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Neutrophil-to-lymphocyte ratio (NLR), a simple marker of systemic inflammatory response, has clinical and prognostic value in patients with cancer. We evaluated the role of NLR prior to biopsy in patients suspected of having cancer prostate cancer. In this retrospective study, we reviewed the records of 204 patients who underwent prostate biopsy in Mizushima Kyodo Hospital between August 2002 and June 2015 and collected the following data : age, C-reactive protein (CRP), prostate volume (PV), clinical cancer staging, prostate-specific antigen (PSA) prior to biopsy , Gleason score (GS), NLR. NLR was calculated by prebiopsy neutrophil and lymphocyte counts. We divided the 83 of 204 patients found to have prostate cancer (PCa) into two or three groups by the results of biopsy, PSA, clinical cancer staging, GS, and D’Amico risk classification. Mann-Whitney U-test and Kruskal-Wallis H-test were used to compare NLR in each group. Significant differences were recognized in NLR between the groups : PSA≧10 ng/ml VS ＜ 10 ng/ml in all patients and in patients with cancer, cT2b≧ VS cT2c≦, GS 6 VS GS 7 VS GS 8≦ in patients with cancer and low risk VS intermediate risk VS high risk in patients with cancer without metastasis. Also we investigated the correlated factor with NLR in patients with cancer without metastasis. On multiple regression analysis including age, CRP, PV, PSA, clinical tumor stage and GS, PSA and GS had a significant association with NLR.

In Japan, prostate cancer is treated with non-steroidal anti-androgen (flutamide and bicalutamide). Development of breast pain during bicalutamide treatment, in prostate cancer patients reduces their quality of life (QOL) and treatment compliance. We studied the safety and effectiveness of switching from bicalutamide to flutamide in 13 prostate cancer patients who developed breast pain during bicalutamide treatment. We estimated the change in breast pain using a face scale and the Expanded Prostate Cancer Index Composite (EPIC) and EPIC-hormone domain (HD) score. The switch to flutamide relieved breast pain in nine patients, had no effect in one patient, and increased breast pain in two patients. One patient dropped out. Furthermore, summary score and hormone function were improved with a significant difference in the EPIC-HD score. Switching to flutamide in prostate cancer patients who develop breast pain during bicalutamide is safe and effective.

A 67-year-old male underwent a radical cystectomy and ileal neobladder construction in September 2002. He developed adhesive ileus postoperatively and underwent an intestine-ascending colon bypass operation with a side-to-side anastomosis in December of 2002. Subsequently, the patient developed ileus frequently, which improved with conservative management. In February 2013, he had fecaluria and was diagnosed with an ileal neobladder-enteric fistula based on computed tomography 2 hours after contrast medium injection. He underwent closure of the intestinal anal side of the anastomosis between the intestine and ascending colon. The fecaluria disappeared and he is making steady progress. An ileal neobladderenteric fistula as a long-term postoperative complication of ileal neobladder construction is extremely rare, with no other reports to our knowledge. Here, we discuss its cause, diagnosis and treatment, with reference to previous reports.

根治的前立腺摘除術(RP)後の高齢男性の排尿パターンを高齢女性との比較を交えて検討した。解析数は男性102名, 女性40名であった。1)国際尿失禁会議質問表を用いた手術後の尿失禁の検討では, 術後1年以内の患者群よりも1年以上経過した患者群の方が失禁の頻度, 量ともに改善する傾向が認められた。2)過活動膀胱症状質問表を用いた検討では, 尿意の切迫感スコアは術後経過が長いほど上昇する傾向を示した。3)国際前立腺症状スコアを用いて高齢女性の排尿機能を検討した結果では, voiding symptomよりもstorage symptom score優位の排尿障害パターンが示された。4)手術前の高齢男性はvoiding symptom優位の排尿障害パターンを示したが, 術後はstorage symptom score優位の排尿障害パターンへと変化しており, 術後の男性患者は高齢女性の排尿障害パターンに類似している可能性が示唆された。, The lower urinary tract anatomy in men after radical prostatectomy (RP) resembles that in women. Out of 112 male patients who had undergone RP for localized prostate cancer, 102 (91%) of them responded to a questionnaire survey. The mean age of the responders at the time of RP was 65.9 +/- 5.3 years. The time of response after RP ranged from 2 months to 6 years (median: 44 months). The instruments used for the assessment of urinary status were the International Prostate Symptom Score (IPSS) and QOL score, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Overactive Bladder Symptom Score (OABSS). Urinary status of 40 elderly female patients aged 59.5 +/- 6.9 years who consulted our outpatient clinic due to conditions (microhematuria, simple renal cyst, etc.) unrelated to lower urinary tract disorders were assessed with the IPSS. In the male patients, total IPSS and QOL score showed significant improvement over time after RP (P = 0.0004, P = 0.0015, respectively). In particular, the voiding symptom score of IPSS showed significant improvement (P < 0.0001). The improvement of incontinence within 1 year after RP was confirmed with ICIQ-SF (p = 0.06). In contrast, the storage symptom score of IPSS after RP was not different with time after RP. Furthermore, the OABSS rose with time after RP (p = 0.08). On the other hand, in the elderly female controls, the storage symptom score of IPSS was significantly higher than voiding symptom score (P = 0.0019). Men who underwent RP showed significant improvement in their voiding symptoms and continence status, but the storage symptoms, progressively worsened following RP. Consequently, careful follow-up and appropriate medical intervention are needed in men after RP as in aging women.

症例は42歳, 男性。AFP値が高いことを指摘されて当院を紹介受診した。この患者は21年間に非セミノーマの右精巣腫瘍の治療歴があった。当院受診時のCTでは右腎静脈から大動脈分岐まで下大静脈を圧排するような形で5×5cmの腫瘍を認めた。当院入院後, シスプラチン・エトポシド・パクリタキセル・イフォスファミドの4剤を併用した化学療法を施行した。しかし, 腫瘍は縮小せずAFP値も上昇した。そのためリンパ節郭清術・右腎摘出術・十二指腸部分切除術・下大静脈切除術を施行した。術後AFP値は正常範囲内に低下して, 現在約48ヵ月経過しているが再発は認めていない。(著者抄録), We report here a case of very late relapse of a nonseminomatous germ cell tumor 21 years after first complete remission. A 42-year-old man, with a clinical history of right testicular cancer, was referred to our hospital with elevated serum alpha-fetoprotein (AFP) level. CT scan demonstrated a 5 x 5 cm retroperitoneal lymph node swelling compressing the inferior vena cava (IVC) extending from the right renal vein down to the bifurcation of the aorta. The patient received a total of four courses of combination chemotherapy consisting of cisplatin, etoposide, paxlitaxel, and ifosfamide. However, the retroperitoneal lymph node metastasis did not respond to chemotherapy, and the serum AFP level increased. Extended bilateral retroperitoneal lymph node dissection with right nephrectomy, partial duodenectomy, and vena cavectomy were performed. The patient has been followed up with no evidence of disease for 48 months after the operation without any further therapy.

急性肺血栓塞栓症(PTE)予防目的で一時留置型下大静脈フィルター(IVCF)を使用した4症例を検討した.症例1は下大静脈(IVC)内腫瘍塞栓を有する精巣癌症例であった.抗癌化学療法施行前にIVCFを挿入したところ, PTEの発症はなく, 予定通り抗癌化学療法を施行できた.症例2はIVC内腫瘍塞栓を有する巨大副腎癌症例で, 手術予定日の20日前にPTEを生じた.IVCF挿入により呼吸状態は改善し, 手術を施行できたが, PTE発症前からIVCFを用いておけばPTEを予防できたと思われた.症例3は腎外傷発症後15日目に右腸骨静脈と右卵巣静脈に血栓が出現した.IVCF挿入により, 2週間後には血栓の縮小がみられた.症例4は全身性エリテマトーデス治療中に左腎静脈内血栓症を認めた.IVCF留置により, 左腎機能は右腎の70%程度まで回復した.IVCF留置に関する有用性と問題点について述べたが, IVCF留置後にPTEの発生はなく, IVCFのPTE予防効果は良好だと思われた, A temporary inferior vena cava (IVC) filter was placed in 4 patients. Patient 1 had an advanced testicular germ cell tumor with IVC tumor thrombosis, patient 2 presented with a large adrenal tumor with IVC tumor thrombosis, patient 3 was found to have deep vein thrombosis following grade 3b renal injury, and patient 4 was suffering severe SLE with renal vein thrombosis. The temporary inferior vena cava filter prevented pulmonary thromboembolism in all cases, and no adverse reaction was observed. Temporary inferior vena cava filter is safe and useful to prevent pulmonary thromboembolism associated with urological disorders.

症例1は8歳男で, 排尿時膀胱造影にて外尿道括約筋遠位部に狭窄があり, 両側II度のVURを認めた.内視鏡的切開術を施行し, 術後3ヵ月で遺尿症を再発した.再度切開術を施行し, 外尿道括約筋のすぐ遠位に膀胱を充満させると強調されるリング状狭窄を認めた.症例2は7歳男で, 排尿時膀胱造影にて外尿道括約筋遠位部に狭窄を認め, 左側にII度のVURを伴っていた.尿道狭窄症と診断し内視鏡的切開術を施行した.膀胱内には軽度の肉柱形成が存在し, 括約筋遠位に巻き貝状の狭窄を認めた.術後4ヵ月でVURは消失していた.症例3は5歳男で, 排尿時膀胱造影にて外尿道括約筋遠位部に狭窄を認め, VURはなかった.内視鏡的切開術を施行し, 膀胱内には軽度の肉柱形成が存在しており, 括約筋遠位に複数の不完全なリング状狭窄を認めたため切開した, We report three cases of congenital urethral stricture in boys. They were 8, 7 and 5 years old. They complained of enuresis both day and night. Voiding cystography revealed bulbar narrowing (Cobb's Collar) in all cases, and vesico-ureteral reflux (VUR) occurred in two cases (three ureters). Endoscopically this lesion showed ring-form stenosis just distal to the urethral sphincter, and incised by using an infantile urethrotome. After the operation, VUR resolved in two ureters and improved in one. In all cases, daytime enuresis resolved dramatically, and night enuresis became controllable. Congenital urethral stenosis in boys is an important clinical entity in pediatric urology, and is not such a rare disease.

症例は62歳男性.全身倦怠感で近医を受診し, 腹部CTにて左腎腫瘍を指摘された.左腎細胞癌を疑い, 経腹的根治的左腎摘出術を施行した.病理組織学的所見では, Vimentinによる免疫染色所見が陽性で, はっきりとした分化を示す成分に乏しい点からmalignant fibrous histiocytomaと診断した.組織学的には腎実質との連続性は明瞭でなく, 画像所見と合わせて腎被膜由来と判断した.術後経過良好で退院した.術後7ヵ月後の現時点において再発は認めていない, A 62-year-old man was admitted with a chief complaint of general malaise. Computed tomography showed a large mass adjacent to the parenchyma of the left kidney. The mass was 17 x 13 x 12 cm in size. Preoperative diagnosis was left renal cell carcinoma and left radical nephrectomy was performed. Histopathologically, the tumor was diagnosed as malignant fibrous histiocytoma (MFH), and the tumor was considered to have arisen from the renal capsule. There has been no recurrence for 7 months postoperatively. We review 40 cases of MFH arising from the kidney or the renal capsule in the literature.

1996年3月から30ヵ月間に前立腺全摘術を施行したT1c前立腺癌40例を対象に検討した.1)術前の生検でGleason scoreが7以上の症例は, PSA, PSAD, free PSA, % free PSAの全てにおいてGleason scoreが6以下の症例と有意な分布差を認め, 全例腫瘍体積が0.5cm3以上であった.2)Gleason scoreが6以下の症例では, 腫瘍体積0.5cm3の区分に, PSA, PSAD, free PSA, % free PSAのうち% free PSAが最も有用で, % free PSAが15ないし20より低い症例は, 腫瘍体積が0.5cm3以上の可能性が高いことが示唆された, The number of cases of stage T1c prostate cancer has dramatically been increasing since the introduction of PSA as a screening test. The patients with T1c prostate cancer are usually treated by radical prostatectomy. In this group, however, some cancers are of small tumor volume and with a Gleason score of less than 7. These cancers are considered to be good candidates for watchful waiting management. We have investigated 40 patients with T1c prostate cancer treated by radical prostatectomy between 1996 and 1998. All 9 patients harboring tumors of Gleason score 7 or greater had tumors larger than 0.5 cm3. We have investigated PSA-related parameters including total PSA (PSA), PSA density (PSAD), free PSA, and % free PSA in 31 patients with T1c cancers of Gleason score 6 or less in order to clarify good preoperative predictors of tumor volume. We compared the distribution of PSA, PSAD, free PSA, and % PSA between the larger and smaller tumor groups. There was no significant difference in PSA, PSAD, or free PSA value. The small tumor group had a greater mean % free PSA than the larger tumor group (23.27 versus 11.88, p = 0.007). Areas under receiver operating characteristic curves were 0.715, 0.794, 0.636, and 0.842 for PSA, PSAD, free PSA and % free PSA. In stage T1c prostate cancer of Gleason score 6 or less, % free PSA may be the most useful preoperative predictor for tumor volume of 0.5 cm3 or greater.

1)Sheldonらの分類でstage IIIA迄の尿膜管癌の初回手術として, 臍・尿膜管全摘除術を加えた膀胱部分切除術にて長期の生存, 膀胱温存が得られる可能性が示唆された.2)CEAは患者血清4例中2例, 尿膜管癌組織5例中5例で陽性であり, 尿膜管癌の腫瘍マーカーとなる可能性が示唆された.3)p53は尿膜管癌組織5例中4例で陽性であったが, stageや予後との相関は認められなかった, Five cases of urachal carcinoma experienced in our hospital during the past 20 years are reported. Surgical resection is considered as the first treatment option of this disease, and other therapies to be less beneficial. Complete surgical extirpation and detection of recurrence in the early stage are considered to be important since local recurrence occurs frequently. We enforced the bladder preserving operation for 4 patients with urachal carcinoma except for 1 case with peritonitis carcinomatosa in the initial diagnosis, and multiple surgical treatment was performed again for 2 patients with recurrence. The bladder was preserved with no evidence of malignancy in three patients for 24, 19 and 5 years, respectively. In the initial management of urachal carcinoma, we believe that bladder-preserving surgery should be considered in selected cases though close follow-up is demanded. Herein, we also report the immunohistochemical study of paraffin-embedded specimens using anti-CEA, CA19-9, CA125 and p53 monoclonal antibodies. The positive reaction was observed in 100% (5/5) for CEA, 80% (4/5) for CA19-9, and 20% (1/5) for CA125. These results suggest that CEA may be a useful marker in the diagnosis of this neoplasm and early detection of its recurrence. Nuclear accumulation of p53 was observed in 80% (4/5), but it did not correlate with the disease progression.

1990年代の我が国における前立腺大症患者数や医療費の動向を総括する目的で厚生省の各種統計資料を分析した.総受療患者数は1987年20.2万人, 1995年33.5万人, 1998年59.0万人へと10年余りで2.9倍に増加し, 特に1995年以降の増加が著明であった.65歳以上の患者が全体の73～80%, 55歳以上が94～98%を占めていた.年間手術件数は5万件前後で, 明らかな年次的増加又は減少傾向は認められなかった.1988～1998年の間に総医療費は750億円から1, 400億円へとほぼ倍増した.入院医療費は総医療費の30～40%を占めていた.薬剤市場規模は1989年の300億円台から1998年には800億円を超えた.特に1995年以降, α遮断薬の使用患者数は24万人から45万人へと激増し, 全患者の70～77%に処方されるようになった, To review the contemporary management of benign prostatic hyperplasia (BPH) in Japan during 1990s, we analyzed several nationwide health statistics by the Ministry of Health and Welfare of Japan. The cross-sectional surveys revealed that the estimated total number of patients receiving treatment increased from 202, 000 in 1987, to 335, 000 and 590, 000, respectively, in 1995 and 1998. Approximately 73-80% of patients were men aged 65 years or over and 94-98% 55 years or older. Urologists treated two thirds of the BPH patients. The incidence of prostatectomies remained relatively stable at 50, 000/year (3.0-3.8 prostatectomies/1, 000 men aged 55 or over). The average hospital stay in 1996 was 24.7 days. The total cost of BPH therapy nearly doubled between 1988 and 1998. The ratio of outpatient to inpatient costs ranged from 1.5 to 2.2 and 60% of the outpatient cost was spent for medical therapy. The total value of the market for medical therapy increased from 30-40 billion yen in 1989 to more than 80 billion yen in 1998. The application of alpha-blockers increased from 243, 000 men (70% of all patients) in 1995 to 452, 000 (77%) in 1998, whereas the number of patients taking antiandrogens, plant extracts and antispasmodic agents/Ca antagonists (for pollakisuria), respectively, remained relatively stable at 60, 000-70, 000, 180, 000 and 300, 000. Because Japan is a rapidly aging society and men aged 55 or older are expected to increase from 15 million in 1995 to 21 million in 2010, cost-effective treatment guidelines for the Japanese BPH patients are needed.

精巣上体精子採取法の適応, 採取方法の選択, 補助生殖技術(ART)とのタイミング, 治療法の問題点について解説した.精巣上体精子採取法は閉塞性無精子症に対する治療法の1つであり, 近年の体外受精・胚移植や顕微授精等のニューテクノロジー, いわゆるARTとの医療連携により多数の産児が得られるようになってきた.しかし本来, 閉塞性無精子症の治療目標は再吻合による閉塞の解除である.閉塞性無精子症におけるマイクロサージェリーの成績向上, 各医の技術の上達が望まれる, Epididymal sperm aspiration technique combined with assisted reproductive technology (ART) including intracytoplasmic sperm injection (ICSI) has provided new frontiers for the treatment of unreconstructable obstructive azoospermia, including congenital bilateral absence of the vas deferens and failed surgical intervention. Epididymal sperm is obtained by several procedures, including microsurgical epididymal sperm aspiration (MESA), mini-MESA (Modified MESA), macroscopic epididymal sperm aspiration (MaESA) and percutaneous epididymal sperm aspiration (PESA). Since 1991 in our department, epididymal sperm aspiration combined with ART was performed by MESA (26 cases, 41 times) and PESA (3 cases, 4 times). Motile sperm retrieval using MESA and PESA was obtained in 34 out of 36 times (94.4%) and 2 out of 4 times (50%), respectively. MESA-ICSI resulted in a 47.3% 2PN (metaphase II) fertilization rate per eggs and a 28.8% pregnancy rate per transfer. With advancement of ICSI technique in which frozen sperm can be used, elective sperm retrieval can be planned at our convenience. PESA is a convenient, inexpensive and effective outpatient clinic procedure for retrieving sperm assisted with ICSI. In summary, infertile couples need to be given realistic options regarding treatment outcome. The fertility potential and age of the female partner need to be considered when addressing male treatment options.

Detection of urinary telomerase activity is superior to the conventional urine cytological examination in terms of sensitivity for diagnosis of low grade urothelial cancers. Several causative factors including pyuria and hematuria which might have affected falsely positive and negative rates of urinary telomerase activity were investigated but their influence seemed negligible. As for progression from superficial to invasive urothelial cancers, destruction of the basement membrane underlying tumor is considered as an important event in the initial step of invasion. Our immunohistochemical analyses revealed that expression of type IV collagen in the basement membrane was reduced or disappeared in more than half of grade 2 to 3, pTa urothelial cancers. Overexpression of p53 tumor suppressor and/or mdm2 oncoprotein was strongly correlated with this basement membrane destruction. Urothelial cancers harboring p53 aberration may be resistant to cisplatin-based chemotherapy because of impairment of apoptosis induction. The relationship between chemosensitivity and p53 status in urothelial cancers was investigated, and a favorable response to neoadjuvant chemotherapy was found in tumors without p53 aberration.

We report a case of transitional cell carcinoma in a patient with chronic renal failure receiving hemodialysis for 22 years. A 55-year-old man was admitted to our hospital. Under diagnosis of invasive bladder cancer and left renal pelvic tumor, removal of the whole urinary tract, e.g., bilateral nephroureterectomy and total cystourethrectomy was performed. Transitional cell carcinoma was found in bilateral renal pelvis, left ureter, bladder and prostate in the resected specimen. Thirteen months after the operation, multiple lung metastases and pathologic bone fracture of the 4th lumber vertebra were found. Chemotherapy (3 courses of modified CISCA, consisting of cisplatin, adriamycin and cyclophosphamide) was performed, but the died of systemic metastases of cancer and bleeding due to perforation of multiple gastric ulcers.

ヒト新鮮腎癌培養細胞及び腎癌株化細胞におけるMHCクラスI, MCHクラスII, ICAM-1, LFA-3, B7の発現を検討した.更に, この発現のIFN-α, cimetidineによる修飾についても検討した.IFN-αは腎癌細胞のMHCクラスI, ICAM-1, LFA-3の発現を, cimetidineはLFA-3の発現を増強することにより, リンパ球の腎癌に対する殺細胞効果を増強していることが示唆された, Recently the combined therapy with interferon-alpha (IFN-alpha) and cimetidine has been reported to be effective against advanced renal cell carcinoma (RCC). IFN-alpha and cimetidine have an antitumor effect partly due to enhancement of cytotoxic activity of lymphocytes against cancer cells. We examined the expression of major histocompatibility complex (MHC) antigens and adhesion molecules on 4 fresh RCC cells and 5 RCC cultured cell lines, which have an important role in recognition and killing of cytotoxic lymphocytes against cancer cells. The effect of treatment with IFN-alpha and/or cimetidine on the expression of MHC antigens and adhesion molecules on RCC cells was also investigated. MHC class I and leukocyte function-associated antigen-3 (LFA-3) were expressed on all RCC cells, but not MHC class II. Intercellular adhesion molecule-1 (ICAM-1) and B7 were expressed on 6 and 5 of 8 RCC cells, respectively. IFN-alpha significantly augmented the expression of MHC class I in 6 of 9 RCC cells, ICAM-1 in 1 and LFA-3 in 2 of 8 RCC cells. However, IFN-alpha did not affect the expression of MHC class II and B7. On the other hand, cimetidine enhanced the expression of LFA-3 in 2 of 8 RCC cells, but not MHC antigens, ICAM-1 or B7. The combination of IFN-alpha and cimetidine did not show a synergistic enhancing effect on the expression of MHC antigens, ICAM-1, LFA-3 or B7. These results suggest that IFN-alpha augments the sensitivity of RCC cells to lysis by cytotoxic lymphocytes partly due to the enhancement of expression of MHC class I, ICAM-1 and LFA-3 on RCC cells, and that cimetidine also augments the susceptibility of RCC cells to lymphocytes by the enhanced expression of LFA-3 on RCC cells.

Nephrogenic adenomaは尿路に発生する比較的稀な良性腫瘍である.29歳男, 72歳女, 75歳男の本例を経験した.尿路の手術後や慢性膀胱炎罹患中に発生する膀胱腫瘍の鑑別診断の1つとして膀胱nephrogenic adenomaは考慮すべき疾患である, Nephrogenic adenoma is a rare, benign tumor of the urinary tract. The origin of this tumor is supposed to be a metaplastic transformation of urothelium in response to stimulation such as recurrent urinary tract infections or surgical trauma. We experienced three cases of nephrogenic adenoma originating in the bladder. The first patient was a 29-year-old man with right vesicoureteral reflux (VUR). When Teflon injection for VUR was performed, a papillary tumor was found on the right wall of the bladder. Transurethral resection of the bladder tumor (TUR-Bt) was performed. The second patient was a 72-year-old woman who was suffering from chronic cystitis. Although she was treated with antibiotics for one year, the symptoms were not improved. Cystoscopy showed multiple papillary tumors at the retrotrigonum of the bladder and TUR-Bt was performed. The third patient was a 75-year-old man who had a history of the left pelvic and bilateral ureteral tumors. Left radical nephroureterectomy and right radical ureterectomy with an ileal graft replacement was performed. Three years later, cystoscopy demonstrated a papillary tumor at the retrotrigonum, which was resected transurethrally. Our cases are the 20th to 22nd cases of the nephrogenic adenoma of the bladder reported in the Japanese literature.

当科において施行した80歳以上と80歳未満の直接効果目的BCG療法施行群の治療成績を比較した.この年齢層においてもBCG膀注は施行可能であるが, その奏効率は80歳未満の症例よりも低かった, To study the efficacy and the safety of intravesical bacillus Calmette-Guerin (BCG) therapy for very elderly patients with superficial bladder cancer, we retrospectively compared patients over 80 years old who had received BCG therapy at our department between 1991 and 1996 (Group A; 10 patients 11 courses), with those below 80 years old (Group B, 17 patients 18 courses). In these patients, skin test reactivity to purified protein derivative showed a significant negative correlation with age (p = 0.016). No irreversible complications were observed in any patient. Persistence of acid-fast bacilli for more than one month after the termination of the course was observed in two patients in group A, and one in group B. A comparison of the cases undergoing eradicational BCG therapy in the two groups, grade 2 transitional cell carcinoma (TCC) was significantly more predominant than grade 3 TCC in group A (p = 0.004). (None of the tumors in group A were of grade 3) The disease-free rate was significantly lower in group A (p < 0.05), but 5 of the 10 patients in this group were finally disease-free. From these results, we conclude that intravesical BCG instillation therapy can be performed in patients over 80 years old, although a relatively lower disease-free rate is expected and special attention should be taken with regard to persistent BCG infection. The lower disease-free rate could be attributable to either diminished cellular immunity or a difference in tumor grade, although a definite conclusion could not be obtained here.

組織プラスミノーゲンアクチベータにて選択的腎動脈線溶療法を施行した腎動脈塞栓症2例(74歳女, 66歳女)を報告した.1例は発症後3日目の治療にもかかわらず塞栓が溶解され腎機能が回復した, Two cases of renal artery embolism treated by selective intra-arterial infusion of tissue plasminogen activator (t-PA) are reported. A 74-year-old woman with atrial fibrillation presented with left flank pain of 54-hour duration. Selective renal angiography revealed embolic obstruction of multiple segmental arteries in the left kidney. She was treated by one-shot intra-arterial t-PA infusion (8, 000, 000 units) and intravenous heparinization (25, 000 units/3 days). Although fibrinolysis was successful except for most distal arterial branches, complete recovery of renal function was not obtained. A 66-year-old man presented with complete obstruction of left main renal artery. He had hyperthyroidism and atrial fibrillation. At 75 hours after onset of left flank pain, he was treated by one-shot intra-arterial t-PA infusion (18, 000, 000 units) and intravenous heparinization (4, 000 units/24 hours). His renal function was recovered completely. Selective intraarterial t-PA infusion is considered an effective treatment for renal artery embolism.

自然排尿型尿路再建術を施行した23例の男子膀胱癌患者の手術成績を検討した.術式はhemi-Kock法8例, Hautmann法12例, Reddy法3例で, 平均経過観察期間は36ヵ月である.手術関連死はなかった.早期合併症は7例にみられ, パウチからの尿瘻4例, 創感染3例, 腎盂腎炎2例であった.昼間尿禁制は22例で得られたが, 夜間尿失禁は7例にみられ, Reddy法では3例全てにみられた.排尿困難は4例にみられ, うち1例は尿閉となった.晩期合併症としては, 尿道狭窄2例, 創ヘルニア 2例, パウチ内結石1例, 胆石症1例であった, Between 1988 and 1996, 23 male patients with bladder cancer underwent bladder substitution after cystectomy, using either the hemi-Kock, Hautmann, and Reddy procedures. The mean postoperative follow-up period was 36 months, with a range of 3 to 85 months. There were no perioperative deaths, and early postoperative complications occurred in 7 patients (30%); transient urine leak from the pouch in 4, wound infection in 3 and pyelonephritis in 2 patients. Twenty-two of the 23 patients (96%) were continent during the day, while 7 (30%) had nocturnal incontinence. All 3 patients with the Reddy procedure had nocturnal incontinence. Complete continence was preserved in 70% of the patients. Dysuria was seen in 4 patients, including retention in 1 patient. Late complications included urethral stricture in 3, wound hernia in 2, metabolic acidosis in 1, stone in the pouch in 1, and gallbladder stone in 1 patient. However, reoperation was necessary in 1 patient for internal urethrotomy and 1 patient for removal of a stone in the neobladder. Mild degree of hydronephrosis and unilateral reflux were seen in 3 patients each, and followed up conservatively. No urethral recurrence has occurred and only 1 patient died of cancer. The need for reoperation was very low and the high reservoir capacity resulted in continence from the beginning in most patients. We considered the neobladder useful as an alternative form of urinary diversion in selected cases.

A case of localized amyloidosis of the ureter is reported. The patient was a 49-year-old female whose chief complaint was macrohematuria. Roentogenographic examination showed left hydronephrosis due to stenosis of left middle ureter. Left nephrouretectomy with cuff was performed with a diagnosis of the left ureteral tumor, and pathological examination revealed localized amyloidosis of the left ureter. Localized amyloidosis of the ureter is a rare lesion, and this is the twenty-first case reported in the Japanese literature. Review of the literature revealed that it is difficult to differentiate this lesion from other ureteral tumors by roentgenographic examination, and it is important to perform preoperative or intraoperative biopsy of ureteral tumors if benign diseases cannot be ruled out.

We report a case of transitional cell carcinoma of the bladder metastasizing to bilateral adrenal glands without other metastasis. A 47-year-old male underwent total cystectomy due to bladder cancer (TCC, G2, pT2) in 1992. One year later, CT scan showed a large tumor in the right adrenal gland. Right adrenalectomy revealed metastatic transitional cell carcinoma. He underwent 3 courses of M-VAC postoperatively. However, one year after the second operation, left adrenal tumor was detected by CT. Because there was no apparent metastasis other than the adrenal gland, left adrenalectomy was performed and the tumor was transitional cell carcinoma of grade 3. He was discharged from the hospital after 2 courses of CISCA chemotherapy, and has been doing well without evidence of recurrence for two years, being supported by the adrenocortical steroids.

ヒト腎及び腎細胞癌組織におけるE-カドヘリンの発現を免疫組織学的に解析した.腎細胞癌の組織学的亜型による発現の差違はその発生母細胞での発現の有無によることが示唆された, E-cadherin, a member of the cadherin family, plays a major role in cell-cell adhesion of normal epithelium. Recent studies have demonstrated that heterogeneous expression, reduction or loss of E-cadherin is involved in invasion and metastasis of cancer cells. In this study, the localization of E-cadherin in the normal human kidney and the relationship between E-cadherin expression and histopathological features in renal cell carcinomas was examined immunohistochemically. Renal cell carcinoma tissues and normal kidney counterparts were obtained from 20 patients. E-cadherin in the normal kidney was detected in the cell-cell border of the distal tubules, collecting duct and Bowman's capsule but not in the proximal tubules. E-cadherin expression was reduced in all the clear cell type renal cell carcinomas with compact or cystic configuration (n = 15), while it was well preserved in all the papillary type (n = 3) and chromophobe cell type (n = 1) renal cell carcinomas. Different expression patterns between primary site and metastasis, i.e., homogeneously weak in primary tumor and heterogeneously positive in metastatis, was observed in a case of clear cell type renal cell carcinoma. Different patterns of expression between clear and non-clear cell type, or between papillary and non-papillary type, together with strong expression in chromophobe type might reflect the origin of each type of renal cell carcinoma. Further studies will clarify whether the change in expression of E-cadherin is associated with the prognosis of renal cell carcinoma.

尿路上皮癌30例について検討した。E-カドヘリンの発現が減弱しているものは全例grade 2以上でpT 2以上が75%を占め, high grade, high stageが有意に多く, 今後予後因子のひとつとなる可能性がある, E-cadherin expression was investigated in 30 patients with urothelial cancer (bladder; 27, ureter; 2, urethra; 1) by an immunohistochemical method. Twelve out of 22 patients with strong and homogeneous expression of E-cadherin (preserved) had grade 1 tumors, while all 8 patients with heterogeneous, weak and homogeneous, or lost expression of E-cadherin (reduced) had grade 2 or grade 3 tumors. Only 2 out of 22 patients with preserved expression had invasive tumors (> or = pT2), whereas 6 out of 8 patients with reduced expression had invasive tumors (p = 0.002). Three out of 4 patients with metastasis had reduced expression and 2 of them died. These findings suggest that urothelial tumors with reduced expression of E-cadherin have high grade and high stage, and E-cadherin expression could be one of the prognostic factors.

MDR1遺伝子を高いレベルで発現する2種類の腎癌細胞を使い, cepを含む5種類のMDR克服剤のVBLに対する感受性増強効果を比較した。さらにcepの各種抗癌剤に対する感受性増強の有無とその程度を検討した。これらをもとにVBL, ADRまたはepi-ADRにcepを併用した動脈内注入化学療法を6症例の腎癌転移巣に対し行い, 骨転移の2症例で著しい治療効果がえられた。このようなP糖蛋白を標的とした化学療法は, 特にBRM療法に比較的抵抗性の骨転移病巣などに対しては, 有効な治療法になりえると考えられた, We analyzed the sensitizing activity of five agents, which have been assumed to be MDR-overcoming drugs, in two human renal cell carcinoma cell lines expressing the MDR1 gene at high levels. In addition, we studied the sensitizing activity of cepharanthin, an MDR-overcoming agents, to vinblastine, adriamycin, epirubicin, cisplatin, mitomycin C and etoposide. Based on the results, we treated 6 patients with metastatic renal cell carcinomas (4: bones, 2: contralateral kidneys) by intraarterial injection of vinblastine and adriamycin (or epirubicin) in combination with cepharanthin. Two of the 4 bone metastasis cases responded markedly to the treatment. Renal tubular impairment was observed in one patient who was treated for the contralateral kidney metastasis.

81歳女.尿道よりの血性分泌物を主訴に受診し, 尿道周囲に腫瘤性病変を認めた.腟前壁に尿道に沿って鶏卵大で弾性軟の腫瘤を触知し, 圧痛はみられなかった.尿細胞診はクラスVで, 移行上皮癌が疑われた.骨盤部CTで尿道周囲に不均一な軟部腫瘤を認めたが, 骨盤部リンパ節に明らかな腫脹はみられなかった.骨盤部MRIで膀胱下面に径4cmの腫瘤を認めた.超音波ガイド下に経腟的針生検を施行し, 腺癌の診断で腫瘍摘出術を施行した, An 81-year-old woman was admitted with a chief complaint of bloody discharge from the urethra. On physical examination an elastic-soft mass was palpable beneath the anterior vaginal wall. Magnetic resonance imaging and computed tomographic scan revealed the mass around the urethra. Transvaginal needle biopsy was performed and the histopathologic finding was adenocarcinoma. The tumor was excised with the uterus, the ovary and the anterior vaginal wall. The macroscopic appearance suggested that the tumor arose in the urethral diverticulum. She had intravesical recurrence at 8 months after the operation, and partial cystectomy was performed. However there was recurrence again, and radical cystectomy was performed finally. We review 81 cases of urethral diverticular carcinoma in the literature.

46歳男.頻尿, 肉眼的血尿を自覚し, 症状が徐々に増悪し排尿痛も出現した.CRP軽度上昇以外の血液・生化学的異常は認めなかった, が膀胱鏡で非乳頭状広基性腫瘍を認めた.骨盤部MRIでは腫瘍は膀胱内腔の大部分を占め, 膀胱周囲脂肪組織および前立腺への浸潤が疑われた.また, 左右内腸骨領域にリンパ節を多数認めたが胸腹部CTおよび骨シンチでは他臓器への転移は認めなかった.経尿道的切除術による生検を実施し膀胱扁平上皮癌, 臨床病期T3bN2M0と診断し全骨盤の外照射を施行した.動脈内注入化学療法を2コースにpepleomycin sulfate(PEP)の全身投与を併用した.MVAC regimenによる全身化学療法を2コース追加しリンパ節も60%縮小しPRとなった.放射線性膀胱炎による血尿, 膀胱刺激症状が強いため, 膀胱全摘除術, リンパ節郭清術, 回腸導管造設術を行った, We report a case of regionally metastatic pure squamous cell carcinoma of the urinary bladder successfully treated with combined radiation and chemotherapy in a 46-year-old man. Clinical staging was T3bN2M0. The patient received 50 Gy external radiation combined with intraarterial and systemic chemotherapy. Pathological complete response was found both in bladder and regional lymph nodes when he underwent radical cystectomy and lymph node dissection. The patient has been alive without evidence of disease for two years postoperatively.

A bisbenzylisoquinoline alkaloid, cepharanthine, significantly enhanced vinblastine, adriamycin and etoposide sensitivities in P-glycoprotein positive renal cancer cells. However, it did not show any enhancing effect on cisplatin sensitivity. Four patients with metastatic renal cell carcinomas were treated with intraarterial chemotherapy using vinblastine and/or adriamycin in combination with cepharanthine for their metastatic lesions (3 bone and 1 contralateral kidney metastases). A partial response was observed in 1 patient with femoral bone metastasis and a minor response in 1 patient with lumbar bone metastasis, although they were also treated with interferons. No adverse effects associated with cepharanthine were seen except in one patient complaining of redness and burning sense of the skin probably due to its vaso-dilatation effect.

A case of multiple urinary stones in a patient with glycogen storage disease type 1 (GSD-1) is reported. In spite of the presence of hyperuricemia, these stones did not consist of uric acid, but mainly of calcium oxalate. Laboratory studies revealed distal renal tubular acidosis and hypocitraturia, but no significant abnormality in calcium metabolism. We discussed the mechanism of calcium stone formation in our case, and its prophylactic treatment by oral administration of citrate compound.

前立腺原発の印環細胞癌の1例を報告する.患者は, 61歳の男性, 頻尿, 排尿時痛を主訴に来院した.経尿道的前立腺生検にて印環細胞癌と判明.放射線療法, ホルモン療法, 抗癌化学療法に抵抗し, 癌性腹膜炎, 全身リンパ節転移にて, 診断後26ヵ月で死亡した.剖検にて, 前立腺原発が確認された, 免疫組織化学的には, CAI9-9およびCEAに陽性, PAPおよびPSAに陰性であった.文献上, 15例目の報告にあたる., We report a rare case of primary signet ring cell adenocarcinoma of the prostate in a 61-year-old male, who died of systemic lymphatic spread. Autopsy ruled out another primary signet ring cell adenocarcinoma outside the prostate. However, immunohistochemically, the tumor stained negatively for prostate-specific antigen. A review of the literature revealed only 15 case reports, including our case.

72歳男.前立腺癌の治療経過中に前立腺小細胞癌が発生した.剖検所見で肝, 肺, 脾, 腎, 骨髄に転移を認めた.前立腺は全て腫瘍で置き換わっており, 膀胱の病巣は前立腺からの連続的な浸潤と考えられた.初発時に認められた腺癌はchromogranin A, NSE染色で陰性であったが, 再発時の小細胞癌には顆粒状に強く陽性に染色された.PSA染色では, 初発時陽性であったが再発時には一部に認められた腺癌成分以外の小細胞癌は陰性であった.転移巣は全て小細胞癌であった, A 72-year-old man had undergone surgical castration for metastatic prostate cancer (stage D2, the PSA value was 4, 300 ng/ml) in September, 1997. He was well clinically for 16 months with undetected level of PSA. However, he presented with general malaise and gross hematuria in May, 1999. After admission to our hospital his condition rapidly deteriorated and he died one week later with respiratory failure. Autopsy revealed extensive involvement of the prostate and bladder by solid tumor with multiple metastases in lungs, liver, spleen, kidneys and bone. Histological examination revealed pure small cell carcinoma of the prostate.

1)表在性膀胱腫瘍のTUR後の再発予防を目的に, TUR後1週目よりの抗癌剤の膀胱内注入療法に加え, 6ヵ月間400 mg/dayのUFTの経口投与を行った.2)全適格例でのTUR後2年の無再発率曲線の比較では, UFT投与による効果は認めなかった.3)しかし, 再発例や, さらに再発かつ多発症例で比較すると, UFT投与群で無再発率が良好な傾向が認められた, The influence of N1-(2-tetrahydrofuryl)-5-fluorouracil plus uracil (UFT) on the recurrence of superficial bladder tumors was evaluated in a randomized clinical study. Group A (n = 196) underwent transurethral resection (TUR) and the intravesical chemoprophylaxis, while group B (n = 193) received 400 mg per a day of UFT orally for 6 months in addition to the instillation therapy. These adjuvant therapy was started one week after TUR. Consequently, 30 patients in group B showed UFT-related toxicity and administration of UFT was discontinued in 10 of them. In addition, 87 patients in group B did not complete the 6-month course of UFT administration. Comparison of 2-year actuarial non-recurrence curves revealed no significant difference between groups A and B. However, UFT seemed to have a favorable prophylactic effect when recurrence rates were compared among those patients with recurrent tumors (generalized Wilcoxon: p = 0.1277), and those with recurrent multiple tumors (p = 0.0847).

Cep, およびSDB-ethylenediamine(N1379)の2剤について検討した。CepはP糖蛋白質の発現の高い腎癌細胞でVBLやADMに対して明らかな感受性増強効果を示した, Most of renal cell carcinomas (RCCs) are refractory at the start of chemotherapy. We have demonstrated that the frequently elevated expression of the multidrug resistance gene (MDR) in RCCs is associated with the intrinsic vinca alkaloids and anthracyclines resistance. The preliminary clinical trials using verapamil or amiodarone in combination with vinblastine or doxorubicin to overcome multidrug-resistant (MDR) tumors could not achieve satisfactory results owing to severe cardiovascular toxicities of such reversing agents. In the present study, we studied the sensitizing ability of bis-benzyl-isoquinoline (cepharanthine) and SDB-ethylenediamine (N-1379) in natural MDR kidney cancer cells. Cepharanthine remarkably sensitized vinblastine and doxorubicin sensitivities in those cells with high MDR RNA levels. From a clinical point of view, cepharanthine seems to be a potent and less toxic agent to treat natural MDR kidney cancers.

全国多施設の共同研究により, 腎細胞癌に対するn-TNFとn-IFN-αの併用療法による有効性と安全性を検討した.1)腎細胞癌31例においてPRが4例認められ奏効率は12.9%であった.IFN-αが前治療に使用された症例にも有効例が認められたことより, 本併用療法の有用性が示唆された.2)副作用は(35例/36例)に認められ, おもな自他覚的副作用は発熱72.2%, 悪寒・戦慄69.4%, 食欲不振22.2%, 全身倦怠感16.7%であり, おもな臨床検査値異常は白血球減少47.2%, 血小板減少22.2%, GOT上昇16.7%, GPT上昇13.9%であった.ほとんどの症例が解熱剤等の処置あるいは無処置で投与継続可能であった.本併用療法による副作用の増強はほとんどなかった, The combination therapy with natural type human tumor necrosis factor (n-TNF; MHR-24) and human lymphoblastoid interferon-alpha (n-IFN-alpha; MOR-22) was investigated for antitumor effect against renal cell carcinoma in a multiclinic cooperative study throughout Japan. The "Response criteria of Japan Society for Cancer Therapy" were followed for the handling of subjects and the evaluation of antitumor effect. MHR-24 was administered at a daily dosage of 5, 000-10, 000 JRU by intravenous drip and MOR-22 at a dosage of 5, 000, 000 IU daily was administered intramuscularly at the same time. Both drugs were administered for 4 weeks or longer. A total of 36 patients were enrolled as subjects in the study. None of them were classified as ineligible. Five patients, were classified as imperfectly evaluable, and 31, as evaluable for the results of treatment. The responses in the evaluable patients were partial response (PR) in 4 patients, minor response (MR) in 3 patients, no change (NC) in 14 patients and progressive disease (PD) in 10 patients, with a response rate of 12.9%. Adverse reactions to the therapy were investigated in all 36 patients. The frequent subjective and objective reactions that occurred were fever, rigors and shivering, anorexia, and generalized malaise, and the frequent abnormal laboratory findings were leukopenia, thrombocytopenia, elevation of GOT, and elevation of GPT.

過去15年間に京都大学泌尿器科を初診した表在性膀胱癌205症例中, 深部浸潤癌や転移癌へ病態変化したものは35例であった.初発腫瘍が多発, grade 2以上, stage T1症例, 尿細胞診陽性症例は病態変化に関して高危険度群であった, We analyzed the clinico-pathological features of the initial tumors in 205 patients with superficial bladder cancer, admitted to Kyoto University Hospital between 1974 and 1988, to investigate the prognostic factors for progression to the muscle invasive disease or metastasis. Of 205 patients, 35 (17%) exhibited muscular invasion alone (12 patients) and/or metastasis (23 patients). Tumor multiplicity, higher grade and positive urinary cytology were the significant risk factors for later malignant progression. Expression of A, B, H-blood group isoantigens in the bladder tumor were significantly decreased from the onset in the patients with initially T1 tumor but not in those with Ta tumor. Significant loss of expression was also found at the time of progression in the initially Ta cases. Thus, loss of A, B, H-blood group antigen expression seems to be correlated with the malignant potential of superficial bladder cancer. However, more feasible and reliable diagnostic markers such as molecular genetical and biochemical markers remain to be developed to predict the malignant potential of the superficial bladder cancer.

We report a case of huge renal arteriovenous aneurysm, which was successfully treated with transcatheter arterial embolization (TAE). A 72-year-old woman was admitted with the clinical symptom of dyspnea on effort. She felt a tremor in the left abdomen. Computerized tomographic scan showed a large enhanced mass (8x7x7 cm) on the left kidney. Selective renal arteriography revealed a renal arteriovenous aneurysm. Transcatheter arterial embolization with a steel coil was performed with minimal loss of renal parenchyma. A total of 270 cases of arteriovenous fistula have been reported in Japan and were statistically analyzed. The number of reports on TAE has dramatically increased since 1978, TAE can be first indicated for treatment of renal arteriovenous fistula in view of less invasiveness and preservation of renal function.

53歳男.8cmの虫垂の遠位側3cmに強い炎症性狭窄が術中に判明した症例で, 盲腸部をGIA自動縫合器を用いて管状化することにより, 虫垂道尿管路の延長(4cmの延長で径9cm)を図った.得られた遊離虫垂をMitrofanoff法でパウチ吻合を行い, 盲腸即断端を臍窩と吻合した.術後経過は順調で, 軽度ストーマ狭窄はあるもののブジーのみで軽快し, 良好な結果が得られた, The Mainz pouch with appendix-umbilical stoma is a very stable method for continent, self-catheterizable urinary reservoir in the presence of a healthy appendix. If the appendix is too short or an unexpected stenosis is seen at its distal portion, the elongation of the conduit using a part of the cecum and the implantation of the conduit to the pouch by the Mitrofanoff method can be a good alternative procedure. We herein report our experience in a 53-year-old male with high grade, invasive bladder tumor, who underwent cystourethrectomy and appendix Mainz pouch operation using the above technique.

泌尿器科術後の排ガス促進処置として, PGF2α製剤を使用し, 無処置あるいはワゴスチグミン, パントテン酸系製剤使用群との比較検討を行った.1)全例の比較において, PGF2α群に平均値上8.7時間の短縮がみられた.2)脊麻下での手術において, PGF2α群に有意の短縮を認めた.3)下部尿路の手術や, 50歳以上の高齢者の術後において, PGF2α群に排ガス時間の短縮の傾向がみられた, To facilitate postoperative flatus, Prostaglandin F2 alpha (PGF2 alpha) was given intravenously to 23 patients who underwent urological operations. The patients were 14 males and 6 females aged from 20 to 77 years old. Patients with hypertension or cardiovascular disease were not included. Twelve operations were performed under general anesthesia, and 8 under epidural anesthesia. Thirteen operations were performed for the upper urinary tract or adrenal gland, and 5 were for the lower urinary tract. In 2 cases, the peritoneal cavity was opened and operations were performed on the intestines. PGF2 alpha 2000 micrograms was added to the postoperative drip infusion and administered in 2 to 3 hours. Until the first flatus was recognized, PGF2 alpha was given once a day in the same manner. Twenty-six patients, 10 of whom were given either vagostigmine or pantothen postoperatively, served as the control group. PGF2 alpha accelerated the postoperative flatus by 8.7 hours (mean) compared with the control group, but it was not significant. The onset of flatus was significantly promoted under epidural anesthesia. Gastrointestinal movement tended to be facilitated in the PGF2 alpha group after lower urinary tract surgery and in the patients over 50 years old. Three patients complained of severe abdominal pain as a side effect; and, injection of PGF2 alpha was stopped. In 7 patients, mild stomachache , vascular pain, nausea, vomiting or elevation of blood pressure were observed.

In vitro chemosensitivity of urological cancers was assessed by a human tumor colony forming assay (HTCA) and a 3H-thymidine incorporation assay. Primary tumor cells from 160 of 253 (63%) urological cancers showed adequate colony growth (greater than 30 colonies per well), and there was a 57% true positive and 100% true negative rate for predicting clinical response of anticancer agents. On the other hand, cells from 37 of 45 (82%) urologic cancers incorporated a sufficient amount of 3H-thymidine (greater than 300 cpm). However, when the positive control drug (chromomycin A3 100 micrograms/ml) was used for the assay quality control, the successful assay rate of the HTCA (38%) was lower than that of the 3H-thymidine incorporation assay (75%), while there was a significant correlation in drug sensitivities between the two assays. Thus, the 3H-thymidine incorporation assay seemed to be more useful than the HTCA for evaluating the chemosensitivity of urologic cancers.

前回の入院患者臨床統計に引き続き1983年1月から1984年12月までの臨床統計を行なった.入院患者予算ベッド数は60で, 占拠率は常時ほぼ80%以上であった.患者数は825名, 性別男子670名, 女子155名で, 男子の比率が増加しているが, 主に前立腺肥大症を含む, 尿路性器腫瘍の増加による.50歳以上の入院が1983年54.1%, 1984年55.8%であった.頻度の高い腫瘍, 結石, 尿路性器奇型の頻度は, 1983年度でそれぞれ47.5, 21.4, 22.6%であり, 1984年には45.2, 25.1, 16.2の割合であった.腫瘍のうちでは前立腺腫瘍, 膀胱腫瘍が大半を占めた.結石では上部尿路結石症が著増を示し, 尿路性器奇形では腎嚢胞をこの項に含めた.尿路性器腫瘍患者の割合は, 1979年以後は1981年を除き常に40%を越えている.死亡46名, 剖検率80.4%であった.年間の手術件数は手術の対象となった臓器の組み合わせで分類した, A clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1983 to 1984.

Among the secondary ureteral tumors, there have been a few true metastases to the ureters. We report a case of metastatic ureteral tumor from the pancreas, and review and discuss 60 cases collected from the Japanese literature.

1) 1978年1月から6ヵ月間に, 京大泌尿器科において入院治療をおこなった泌尿性器悪性腫瘍患者610名のうち, 血清Ca値11.0 mg/dl以上の高Ca血症の合併をみたのは, 20例(3.3%)であった.そのうちわけは, 腎細胞癌62例中10例(16.1%), 膀胱癌321例中6例(1.9%), 腎盂尿管癌45例中3例(6.7%), 前立腺癌95例中1例(1.1%)であった.2)高Ca血症に対し, 原発病巣の手術的切除と, 癌化学療法が有効であった.保存的療法として, 輪液療法に加えて, インドメサシン, ステロイド剤, 合成ウナギカルチトニンの単独あるいは併用投与をおこない, 11例において平均3.7 mg/dlの低Ca効果を得た.しかし, 血清Ca値の再上昇をきたしたものが多かった.3)手術をおこないえた腎癌の2例を除いて, 18例いずれの症例も広範な遠隔転移あるいは局所の再発侵潤をきたしており, 高Ca血症の出現後5日から9ヵ月(平均2ヵ月)の間に死亡した, Twenty cases (3.3%) of hypercalcemia of more than 11.0 mg/dl associated with urogenital malignancy were observed in 610 inpatients during the past 5 years and 6 months (Jan. 1978-June 1983). Incidences were 10 (16.1%) out of 62 cases of renal cell carcinoma, 6 (1.9%) out of 321 cases of bladder cancer, 3 (6.7%) out of 45 cases of renal pelvic and ureteral cancer, and one (1.1%) out of 95 cases of prostatic cancer. As treatment, surgery (radical nephrectomy) and anti-cancer chemotherapy were effective in 3 cases (2 renal cell carcinomas and one renal pelvic cancer). Conservative therapy with hydration combined with either indomethacin, steroid or eel calcitonin was effective in 11 cases, and s-Ca level was decreased by 3.7 mg/dl on the average. Eighteen patients were in the terminal stage of malignancy when hypercalcemia was observed, and died 5 days to 9 months (mean; 2 months) after the onset of hypercalcemia.

1983, 1984年の2年間の当科外来患者臨床統計を行なった.1983年は男性3070人, 女性1715人で合計4821人, 1984年は男性3152人, 女性1703人の合計4855人で男女比はほゞ2:1であった.年齢階層別には1983年と比べ1984年には70歳以上が5倍弱の増加を示した.疾患別患者数では尿石症は下部尿路結石の割合が依然として低く, 全尿石症の2～3%に過ぎなかった.腎盂腎炎の頻度は前回調査と同じで女性が男性の2倍を占めた.STDの明らかな増加は見られなかった.尿性器結核も前回とほゞ同じ傾向であった.尿性器腫瘍も前回と比べ著しい変化を示したものはなく, その他の上・下部尿路疾患もほゞ同様であったが, 原因不明熱で来院する患者の増加が予測された.内視鏡検査は1983年には延べ1157件, 1984年には970件, IVPやDIPは年間約2400件行なわれた, The statistics of the patients seen at our Urological Outpatients Clinic during 1983 and 1984 are reviewed.

A statistic survey was carried out on the patients, diseases, and operations experienced at the urological ward of Kyoto University Hospital during the years of 1977 to 1982.

Metastatic tumor of the penis is uncommon in spite of its rich blood supply, abundant vascular space and the proximity of the pelvic organs which have a high incidence of malignant neoplasms. We report three cases of metastatic penile tumors. The primary sites of these cases were the left ureter, the right kidney and the rectum. We review and discuss sixty two cases collected from the Japanese literature, including our cases.

We report a case of renal oncocytoma and review 158 cases in the literature. The patient was a 75-year-old woman whose chief complaint was epigastric discomfort without any urological symptoms. The right renal tumor was incidentally discovered by ultrasonography. Its angiographic patterns such as spoke-wheel appearance and homogeneous nephrogram were "characteristic" of renal oncocytoma. We diagnosed it as oncocytoma by microscopical and ultrastructural observation.

A recent six year statistic survey was carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital.