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A 64-year old female presented with urinary retention. Physical examination revealed a firm mass on the anterior vaginal wall. Magnetic resonance imaging showed a tumor surrounding the urethra, which invaded to the vesical triangle and the anterior vaginal wall. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated, but squamous cell carcinoma antigen and prostate specific antigen were within normal limits. Pathological examinations of the transurethral and transvaginal needle biopsy specimen suggested mucinous adenocarcinoma. First, the patient received local chemoradiotherapy and systemic chemotherapy using a fluoropyrimidine drug TS-1 and cisplatin. The tumor markers declined to within normal limits after this preoperative therapy. Then she underwent total cysto-urethrectomy with anterior vaginal wall resection, pelvic lymphadenectomy, and urinary diversion with ureterocutaneous fistula. Histopathological examination of the surgical specimen showed mutinous adenocarcinoma invading to the vesical triangle and the anterior vaginal wall. No metastasis was found in the lymph nodes. The final diagnosis was urethral adenocarcinoma, pT4N0, Stage IV. Five months after surgery, local recurrence and distant metastases appeared, and she died 14 months after surgery.

We report a case of prostatic duct adenocarcinoma treated with radical prostatectomy. Advanced pathological stage (pT3bpN1) was beyond the prediction of the favorable preoperative parameters (cT1cN0, PSA 7.64 ng/ml). The main tumor of ductal adenocarcinoma was occupying the transitional zone and surrounded by scattered micro-foci of acinar adenocarcinoma. We identified coexistence of ductal and acinar adenocarcinoma cells side by side in the same gland. Pure ductal cancer cells were detected in the metastasized lymph node without acinar cancer cells. Strong staining of PSA and loss of p63 expression by both types of adenocarcinoma cells were confirmed immunohistochemically. We discuss the clinical significance of prostatic duct adenocarcinoma in comparision with typical acinar adenocarcinoma.

A 58-year-old woman visited our hospital with complaints of serious edematous change in the left lower extremity, eleven months after she received total cystectomy and ileal conduit. Although enhanced pelvic computerized tomography (CT) and magnetic resonance imaging (MRI) were repeatedly performed, the pelvic recurrence was not detected. To investigate the presence or absence of pelvic recurrence further, we performed 18F-fluorodeoxyglucose positron emission/computerized tomography (18F-FDG-PET/CT). 18F-FDG-PET/CT clearly demonstrated high uptake by the pelvic lymph node recurrence. We selected radiochemotherapy using a limited irradiation field for the treatment of lymph node recurrence to cure the edema. One month after the treatment, the edema in the left lower extremity was greatly improved. Four months later, 18F-FDG-PET/CT was performed again to evaluate the efficacy of the treatment and reduced uptake of the irradiation field was observed.

A 35-year-old man presented with a 17-month history of abdominal distension and left upper quadrant pain. He had no episodes suggesting the presence of hypertension. Hormonal studies were insignificant. Imaging studies demonstrated a bulky tumor with cyst formation measuring 22 cm. Preoperative differential diagnoses included an adrenal tumor, extra-adrenal retroperitoneal tumor and pancreatic mucinous tumor. Intraoperatively, no abnormality was observed in the pancreas. A tight adhesion of the tumor to the left kidney necessitated an en bloc resection of the tumor with the left kidney. The resected specimen, 22 x 20 x 8 cm, weighed 5,050 g. Pathologically, the tumor was ganglioneuroma originating from the left adrenal gland. Convalescence was uneventful, and abdominal symptoms disappeared. The patient has been doing well without evidence of recurrece 48 months after the operation.

A 52-year-old house wife presented with pain on urination. Cystoscopy and magnetic resonance imaging revealed solid and sessile tumor of 3 cm in diameter invading the bladder wall. Pathological examination of the transurethral resection specimen showed proliferation of spindle cells and epithelial cells. Since both types of cells were positive for cytokeratin immunostaining, sarcomatoid carcinoma was highly suspected. She underwent anterior pelvic exenteration and construction of continent reservoir (Penn Pouch). Since the tumor cells showed spindle cell proliferation alone without epithelial growth and positive staining for anaplastic lymphoma kinase, we corrected the final diagnosis as an inflammatory myofibroblastic tumor of the urinary bladder. She has been doing well without recurrence for 1 year.

A previous study indicated that distilled water could prevent bladder tumor cell implantation in an in vitro assay. We investigated whether a large amount of distilled water irrigation prevented recurrence of superficial bladder cancer in the clinical setting and then we estimated whether cancer cell implantation at the time of transurethral resection is a major mechanism of recurrence. Between May 2000 and January 2002, 22 patients with primary, superficial bladder carcinoma who underwent transurethral resection of bladder tumors (TURBT) were enrolled in this study. The patients underwent bladder washout with 1,000 ml distilled water immediately after TURBT, and then intravesical irrigation with 3,000 ml water for three hours. Control patients were randomly chosen from those who previously underwent TURBT in our hospital and had similar prognostic factors. The 1- and 2-year recurrence-free rates in the patients undergoing distilled water irrigation were both 45% and those in the control patients were 65% and 45%, respectively. There were no significant differences between the two groups. This result indicates that distilled water was ineffective in preventing recurrence of superficial bladder tumor.

Bilharziasis is an endemic disease distributed mostly in African countries and the Middle East, and causes severe disturbances of urinary tract secondarily. Although it used to be a very rare disease in Japan, modern human mobility and jet travel have brought this tropical disease into our country far from endemic areas. A 25-year-old Japanese male presented to our hospital with macroscopic hematuria. He had an experience of traveling to Malawi two years before. Cystourethroscopy demonstrated so-called 'bilharzial tubercles', many yellowish specks of mucosa at the posterior wall and dome of the bladder. The diagnosis of bilharziasis was made by detection of Schistosoma haematobium eggs in urine and histological specimen obtained by transurethral biopsy. In this case, radiographic and pathological examinations revealed neither obstructive uropathy nor urothelial malignancy. He was treated with praziquantel, and the disease is under good control.

We investigated the clinical risk factors and bacteriological examination for surgical site infection (SSI) in 144 portless endoscopic surgeries consisting of 66 clean and 78 clean-contaminated surgeries in urological diseases from April 2000 to December 2001. There were no cases of SSI in the clean surgeries. SSI occurred in 5 cases (3.5%) of clean-contaminated surgeries including total cystectomy and ileal conduit in 4 cases and total prostatectomy in 1 case. Multivariate statistical studies revealed that usage of ileum during operation and preoperative hypo-albuminemia were significant risk factors for SSI. Gram-negative rods and anaerobic bacteria were isolated from the operative wound in the total cystectomy and ileal conduit, suggesting that SSI in the operation with usage of the ileum was partially derived from contamination with endogenous bacteria, while, normal flora of the skin in the wound did not cause any post-operative SSI.

A 67-year-old woman underwent abdominal ultrasonography as part of a general health examination and was incidentally found to have a mass 5 cm in diameter in the left adrenal gland. She had no experience of abdominal trauma. Computerized tomography (CT) revealed a 5.5 x 5.0 cm mass in the left adrenal gland, which was heterogeneously enhanced by the contrast medium. Hormanal data for adrenal function were all within the normal range. For the suspected non-functioning adrenal tumor, the patient underwent adrenalectomy. Histopathological examination demonstrated only hematoma without tumor cells.

Three cases of cyclophosphamide (CPM)-induced transitional cell carcinoma (TCC) of the bladder are reported. A 36-year-old female (case 1) and a 63-year-old male (case 2) received CPM at total doses of 104 g and 100 g, respectively, for the therapy of Wegener's granulomatosis. A 50-year-old female (case 3) received CPM at a dose of 57 g for the therapy of recurrent breast cancer. They visited our institute with the chief complaint of macrohematuria. In all cases, cystoscopy revealed bladder tumor with hemorrhagic cystitis. They underwent transurethral resection of bladder tumor. Histological examination revealed grade 2 TCC in cases 1 and 2 and grade 3 TCC in case 3. All patients underwent intravesical instillation of Mitomycin C with or without hyperthermia. Including our 3 cases, 17 cases of CPM-induced bladder tumor have been reported in the Japanese literature.

In renal infections, lack of peculiar symptoms and consequent delay of diagnosis can sometimes lead to a critical condition of the patient. We report three cases of life-threatening renal infections in female patients, two of which were subsequently fata. One patient died of left emphysematous pyelonephritis with bilateral pleuritis. The patient was correctly diagnosed 13 days after the onset of symptoms and expired 2 months later despite nephrectomy on the day of diagnosis. The second patient died of septic shock 3 days following the onset of symptoms. Autopsy revealed multiple perinephric abscess of the left kidney. The non-fatal case was a perinephric abscess spread to the iliopsoas muscle. The patient was diagnosed with perinephric abscess 11 days after the onset of symptoms and eventually underwent nephrectomy 9 days later. Two of the patients were diabetics and the third was a probable diabetic, who died too suddenly to confirm the diagnosis. Herein, we review the literature of, and discuss the diagnosis and management of serious renal infection.

A 52-year-old man underwent nephroureterectomy against left distal ureteral cancer (transitional cell carcinoma, Grade 2, pTa), and was followed up by surveillance alone. Twenty-two months postoperatively, a pedunculated tumor was found in the anterior urethra by cystourethroscopy. Pathological examination of the tumor resected transurethrally revealed a fibroepithelial polyp. There have been only twelve cases of fibroepithelial polyp of the anterior urethra reported in the literature. Since 4 out of 8 adult cases among them were found during the postoperative follow up period of urothelial cancer, mechanical irritation by repeated transurethral procedures might be responsible for the development of fibroepithelial polyp of the anterior urethra in these cases. If anterior urethral tumor is found during follow-up urothelial carcinoma, benign urethral polyp should be considered in the differential diagnosis.

We compared the efficacy of naftopidil with that of tamsulosin hydrochloride for benign prostatic hyperplasia patients. Eighty-five patients without improvement of quality of life (QOL) score by the administration of 50-75 mg naftopidil for more than four weeks were assigned to receive doses of 0.1-0.2 mg tamsulosin hydrochloride and 89 patients without improvement of QOL score by the administration of 0.1-0.2 mg tamsulosin hydrochloride for more than four weeks were assigned to receive doses of 50-75 mg naftopidil once a day for 8 weeks. International prostate symptom score, maximum flow rate, residual urine volume and side effect profile were determined before the administration of the first medicine, before the administration of the second medicine and after 8 weeks of treatment with the second medicine. In the group without improvement of QOL score by naftopidil, significant improvements in symptoms of urgency, weak stream and straining were observed after 8 weeks of treatment with tamsulosin hydrochloride. In the group without improvement of QOL score by tamsulosin hydrochloride, significant improvements in symptoms of incomplete emptying, intermittency and nocturia were observed after 8 weeks of treatment with naftopidil. In conclusion, improvement of symptoms by each alpha 1-blocker differs symptom by symptom. Tamsulosin hydrochloride was superior to naftopidil for the symptoms of urine flow and naftopidil was superior to tamsulosin hydrochloride for the symptom of nocturia.