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(Objective) We investigated the clinical features of patients under surveillance for localized renal masses. (Methods) This study was a retrospective analysis of 15 patients who were diagnosed as having clinically localized renal cell carcinoma and were placed under surveillance and 68 patients who underwent immediate radical operation for renal masses. (Results) The age at diagnosis in the surveillance group was significantly higher than in the immediate operation group (median, 81 vs. 65 years, respectively, P<0.01). The Charlson Comorbidity Index in the surveillance group was significantly higher than in the immediate operation group (median, 5 vs. 2, respectively, P<0.01) and 10 patients (67%) had complications, which was one of the reasons for surveillance. The median initial tumor size in the surveillance group was 2.5 cm (1.5-10.1). There was no significant difference in the tumor size between the two groups. During a median follow-up of 19 months (6-55) the median tumor growth rate was 0.29 cm per year (-0.19-0.65) in the surveillance group. Of the 15 patients with computed tomography follow-up, four underwent surgical resection of the renal masses after surveillance. The histological diagnosis was clear cell renal cell carcinoma in all four. During follow-up, two patients died of other causes and one patient had bone metastasis but there was no death related to the renal masses in the surveillance group. (Conclusions) The appropriateness of the surveillance should be considered when we initiate surveillance for patients with renal masses because metastasis was detected in one patient in this study. On the other hand, surveillance may be an acceptable management method for elderly or severely comorbid patients because there were two deaths from other causes in the surveillance group.

We evaluated the relationship between regional lymph node metastasis and tumor size in patients with M0 renal cell carcinoma who received regional lymph node dissection. The study involved 234 of the 247 patients with localized renal cell carcinoma who underwent radical nephrectomy with lymph node dissection at our institute between 1985 and 1999. Patients were arbitrarily classified into 3 groups by the greatest diameter of the tumor on preoperative computed tomography (CT): 4.0 cm or less (group A), 4.1 to 7.0 cm (group B), and 7.1 cm or more (group C). The incidence of lymph node metastasis was assessed in each group. The current study showed that 11 (4.7%) of the 234 patients with lymph node dissection together with radical nephrectomy were lymph node positive. The incidences of lymph node metastasis were 4.0% in group A, 2.3% in group B, and 8.4% in group C (p = 0.79). Of these 11 patients with lymph node metastasis, 2 (18.2%) have so far survived for over 5 years following surgery. Although the role of regional lymph node dissection with radical nephrectomy might be limited and controversial in renal cell carcinoma, urological surgeons should always be aware of possible metastasis for any tumor size.

Background: We investigated the effects of transforming growth factor (TGF)-betas on morphological and receptor phenotypes, as well as proliferation of four currently established human prostatic myofibroblast cell lines and one commercially available prostatic stromal cell line., Methods: The effects of TGF-betas on morphological changes and proliferation of the cells were studied by immunohistochemistry and bromodeoxyuridine assay, respectively. The expression of alpha 1-receptor subtypes was measured by real time quantitative reverse transcription-polymerase chain reaction (RT-PCR) and the radioligand binding assay for the receptors was also performed., Results: TGF-betas 1, 2, and 3 induced expression of desmin and myosin of cells of the established cell lines, and significantly inhibited their growth. The alpha 1a-receptor was expressed only in the commercially available cell line and alpha 1b and 1d, in all cell lines. TGF-beta 1 suppressed the expression of all three subtypes of the alpha 1-receptor. The binding sites of cells of all the cell lines were reduced by treatment with this growth factor., Conclusions: TGF-betas may induce human prostatic stromal cells to express the smooth muscle phenotype and inhibited their growth. However, the growth factor reduced the binding sites of the receptor and suppressed mRNA expression of its subtypes, suggesting that morphological and receptor phenotypes may be regulated via more than one pathway by TGF-beta(s)., (Copyright 2003 Wiley-Liss, Inc.)

Introduction: The Stamey bladder neck suspension for stress urinary incontinence in females is thought to be an excellent procedure. However, recent studies revealed that complications of this procedure have not been negligible. In this retrospective study, complications of the Stamey needle bladder neck suspension were examined., Materials and Methods: The Stamey procedure was performed either alone or in combination with anterior colporrhaphy for 86 female patients with stress urinary incontinence between 1989 and 1999. The mean follow-up period was 37.6 months and the mean age was 59.1 years. We studied the complications postoperatively pointed out by patients' complaint and image examination., Results: The overall incidence of complications was 37.2%. Voiding difficulties and lower abdominal pain were present in 15 cases, respectively. We experienced 2 unusual cases in whom suspensory stitches had to be removed due to abdominal pain., Conclusions: Although the Stamey bladder neck suspension is thought to be an excellent procedure for stress urinary incontinence, surgeons should beware of possible complications and be alert of the symptoms, such as abdominal pain and bladder irritation., (Copyright 2002 S. Karger AG, Basel)

A case of sarcomatoid transitional cell carcinoma of the renal pelvis is reported. It was distinguished from carcinosarcoma by immunohistochemical study. The tumor was difficult to distinguish from a renal parenchymal tumor in imaging studies because it originated from a duplicated renal pelvis.

Objectives: To elucidate the risk factors for a second or third intravesical recurrence in patients with superficial bladder cancer., Methods: Of 84 consecutive patients newly diagnosed as having superficial bladder cancer in Sapporo Medical University Hospital, 30 patients who had at least one recurrent superficial bladder cancer and were followed up for more than 3 years were included in this study. Multivariate analysis by Cox's proportional hazards model was used to determine which clinical and pathologic variables significantly affected the second and third recurrences. Stepwise regression analysis was used to determine which clinical and pathologic variables significantly affected multiple recurrences of bladder cancer., Results: The 1, 2, and 5-year recurrence-free rates as determined by the Kaplan-Meier method were 66.1%, 43.8%, and 29.8% for a second recurrence and 67.4%, 61.8%, and 39.2% for a third recurrence, respectively. Multivariate analysis revealed that only the interval between the initial transurethral resection of the bladder cancer and the first recurrence was a significant and independent factor affecting the second recurrence. In the study of the third recurrence, the interval between the first and second recurrences was the only definite risk factor for the third one. When multiple recurrences were considered, stepwise regression analysis revealed that a time of 6 months or less from the initial transurethral resection until the first recurrence was a significant factor that affected the total frequency of bladder cancer recurrence (R(2) = 0.220, P = 0.0078)., Conclusions: The results of our study indicate that patients will have the potential for frequent recurrences if they have the disease with recurrence after a short interval. This result may contribute to the selection of patients with superficial bladder cancer to receive aggressive adjuvant treatments to prevent frequent recurrences.

Objectives: To determine the clinical and pathologic risk factors for initial intravesical recurrence in patients with primary renal pelvic and/or ureteral cancer and to examine the progression in the bladder in patients having high risk factors for intravesical recurrence., Methods: This study included 69 patients with renal pelvic and/or ureteral cancer. We excluded patients with distant metastases, those with a short period of follow-up, and those having a previous history or concomitance of bladder cancer. The exclusion criteria were chosen to avoid contamination by patients with a poor prognosis who might die of the primary cancer before bladder cancer development. Multivariate analysis by Cox's proportional hazards model was used to determine what clinical and pathologic variables significantly affected the initial intravesical recurrence of cancer. We also studied the stage progression of cancer that recurred in the bladder., Results: Initial intravesical recurrence of the cancer was found in 22 patients during a median follow-up period of 53 months (range 12 to 225). The intravesical disease-free rate after upper tract urothelial cancer was 65% (rate of disease recurrence in bladder 35%) at 5 years by the Kaplan-Meier method. The extent (multifocality) of the upper urinary cancer (P = 0.0038) and pathologic stage (P = 0.0409) independently influenced intravesical recurrence. Age, sex, adjuvant chemotherapy, configuration of the primary tumor, primary cancer size, and pathologic grade did not affect recurrence. The rate of stage progression also was not influenced by the extent of the disease in the upper urinary tract., Conclusions: The extent and pathologic stage of cancer in the upper urinary tract were significant and independent factors for initial intravesical recurrence of cancer. However, no difference was found in clinical outcome in terms of stage progression between patients having high risk factors for intravesical recurrence and those without them.

Objectives: We examined the incidence of positive findings (concomitant carcinoma in situ (CIS), frank carcinoma and dysplasia) for normal-appearing mucosal biopsies in superficial bladder carcinoma and the clinical outcome of patients with positive biopsy results., Methods: Eighty-four cases of newly diagnosed superficial bladder carcinoma, from whom biopsies of preselected cystoscopically normal-appearing mucosal tissue were taken at the time of initial treatment, were studied. Multivariate analysis by Cox's proportional hazards model was applied., Results: Twenty-seven percent of the patients with superficial bladder carcinoma showed positive biopsy results. Positive biopsy results independently influenced intravesical recurrence by Cox's proportional hazards model., Conclusions: Positive mucosal biopsy results are a significant indicator of intravesical recurrence in patients with superficial bladder carcinoma.

Objectives: We evaluated the clinical significance of lymph node metastasis in patients with carcinomas of the renal pelvis and ureter., Methods: 68 patients without distant metastasis were included in this study. Multivariate analysis by Cox's proportional hazards model was applied to detect the prognostic factor(s)., Results: 12 patients (17.6%) had nodal involvement. More than 10% of the patients with pT1-2 showed nodal metastasis. Preoperatively determined clinical factors were not a predictive factor for nodal involvement. Nodal metastasis was the only significant negative prognostic factor for patient survival by multivariate analysis., Conclusions: Lymph node dissection is valuable to predict the clinical outcome of the patients with carcinoma of the renal pelvis and ureter. Attention should be paid to nodal status to select patients for conservative surgery.

Endoscopic reconstruction was performed in 5 patients after complete traumatic disruption of the urethra. A prostatic urethra was disrupted in 1 patient, prostatic and membranous urethrae in 1 and bulbous urethra in 3. After endoscopic reconstruction, all patients required additional internal urethrotomy and urethral bougienage, but became able to void by themselves. Four patients had maximum flow rates between 13.8 and 41.9 ml/s. However, the other patient with an obliterated urethral segment of 4.6 cm had traumatic impotence preoperatively and a poor voiding status after reconstruction. None of the patients developed urinary incontinence or impotence associated with the operation. In conclusion, endoscopic reconstruction is recommended as the initial procedure for patients with obliterated segments smaller than 3 cm.