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We retrospectively reviewed 182 patients who underwent radical prostatectomy in our hospital between April, 2009 to December, 2012, and who had not received any prior hormonal therapy. We also excluded the patients who couldn't followed up more than 6 months after surgery and pN1 patients. Positive surgical margins were observed in 65 cases. We determined what were the significant factors associated with the margin status. The another aim of present study is to evaluate the risk factor which might have significance for biochemical recurrence. BMI ≥ 25.0, prostate volume < 40 cm3, and biopsy positive core ≥ 25% were significant predictors of positive surgical margin. PSA nadir ≥ 0.02 ng/ml and pT3 were the significant factors which associated with biochemical recurrence of those patients with positive margin status.

We report a case of renal cell carcinoma in whom preoperative interferon-alpha therapy was successful in reducing the primary lesion and the tumor thrombus extending into the inferior vena cava. A 67-year-old man was referred to our hospital because of his right renal mass. We made a diagnosis of a right renal tumor with tumor thrombus by imaging examinations. Because his performance status was 3, a radical operation was considered risky. So we started interferon-alpha therapy. Four months after the start of interferon-alpha therapy, the primary lesion and the tumor thrombus reduced in their size, and the clinical response was evaluated as partial response by the response criteria for urological cancer treatment. Because of improving the performance status and reducing the tumor size, radical nephrectomy and tumor thrombectomy could be performed. Pathological examinations revealed that viable renal cell carcinomas were found only in some small parts of the primary lesion, but not in the tumor thrombus. Postoperatively, no recurrence and metastasis of renal cell carcinoma of the patient have been detected in these two and a half years.

Because of the progress made with assisted reproductive techniques, we decided to clarify the indication for testis biopsy in Japanese azoospermic patients. A total of 88 azoospermic patients were recruited with testis histologies obtained by bilateral biopsy. Testicular histology was evaluated using Johnsen's score count. Patients with at least 1 testis containing sperm were assigned to the active spermatogenesis group. Patients whose testes had no sperm were assigned to the hypospermatogenesis group. Differences in terms of the clinical data between the 2 groups were analyzed. Clinical data consisted of past history, physical examination and hormone concentrations. The unpaired t test was generally used to examine the statistical significance of any differences between the 2 groups. 1) There were significant differences between the 2 groups in the levels of serum testosterone and luteinizing hormone. 2) There were markedly significant differences between the 2 groups in terms of testis volume and the concentration of serum follicle-stimulating hormone (FSH). 3) The smallest testis volume and the highest serum FSH value in the active spermatogenesis group were 7 ml and 32.7 mlU/ml (normal range 2.9-8.2), respectively. In conclusion, although the presence or absence of active spermatogenesis can be accurately predicted by measuring the testis volume and serum FSH, testis biopsy should be carried out in patients with a testis volume greater than 7 ml or a serum FSH less than 4 times normal when the use of assisted reproductive techniques are planned.

A 59-year-old man was referred to our hospital with the chief complaint of painless left scrotal swelling. He was diagnosed with left hydrocele testis and underwent puncture of hydrocele. Radical hydrocelectomy was performed because of its frequent recurrence in a short period. A hard mass was found across the spermatic cord during the operation. The mass was removed, and histopathological examination revealed a well-differentiated liposarcoma. This was the 107th case of liposarcoma of the spermatic cord and the 3rd case with a hydrocele.

A 63-year-old man presented to our hospital suffering from dull pain in his right flank and general malaise.Abdominal computed tomography (CT) revealed a 21X14 cm retroperitoneal tumor adjacent to the right kidney. He underwent extirpation of the tumor,which weighed 2,900 g. Histopathological diagnosis was high-grade myxofibrosarcoma. Six months after initial surgery,CT revealed isolated metastasis in the upper lobe of the left lung,which was surgically treated. Eleven months after the original tumor excision, CT revealed lymph node metastasis dorsal to the inferior vena cava,which was also removed. Because he refused to receive adjuvant chemotherapy,he was observed for 2 months until CT revealed multiple liver metastases and para-aortic lymph node metastasis. He underwent 1 cycle of combined chemotherapy with doxorubicin and carboplatin,but metastatic lesions grew larger rapidly and his general state became too poor to continue chemotherapy. He is under best supportive care 17 months after the initial surgery.

A 70-year-old Japanese man complained of a nodular, non-tender scrotal mass, which had been gradually increasing in size over the last 10 years. Excisional biopsy of the scrotal specimen revealed chondroid syringoma, a very rare benign tumor, more likely to occur in the head and neck region. This is the eighth such case reported, and is an important type of scrotal tumor.

To evaluate the optimal temperature for DNA, RNA, and protein syntheses in the prepubertal, pubertal, and postpubertal human testis, the levels of incorporation of 3H-thymidine, 14C-uridine, and 14C-leucine into cultured testicular tissue were studied at 28 degrees C, 31 degrees C, 34 degrees C, 37 degrees C, 40 degrees C, and 43 degrees C. The maximum level of 3H-thymidine incorporation in prepubertal testes occurred at 37 degrees C, whereas the maximum incorporation in the pubertal and postpubertal testes occurred at 31 degrees C. Incorporations of 14C-uridine and 14C-leucine in the three groups were temperature dependent (28 degrees C to 37 degrees C). DNA synthesis by germ cells in the pubertal and postpubertal testes was maximum at 31 degrees C and was impaired at body temperature (37 degrees C), whereas in the prepubertal testis it was temperature dependent with a maximum at 37 degrees C. RNA and protein synthesis in the three groups was temperature dependent at 28 degrees C to 37 degrees C, was depressed at 40 degrees C, and remarkably depressed at 43 degrees C.

To study the spermatogenic potential of the early prepubertal inguinal testis and the effect of temperature on spermatogenesis, the levels of incorporation of 3H-thymidine and 14C-uridine into the testicular tissue were studied at 31 degrees C and 37 degrees C in vitro and compared with those of scrotal (descended) testis. 3H-thymidine incorporation into the inguinal testicular tissue at 31 degrees C, which is close to normal testicular temperature, was significantly lower than that of the scrotal testis. There was no significant differences in 14C-uridine incorporation between inguinal and scrotal testis at that temperature. At 37 degrees C, which is close to normal body temperature, 3H-thymidine and 14C-uridine incorporation into the tissues of inguinal and scrotal testes was significantly higher than at 31 degrees C. It would appear that DNA synthesis of the inguinal testis is lower than that of the scrotal testis at 31 degrees C, and higher temperature, at least for a short while, did not contribute to the impairment of spermatogenic potential in early prepubertal inguinal testis.

A 78-year-old man had undergone transurethral resection of bladder tumor (TUR-Bt) 6 times since he was diagnosed as having bladder cancer. Past histology was urothelial carcinoma, pTa, G1-G2. During the follow-up, recurrent bladder cancer was found. Enhanced computed tomography and drip infusion pyelography revealed pelvic cancer with tumor embolus in the inferior vena cava. Therefore, TUR-Bt and total ureteronephrectomy with removal of the thrombus from the vena cava was performed. The histopathological diagnosis was urothelial carcinoma of the bladder and Bellini duct carcinoma of the kidney, but in immunohistostaining surgical specimen of both bladder and kidney showed some similarities. This disease is rare. Several reports indicate an association between Bellini and urothelial carcinoma. We describe the case of the Bellini duct carcinoma of the kidney during the follow-up for bladder cancer with possibility of the association between Bellini and urothelial carcinoma.

Perforation of the bladder related to long-term indwelling urethral catheter is a rare and serious complication. A 85-year-old man with an indwelling urethral catheter presented severe hematuria, abdominal pain with rebound tenderness and muscular tension over the suprapubic area after the exchange of the urethral catheter. Computed tomography and cystogram revealed experitoneal bladder perforation due to indwelling catheter. Three weeks after the indwelling urethral catheter had been placed, the perforation was closed. In most cases, laparotomy and suprapubic cystostomy are performed. We describe the case of experitoneal bladder perforation successfully treated by urethral drainage.

A 69 year-old woman visited our hospital with a chief complaint of macrohematuria in April 2004. She was diagnosed with bladder tumor. She underwent transurethral resection ofbladdar tumor three times and right partial ureterectomy for ureteral tumor following primary bladder carcinoma. All pathological findings demonstrated that the tumor was urothelial carcinoma (UC), G1-G2, pT1 including right ureteral tumor. In spite of intravesical instillation of BCG, recurrent invasive bladder tumor was found in June 2006. In July 2006, we performed total cystectomy and construction of ileal conduit. Surgical specimen revealed small cell carcinoma and immunohistochemical staining with NSE and synaptophysin was positive. On day 67 after operation, the patient died of multiple metastases to liver and bone.

Eight months after radical surgery for small-cell neuroendocrine carcinoma (SCNC) of the urinary bladder, a 69-year-old man was admitted with a brain tumor in the left frontal lobe. The tumor, about 5 cm in diameter, was intensely but heterogeneously enhanced on computed tomography and magnetic resonance imaging. The tumor was subtotally removed, leaving only the portion adjacent to the anterior horn of the left lateral ventricle. Microscopically, the tumor was composed of diffuse sheets of small tumor cells with round to spindle-shaped nuclei, indistinct nucleoli, scant or absent cytoplasm, and indistinct cell margins. Immunohistochemically, the tumor cells were positive for synaptophysin, neuron-specific enolase, chromogranin A, and keratin. Ultrastructurally, the tumor cells showed classic neurosecretory granules and microvilli in the cytoplasm. The tumor was diagnosed as a brain metastasis from SCNC of the urinary bladder. After surgery, whole-brain radiation therapy of 40 Gy was performed, which succeeded in controlling the residual tumor. However, 4 months after surgery, the patient died of meningeal carcinomatosis. To our knowledge, this is the first report focusing on brain metastasis from SCNC of the urinary bladder. The clinicopathological features and pathological diagnosis of this tumor are discussed.

Summary This study evaluated how many patients with azoospermia might have fertility potential using assisted conception techniques. A total of 102 male patients with aioospermia were included in the study. Thirteen patients had sex chromosomal abnormalities. Testicular biopsy performed in the other 89 patients showed incomplete spermatogenesis in 47 of them whereas 42 had complete spermatogenesis. In the latter 42 patients, distal vasography demonstrated bilateral obstruction of the excurrent ducts in 14 patients whereas no distal obstruction of the ducts was found in 28. The 89 patients were divided into three groups according to the findings of testicular biopsy and distal vasography. In the 14 patients with both complete spermatogenesis and distal obstruction of the excurrent ducts, surgical procedures are applicable. The pathogenesis of the 28 patients with complete spermatogenesis but without distal obstruction of the ducts should be clarified for further treatment.

A 38-year-old man with a complaint of male infertility due to azoospermia was found to have bilateral Leydig cell tumors. The tumors were synchronous, not clearly palpable and not diagnostic by ultrasonography. The serum level of estradiol was remarkably increased, and that of testosterone was above the normal upper limit. Tumors of 0.8 cm in diameter were detected by scrotal exploration, and findings of Leydig cell tumors in the bilateral testes were confirmed by histologic and electron-microscopic studies.

Analysis of single-stranded conformation polymorphisms in polymerase chain reaction (PCR) products (PCR-SSCP) is a sensitive method for detecting point mutations in genomic DNA. To investigate its utility in examining the androgen receptor gene, we analyzed data on a patient with the testicular feminization syndrome (TFS) with a known point mutation in exon C. We detected mobility shifts of fragments of the corresponding region. Since examination of the subject's brother (legally sister), who also has TFS, revealed an identical shift pattern, we sequenced the exon C of the sibling and detected a mutation identical to that in the former. We conclude that PCR-SSCP is available for screening mutations of the androgen receptor gene.

To assess the clinical significance of subclinical right varicocele, we used scrotal sonography for a prospective study of 68 infertile patients with a clinical left varicocele. A significant difference was found in the improvement in postoperative semen characteristics between sonographically diagnosed bilateral and unilateral groups. We conclude that a subclinical right varicocele is also detrimental for spermatogenesis in patients with a clinical left varicocele.

Mitotic chromosomal analysis was done on 130 cases of male infertility, 85 with azoospermia and 45 with oligospermia. Eighteen cases of chromosomal aberrations were found, consisting of eight cases of Klinefelter's syndrome, four with 46, XYq-(including one mosaic case), three translocations, one with 47, XYY, one with 46, XY, 15p+ and one with normal variant. Among these, 46 XYq- is a notable karyotype because it cannot be accurately diagnosed without Q-banding, and because 46, XYq- is important for determining the role of the locus on the long arm of the Y chromosome which is supposed to include spermatogenesis. Eleven cases of 46, XYq- in azoospermic males, including our cases, have been reviewed in the Japanese literature. Statistical analysis of the values of testicular volume and serum hormones in these azoospermia cases, revealed obvious differences between normal and abnormal karyotypes and also between 46, XYq- and Klinefelter's syndrome.

We present an unusual case with bilateral testicular Leydig cell tumors displaying extraadrenal expression of steroid 21-hydroxylase and 11 beta-hydroxylase. Histological examination of a 38-yr-old man infertile due to azoospermia showed him to have bilateral testicular Leydig cell tumors. The in vitro steroidogenic potential of the tumors and their adjacent testicular tissue was evaluated using organ culture. Tumor tissue was found to secrete deoxycorticosterone (DOC), corticosterone (B) and cortisol, which are not produced in normal adult testis, into the medium, while testicular tissue adjacent to the tumors secreted a small amount of DOC and B. Northern blot analysis with cytochrome P-450C21 complementary DNA (cDNA) and P-45011 beta cDNA as probes revealed that the tumor contained a considerable amount of mRNA for P-450C21 and P-45011 beta, while the MRNAs were not detected in the testicular tissues adjacent to the tumors. It is suggested that the high local levels of estrogen and/or progesterone within the Leydig cell tumors and their adjacent testicular tissues induced extraadrenal expression of steroid 21-hydroxylase and 11 beta-hydroxylase by the tumors and their adjacent testicular tissues.

Human lymphoblastoid interferon-alpha was administered intramuscularly at a dose of 5 x 10(6) units/day to 20 metastatic renal cell carcinoma patients. For potentiating the antitumor effect of interferon, cimetidine was also given to them orally at a dose of 800 mg/day. The combination therapy obtained a complete response in three patients (15%) and a partial response in three (15%). Nine patients (45%) had stable disease and five (25%), progressive disease. All six patients who responded to the combination therapy had been nephrectomized and had pulmonary metastases. Two of them also had metastases to other sites (mediastinal lymph nodes and bone). The pulmonary metastases were significantly more receptive to interferon therapy than those at the other sites. The average times before a response was obtained were 2.2 months for a minor response, 2.7 months for a partial response and 3.0 months for a complete response, and the average duration of response was 26 months. The six patients who responded survived for a significantly longer period than the 14 non-responding patients treated with interferon in combination with cimetidine. The major toxicities encountered were fever, fatigue and anorexia due to interferon, and the combination therapy was well tolerated except in three patients. The results suggest that interferon-alpha and cimetidine combination therapy may be of use in the management of patients with metastatic renal cell carcinoma.

Localization of androgen receptors (ARs) in the human testis Leydig cells was examined with an AR assay and Northern blot analysis. Leydig cells, highly purified on a Percoll gradient, were used for the experiments. AR concentration in the total cell extract containing both the cytosol and nuclear fractions in Leydig cells was measured using [3H]methyltrienolone. ARs in Leydig cells showed a high affinity for [3H]methyltrienolone and the Kd and Bmax of the receptors were 1.24 nM and 11.7 fmol/mg protein, respectively. Northern blot analysis, using a 32P-labeled full-length human AR complementary DNA (cDNA) detected a 9.5-kb hybridizing band in the total RNA extracted from Leydig cells. These data can be interpreted as evidence of the existence of ARs in human Leydig cells.

Four cases of mixed gonadal dysgenesis encountered in our institute are described here, and 65 cases of mixed gonadal dysgenesis in the Japanese literature, including our cases, are reviewed. Of the four cases reported here, three had a chromosomal structure of 46,XY and one of 45,XO/46,XYq-. A chromosomal structure of 45,XO/46,XY accounts for 35% of all cases of mixed gonadal dysgenesis reported in the Japanese literature, 46,XY for 31%, and other types for 24%. Two of our cases (50%) also had a gonadal tumor. The overall incidence of gonadal tumor occurring after onset of puberty and reported in the Japanese literature is 17%.

To know the secretory potential of Sertoli cells in pubertal testes of males who underwent orchiopexy at a prepubertal age, the plasminogen activator (PA) activity of 12 patients was measured in vitro and compared with that of pubertal testes of patients with varicocele. The assay system for PA activity was based on the solubilization of 125I-fibrin in the presence of plasminogen, and the PA activity in each patient was obtained as the maximum increment with stimulation by ovine FSH in the culture medium of testicular cells. The mean value of PA activity in patients after orchiopexy was remarkably lower than that in varicocele patients (p less than 0.005), which corresponded with histological differences in spermatogenesis between the two groups. These results suggest that in comparison to those patients with varicocele, the patients with prepubertal undescended testis showed impaired potential for protein biosynthesis despite successful orchiopexy.

The operative treatment for surgical repair of bilateral testicular varicoceles was evaluated in terms of the improvement achieved in the sperm density and percentage progressive motile sperm. These parameters were compared for 27 cases of bilateral varicocele diagnosed by palpation and subjected to bilateral high ligation of the internal spermatic vein and for 40 cases of left unilateral testicular varicocele. There were no significant differences in preoperative values (such as sperm density; progressive motile sperm; serum levels of luteinizing hormone, follicle-stimulating hormone, and testosterone; and Johnson's score count) between the bilateral and unilateral testicular varicocele groups. The improvement in postoperative sperm density in the cases with bilateral testicular varicocele was apparently less satisfactory than in the cases with testicular varicocele only on the left side.

The synthesis of DNA, RNA, and protein by varicocele testes with spermatogenic dysfunction was studied by examination of the levels of incorporation of [3H]thymidine, [14C]uridine, and [14C]leucine into the testicular tissue at 31 degrees C in vitro. The results suggest that DNA synthesis by the testis with moderate tubular damage is impaired whereas synthesis of RNA and protein is not. The cell regenerative ability of the testis with moderate tubular damage may be poor in spite of the preservation of testicular cell RNA and protein synthesis.

To evaluate the responsiveness of spermatogenesis in the normal human testis to human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG), the DNA synthesis of spermatogonia was investigated using 3H-thymidine uptake by cultured tissue fragments of human testis with or without treatment with hCG and/or hMG. Two groups treated with different concentrations of hCG showed no difference in 3H-thymidine incorporation into testicular tissue compared with untreated control. In two other groups treatment with combined hMG/hCG in different concentrations induced significant changes in 3H-thymidine incorporation compared with control (p less than 0.01, p less than 0.01). Combined hMG/hCG treatment was effective in inducing spermatogenesis by normal human testicular tissue.

SDS-polyacrylamide gel electrophoresis followed by enzymography of a human testicular cell culture medium demonstrated that the molecular weight of plasminogen activator (PA) secreted was similar to that of human urokinase and it was also confirmed that follicle-stimulating hormone (FSH) stimulated PA secretion. To further investigate the correlation between spermatogenic impairment and secretory potential of PA in human testicular cells in vivo, the maximum increment in PA activity as a result of treatment with ovine FSH was measured for two groups of patients with different degrees of spermatogenic impairment. The mean value of maximum increment in PA activity in one group with severely impaired testes was remarkably lower than that in another group with slightly impaired testes. Protein biosynthesis in human testicular cells dependent on FSH appears to be impaired with the progression of spermatogenic impairment.

To determine the fertility potential of men with an undescended testis a retrospective study was performed on 274 patients by evaluating sperm density and sperm motility, as well as histopathological findings of the seminiferous tubules. The patients, who had been treated surgically when they were 2 to 5 or 9 to 12 years old and who were examined when they were 18 to 39 years old, were divided into 4 groups: group 1 (61 patients) underwent bilateral orchiopexy, group 2 (149) underwent unilateral orchiopexy, group 3 (26) underwent unilateral orchiectomy and group 4 (38) received no surgical treatment for a unilateral undescended testis. Significant differences in the sperm density and motility were detected between group 1 (normal range 0 to 7 per cent) and group 2 or 3 (normal range 72 to 79 per cent), and between group 2 or 3 and group 4 (normal range 42 to 58 per cent). Histopathological differences were significant between group 1 or 2 (Johnsen's score count 6.06 to 6.11) and group 4 (4.72) for the affected side, and between group 2 or 3 (9.09 to 9.20) and group 4 (8.60) for the unaffected side. The results suggest that surgical treatment may not significantly ameliorate the fertility potential of patients with bilateral undescended testes. On the other hand, in patients with unilateral undescended testis an operation not later than at early puberty is advisable to maintain the spermatogenic function in the unaffected testis. It is suggested that some unknown factors relating to the highly impaired unilateral undescended testis may in some way inhibit function of the contralateral unaffected testis.

To study the spermatogenic potential of the early pubertal cryptorchid testis, testicular DNA synthesis was examined in vitro. DNA synthesis by early pubertal cryptorchid testis was inhibited and lost its normal temperature sensitivity. The spermatogenic potential of the cryptorchid testis may be impaired as early as puberty.

Serum immunosuppressive acidic protein was compared to lactic dehydrogenase as a marker for testicular cancer in 54 patients with testicular cancer, 62 with benign urological diseases and 203 healthy controls. The mean value of serum immunosuppressive acidic protein in patients with testicular cancer (598 +/- 293 micrograms. per ml.) was statistically higher than that in patients with benign disease (429 +/- 163 micrograms. per ml.) and healthy controls (368 +/- 73 micrograms. per ml.). There were statistically significant differences in serum immunosuppressive acidic protein levels between controls and patients with stage 2 (p less than 0.0001) or stage 3 (p less than 0.001) testicular cancer, and between those with stage 1 and stage 2 (p less than 0.0001) or stage 3 (p less than 0.001) disease, respectively. The usefulness of immunosuppressive acidic protein as a marker for testicular cancer also was compared to that of lactic dehydrogenase. Immunosuppressive acidic protein and lactic dehydrogenase levels were elevated almost equally in patients with stage 2 or 3 disease (range 71 to 92 per cent). However, immunosuppressive acidic protein levels were elevated in only 3 of 25 patients with stage 1 cancer (12 per cent), compared to 11 of 25 (44 per cent) with elevated lactic dehydrogenase levels. Immunosuppressive acidic protein was correlated better with tumor stage. In conclusion, serum immunosuppressive acidic protein determinations may be useful in patients with testicular cancer for staging, monitoring treatment results and predicting recurrence.

A case of bilateral pheochromocytoma with an associated pancreatic islet cell tumor is reported. Prominent calcification was noted in the left adrenal tumor.