4 (female F344 rats) received a 3-week simultaneous administration of 0.05% EHEN in the drinking water and 3% uracil in the diet after one week's acclimation. In all the above four groups, the rats were thereafter given a basal diet and water without chemical addition for a 29-week period. Group 5 (male Wistar rats), group 6 (female Wistar rats), group 7 (male F344 rats) and group 8 (female F344 rats) received no chemicals for the entire 33 weeks. At the end of the experiment, renal adenocarcinomas were found in 85, 68, 14 and 0% of the rats in groups 1, 2, 3 and 4, respectively. The incidence of adenomas and adenocarcinomas in Wistar rats were significantly greater than in F344 rats (p < 0.0001). These findings indicate strain and possibly sex differences in kidney carcinogenesis in rats treated with EHEN and uracil, and simultaneous administration of the two agents to male Wistar rats might have an advantage for models to induce advanced renal carcinoma at a high incidence.

To compare the prophylactic effect of oral and intravenous antibiotics against postoperative fever and urinary tract infection (UTI) after transurethral resection of the prostate (TUR-P), we conducted a multi-center prospective randomized study. The incidence of pyrexia over 38 degrees C was defined as the primary endpoint. One hundred and fifty patients with sterile urine before TUR-P were entered into this study. The patients were allocated randomly into the two arms; arm A cefotiam 4 g a day for 7 days, arm B tosufloxacin 300 mg a day for 7 days, based on the stratification into the 4 groups determined with/without preoperative indwelling catheters and with/without the history of preoperative UTI. Of these patients, 143 were eligible. We divided 124 patients without preoperative UTI and without indwelling catheters as the "low risk group", and the other 19 patients with preoperative UTI and/or with indwelling catheters as the "high risk group". In the low risk group, 9 patients out of 63 (14.3%) in arm A and 6 out of 61 (9.8%) in arm B had pyrexia during 7 postoperative days. The incidence of fever in arm B was 4.4% less than that in arm A and the 95% confidence limit was from -7% to 16%. In the high risk group, 4 out of 11 (36.4%) patients in arm A and none of 8 in arm B had fever but the difference was not significant. The incidence of post operative UTI in the low risk group on the 4 to 5, 9 to 12, 23 to 26 and 37 to 40 postoperative days was 8.3, 16.4, 25.0 and 23.9% in arm A and 6.7, 16.7, 29.6 and 36.7% in arm B, respectively. The prophylactic effect of oral administration of tosufloxacin is equivalent to that of the intravenous administration of cefotiam. The use of oral antibiotics is beneficial to reducing the cost of medication.

We report a case of CA19-9 producing transitional cell carcinoma of the right ureter effectively responsive to combination chemotherapy (methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) regimen) in a 53-year-old woman. The maximum level of serum CA19-9 showed 3,000 U/ml and clinical staging of the tumor was T4 N3 M0. Marked regression of the tumor was identified by computed tomographic scan and the level of serum CA19-9 returned to the normal range after 3 courses of M-VAC therapy. Right total nephro-ureterectomy and partial cystectomy was done and the surgical specimen revealed no viable tumors. She is alive without evidence of local recurrence or metastasis at 6 months after resection. The serum CA19-9 level was useful for monitoring the clinical course.

We report a 68-year-old man with renal cell carcinoma in a horseshoe kidney. Abdominal computed tomography revealed a left renal tumor in a horseshoe kidney, and we carried out left radical nephrectomy. Histopathological diagnosis was renal cell carcinoma. Only 19 cases of renal cell carcinoma in a horseshoe kidney have been reported in Japan, and our case was the 20th.

We report a 76-year-old man with a multilocular cystic renal cell carcinoma resembling a multilocular renal cyst by radiological diagnosis. His creatinine clearance was 43 ml per minute and we carried out simple enucleation, to avoid renal failure after radical nephrectomy and because of low percentage of local recurrence after renal conservative surgery of low stage renal cell carcinoma. We have been following up the patient carefully.

This is a case report of primary localized amyloidosis of the urinary bladder. The patient was a 73-year-old woman who had relapse of this disease three times. Primary localized amyloidosis of the urinary bladder is an especially rare disease and the prognosis is excellent in most cases. We performed transurethral resection of the bladder tumor (TUR-Bt) each time and we are following up this patient carefully. After the last TUR-Bt, she has had no recurrence for 7 months. Considering multifocal recurrence and excellent prognosis, we stress the importance of TUR-Bt for diagnosis and careful follow up.

A case of simultaneous bilateral renal pelvic tumors is reported. A 64-year-old man with the chief complaint of gross hematuria and left flank pain was admitted. Clinical investigations revealed a tumor in the right pelvis and ureter, and another tumor in the left renal pelvis. The right ureteral tumor had invaded the bladder. Right nephroureterectomy, total cystectomy, left partial pyelectomy and ureterocutaneostomy were performed. By pathological examination, right renal pelvic and ureteral tumors were non-papillary transitional cell carcinoma, grade 3, pT4, and the left renal pelvic tumor was papillary transitional cell carcinoma, grade 2, pT1. To our knowledge, this is the 16th case of simultaneous bilateral urothelial tumors of the upper urinary tract in Japan.

Fifty-eight of the 44,698 patients seen at our Department, between 1972 and 1984 had a testicular tumor. The incidence rate was 0.13%. The mean age of these 58 cases was 28.6 years and two peak distributions, one in the 0 to 5 year and another in 26 to 30 year age group were observed. Among them, 54 patients (93.1%) had chief complaints of painless testicular swelling at initial examination. The vast majority of them had unilateral tumors; 28 in the right and 29 in the left. Only one patient had bilateral seminomas. Histologically, 30 of them (51.7%) were seminoma, 8 were embryonal carcinoma (13.8%), 2 were teratoma (3.5%) and the remaining 18 had tumors of double or multiple histological type. Most of the seminomas were treated by a combination of high orchiectomy and radiotherapy, and chemotherapy was done mainly for non-seminomatous cases. The 5-year survival rate calculated by the Kaplan-Meier method was 100% for patients with low stage (I, II) seminomas and 62% for those with non-seminomatous tumors.

Two cases of bilateral renal cell carcinoma are reported. The first case is of a 54-year-old male who visited our hospital on March 7, 1984 complaining of colicky pain in his left flank. Intravenous urography showed a large mass in the upper pole of the left kidney causing deformity and dislocation of the upper calyces. There were no remarkable findings in the right kidney. Abdominal CT-scan and arteriography revealed a round and hypervascular tumor with soft tissue mass density in the upper pole of both kidneys. Nephrectomy of the left and segmental resection of the upper pole of the right kidney were performed on April 11, 1984. The second case is a 47-year-old male who visited our hospital complaining of total gross hematuria. Intravenous urography showed a large soft tissue mass at the lower pole of the left kidney. Abdominal CT-scan revealed a large tumor mass associated with central necrosis in the left kidney and also a small tumor lesion at the center of the contralateral kidney. Bilateral nephrectomy was performed on December 19, 1984, and the patient was referred to hemodialysis treatment. The cut section of the nephrectomized right kidney specimen revealed multiple minor accessory tumors. Both patients have been doing well without any evidence of recurrence or metastasis.

We conducted a second mass screening for prostatism on males 50 years of age and older in the Tanno town area, to determine the incidence of benign prostatic hypertrophy (BPH) and prostatic carcinoma. We also studied how often elderly males had symptoms related to prostatism according to their age. The incidence of BPH was 10.0% in these males who were received the first and/or second mass screening as well as those treated previously, when BPH was defined as the prostate with a moderately or greater enlarged size upon digital palpation. The incidence of BPH was 8.9% in males fifty years of age and older who lived in Tanno town. The figures tended to elevate with the advance of age. Two new patients with prostatic carcinoma were discovered during this second mass screening, which resulted in a total of 8 patients discovered in this area. Of these 8 patients, 6 had been found in the first screening. The incidence of prostatic carcinoma was 1.4% in those males who received the first or second mass screening as well as those treated previously, and that in all the males who lived in the town was 1.0%. Further efforts will be necessary to establish a more convenient system that can provide less costly screening procedures and more effective diagnostic procedures to detect localized prostatic carcinoma. With advance in age the male tended to have a higher incidence of prostate with a moderately or markedly enlarged size, and symptoms related to prostatism. In addition, the urinary flow rate tended to decrease, irrespective of the prostate size. The results supported the significance of mass screening for prostatism.

The uroflowmetry of a total of 533 males over 50 years old, who had undergone a mass examination of the prostate in Tanno Town, Hokkaido Prefecture in 1982, and 1985, was studied. These subjects were divided into 4 groups, i.e., those 50 to 69 years old and those over 70 years old and those with and without prostatic hypertrophy by rectal palpation, the relationship between voided volume and flow rate was examined. Subjects without prostatic hypertrophy by rectal palpation in the older group showed markedly lower flow rate rate than the younger group and subjects with prostatic hypertrophy in the younger group had a lower flow rate than the older group. Thus, urinary disturbance in elderly men was supposed to occur due to aging changes such as benign prostatic hypertrophy and bladder neck contracture.

One hundred and sixty-seven patients with newly diagnosed, previously untreated prostatic adenocarcinoma, during the period between July, 1971 and March, 1934, were studied. The histopathologic specimens of the prostate were classified by the Japanese General Rules of Prostatic Cancer (JGRPC) and by Gleason's classification. The number of patients with well, moderately and poorly differentiated prostatic carcinomas according to the JGRPC classification was 42, 74 and 51 respectively, and the number of the patients with Gleason's pattern 1, 2, 3, 4, and 5 was 24, 20, 32, 43 and 48, respectively. The number of patients with Gleason's score (primary plus secondary pattern) 2 to 4, 5 to 7 and 8 to 10 groups was 40, 76 and 51 respectively. There was no significant difference in survival rate between well and moderately differentiated groups, but the survival rate of the group with poorly differentiated tumor was significantly lower than that of the moderately differentiated (p less than 0.01) and well differentiated (p less than 0.001) groups. There was no significant difference in 10-year survival rate between the score 2-4 and score 5-8 groups, but the score 9-10 group had a significantly lower survival rate than the score 5-8 group (p less than 0.01) and score 2-4 (p less than 0.005) group. JGRPC and Gleason's classification are thought to be equally useful in estimating prognosis of prostatic cancer, but the former is more concise and easily applicable than the latter.

We have compared three treatments of congenital adrenal hyperplasia (CAH) for their effect on physical development. Thirteen girls and two boys with CAH due to 21-hydroxylase deficiency were treated with three different treatments, hydrocortisone (HC), dexamethasone (DXM) and cyproterone acetate (CA). The results showed that height growth was better with HC and CA than DXM, and bone excessive maturation was more suppressed with DXM and CA than HC. A dose-dependent relationship was revealed between body weight and dose of HC. Iatrogenic obesity was found in 42.9% and 38.1% of the patients treated with DXM and HC, but none of the patients treated with CA did became obese. Physical growth was better with CA treatment than HC or DXM treatment, but CA may have a suppressive effect on the pituitary-adrenal axis observed carefully, especially on prepubertal and pubertal cases.

Two boys and one girl with idiopathic precocious puberty were treated with medroxyprogesterone acetate (MPA) for 2 years and 2 months to 9 years and 5 months, and its efficiency was evaluated. Treatment with MPA suppressed the gonadotropin levels, the signs and symptoms of patients with precocious puberty, and also had a suppressive effect on bone-age advance, so these patients showed almost normal growth in height. There has been controversy about the age when treatment for idiopathic precocious puberty should be finished. Our data suggested that the treatment should be stopped at 11-13 years when patients reach the age of puberty.

Antiandrogen and alpha-adrenergic blockers have recently been tried in the medical treatment for benign prostatic hypertrophy and bladder neck contracture. We herein report our results of a randomized comparative study on the clinical efficacy of oxendolone, bunazosin hydrochloride (bunazosin) and their combination for the treatment of benign prostatic hypertrophy and bladder neck contracture. The attending doctors evaluated at twelve weeks the improvement rate for three treatment regimens, 400 mg/day oxendolone, 3 mg/day bunazosin and a combination of both. Oxendolone + bunazosin showed the highest improvement rate in the evaluation of each subjective symptom and objective finding and of both. Oxendolone + bunazosin tended to show a better clinical efficacy than the other of these regimens, when the improvement was defined as that with more than one degree in the severity of retarded voiding, prolonged voiding, urinary stream condition, abdominal pressure on voiding and residual urine sensation. The improvement of such subjective symptoms seemed to occur earlier with oxendolone + bunazosin or bunazosin than with oxendolone. A significant difference was shown among the three treatment regimens in the general improvement rate on four subjective symptoms, with oxendolone + bunazosin being the highest followed by bunazosin and oxendolone in this order. The improvement rates of maximum and mean flow rate which are most important parameters to evaluate the voiding condition, at twelve weeks were significantly higher with oxendolone + bunazosin. No serious side effects were observed in this study, although treatment regimens containing bunazosin caused some minor side effects. These side effects could be prevented by the use of initial low doses of bunazosin with a subsequent gradual increment up to 3 mg/day. Taking the differences in the mechanism of oxendolone and bunazosin and the results of our study into consideration, we believe that the combination of oxendolone and bunazosin would be more useful in a clinical situation.