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A 43-year-old male visited our hospital with complaints of right scrotal swelling and lower abdominal mass. Computed tomographic (CT) scan showed the right testicular tumor and regional enlarged lymph nodes. However, there were no metastasis in lung, brain, liver, and bone. First, we performed chemotherapy of modified PVB regimen (cisplatinum, vinblastine, peplomycin) prior to the right orchiectomy, because a tumor lump was palpable from the right testis to the lower abdominal mass. After three courses of modified PVB chemotherapy, beta-HCG, HCG and LDH values became within normal limits and all tumors were necrotic on the CT scan. Then, we performed the right orchiectomy and retroperitoneal lymphadenectomy simultaneously. After operation, two courses of VIP chemotherapy (etoposide, ifosfamide, cisplatinum) were performed since viable cells in one of the obturator lymph nodes were pathologically noticed. The patient has been free of recurrence of the tumor for 15 months after the treatment. In the particular case, in which the primary testicular tumor was not extirpated en bloc, the initial chemotherapy followed by orchiectomy was found to be feasible.

経直腸的なサーフェスコイルを用いたMRIの膀胱頸部および前立腺疾患における有用性について15例を対象に検討した。1)経直腸的MRIは安全に施行でき, body coil画像に比べより解像力に優れ, 詳細な情報がえられることが示唆された。2)前立腺の内部構造が明確に描出され, 前立腺癌および肥大症などの前立腺腫瘍性疾患の画像診断に有用と考えられた。3)膀胱腫瘍においては, 通常画像診断が困難とされている膀胱頸部腫瘍のステージングにおいても有用である, Endorectal magnetic resonance imaging (MRI) using an endorectal surface coil has been evaluated basically and clinically. This new modality obtained increased resolution magnetic resonance images of the pathologic conditions of the prostate and bladder. Compared with images obtained with a body coil, the surface coil images clearly demonstrate prostatic intraglandular zonal anatomy. The clear images of prostatic capsule and neurovascular bundle seen on the surface coil may contribute to the local staging of prostate cancer. The staging diagnosis of bladder tumor located in the bladder neck will be the best candidate for endorectal MRI. Enhancement with gadolinium may improve the ability to differentiate superficial from deep bladder-wall tumors. We concluded that endorectal MRI is safely performed and is extremely useful for the local staging of prostate cancer and bladder neck tumor. Further studies will be required to evaluate the clinical significance of this new modality.

60歳男.糖尿病のために入院していたが, 腹部CTで両側腎に充実性腫瘤を指摘され, 精査加療目的にて当科転科となった.画像診断などから右腎腫瘍は腎細胞癌を強く疑い, 術前診断として腎細胞癌T1bNOMOと考えた.左腎に関しては良性腫瘍の可能性も示唆されたが, 腎細胞癌を完全に否定できず, 術前診断は腎細胞癌T1aNOMOとした.右腎については根治性を優先し根治的全摘術, 左腎については腎機能温存のため, 術中迅速病理組織検査で悪性細胞が存在しないことを確認の上, 部分切除を経腹的アプローチで行った.病理組織学所見は, 右腎腫瘍は乳頭状腎細胞癌, G2, IFNα, pT1bN0M0と診断し, 左腎腫瘍はオンコサイトーマと診断した.術後経過は良好で, 6ヵ月を経た現時点において再発を認めていない, A 60-year-old male was admitted with bilateral renal masses with a diameter of 50 mm (right kidney), and 15 mm (left kidney) found incidentally by computed tomography. Renal angiography demonstrated neovascularization in the lower pole of the right kidney, but no remarkable findings in the left kidney. We could not deny the possibility of bilateral renal cell carcinoma. Right radical nephrectomy and left partial nephrectomy were performed. The histopathological finding revealed diagnosis of right papillary renal cell carcinoma and left oncocytoma. To our knowledge, this is the third case of renal oncocytoma with synchronous contralateral renal cell carcinoma reported in Japan.

尿路結石患者113名を対象とした。1)栄養指導前後におけるおもな食事内容の変化では, 男性の蛋白摂取量に有意の低下を認めたが, 他のものは特に有意の差はなかった。2)栄養指導前後におけるおもな尿中物質には, 特に有意の変化をみたものはなかった。3)栄養指導前の尿酸排泄量650mg/day以上, カルシウム排泄量250mg/day以上, 一日蓚酸排泄量が45mg/day以上のそれぞれの症例を検討した結果, 栄養指導によりそれぞれが有意に減少した。4)食事内容と尿中排泄物との相関を見ると, 蛋白摂取量と尿中尿酸, カルシウム, 燐排泄量およびVit. C摂取量と尿中クエン酸排泄量との間に正の相関を認め, カルシウム摂取量と尿中蓚酸排泄量との間に負の相関を認めた。5)栄養指導前後を比較すると, 結石再発率は有意に減少した, We studied the dietary habits of 113 upper urinary tract stone formers and 24-h urine specimens before and after dietary control. Protein intake was decreased in male patients after dietary control but urinary risk factors were not changed significantly. The excretion of urinary risk factors (calcium, uric acid and oxalate) was decreased in the patients who had calcium excretion of more than 250 mg per day or uric acid excretion more than 650 mg per day or oxalate excretion more than 45 mg per day before the control. The daily protein intake was significantly correlated to urinary uric acid, calcium, and phosphate excretion and the daily vitamin C intake to urinary citrate excretion. There was a negative correlation between the daily calcium intake and urinary oxalate. The mean stone episode rate of these patients was significantly decreased from 0.174 to 0.059 stones per year by dietary control (p < 0.005).

重症高血圧が発見された7歳女児で, 尿中ノルアドレナリン排泄及び血漿ノルアドレナリン値が上昇していた.血漿レニン活性は著しく上昇していた.左腎門部塊と左腎動脈狭窄が認められ, この塊はMRIのT2強調画像で極めて明るい病変を示した.DMSA腎シンチでは左腎の摂取率は4.7%と低かった.左腎動脈狭窄を伴う異所性褐色細胞腫と診断し左腎動脈下面及び大動脈側面に接して存在する27×23×13 mmの腫瘍と左腎を摘出した.電顕で腫瘍内に特徴的神経分泌顆粒を認めた.左腎動脈壁の線維症は軽度であった.術後, 血中ノルアドレナリン値がやや高い以外は全て正常化した, A 7-year-old female was discovered to be severely hypertensive. Urinary noradrenaline excretion and plasma noradrenaline level were elevated. Plasma renin activity was markedly elevated. She was found to have a mass in the hilus of the left kidney and left renal artery stenosis. Magnetic resonance imaging (MRI) of the mass revealed an extremely bright lesion on T2 weighted image. DMSA renal scintigraphy revealed a low uptake rate (4.7%) in the left kidney. A diagnosis of extra-adrenal pheochromocytoma associated with left sided renal artery stenosis was made. The mass and left kidney were removed. Electronmicroscopic examination of the mass revealed characteristic neurosecretory granules. There was only slight fibrosis in the wall of the removed left renal artery.

Case 1: A 48-year-old male with stage 4 penile cancer is reported. We used peplomycin (PEP) and cisplatinum (CDDP) for preoperative chemotherapy. Chemotherapy was effective. Radical surgery with bilateral inguinal lymphadenectomy was done and skin defect was covered with a skin flap. Case 2: A 61-year-old male with stage 4 penile cancer underwent radical surgery after modified MBD therapy with methotrexate (MTX), PEP and CDDP. Emasculation with skin resection and inguinal and pelvic lymphadenectomy were performed. The skin defect was deep and wide. It was covered with a glacilis myocutaneous skin flap. Distal end of the flap became necrotic. It was covered with tensor fascia lata myocutaneous flap. Seventeen patients with penile cancer were treated between 1972 and 1990 at Mie University Hospital. Nine patients were in stage 1, 4 stage 2, 1 stage 3, 3 stage 4. Treatment consisted of surgery (3), surgery+chemotherapy (10), surgery+chemotherapy+irradiation (2), chemotherapy+irradiation (1), and surgery+irradiation(1). Cancer death was observed in 2 cases (stage 2), 2 patients died of other diseases, 10 are alive, and 3 patients were lost to follow up.

1986年8月より1990年7月までに, 20例のKock continent ileal reservoirによる尿路変更術を施行した.術後3ヵ月以内の早期合併症として, 創部感染4例, 尿管回腸吻合部からの尿漏出3例, 輸出脚の脱出, 腸閉塞は各2例, 逆流, 尿管狭窄, 回腸吻合不善, 術後膵炎は各1例づつ認めた.晩期合併症としてpouch内結石形成2例, 輸入脚狭窄1例をみたが, この狭窄はDacron collarの部位に認めた.早期10例と後期10例に分け, 各グループの合併症と手術成績を比較検討した.早期10例のうち8例にのべ14例の合併症を認めたが, 後期10例では4例に減少した.症例が増すにしたがって早期合併症は減少し, 手術成績も後期10例の方が早期10例より良好であった.術後水腎症の検討を行ったところ, 術後1, 2ヵ月目では9例に軽度の水腎症が認められたが, 術後3ヵ月以降は5例と, 正常化する傾向が認められた.pouch内に400～500 ml注入時の最大pouch内圧は37.9±12.2 cmH2O (mean±SD)と, 注入に伴う内圧の著明な上昇は認めなかった, From August 1986 through July 1990, 20 patients underwent construction of the Kock continent ileal reservoir and were observed for more than three months. The early complications within the first 3 months were wound infection in four patients (20%), leakage at uretero-intestinal anastomosis in three patients (15%), prolapse of efferent limb and ileus in two patients (10%) and reflux, ureteral stenosis, intestinal fistula and postoperative pancreatitis in one patient (5%). The three late complications included stone formation in two patients and stenosis at an afferent limb in one patient. The stenosis occurred at the position of Dacron collar. The patients were divided into two groups and we compared the recent 10 patients with the initial 10 patients on complications and end results. In the initial group, 8 patients (80%) had 14 complications. In the recent group, 4 patients had 4 complications. The early complications have been reduced with the increase of Kock pouch operation. The result of the recent group was better than that of the initial group. Frequency of postoperative hydronephrosis in patients with Kock pouch was investigated. In nine patients (45%) the minimal hydronephrosis occurred within the first two months and in 5 patients (25%) three months after the operation. It had a normalizing tendency. The maximum pouch pressure at the pouch volume of 400 to 500 ml was not significantly high (37.9 +/- 12.2 cmH2O, mean +/- S.D.).

症例は36歳女性で, 10年ほど前から外尿道口周囲の腫瘤に気付くも症状がなく放置していた.2年ほど前から腫瘤部の破裂, 白色液の排出, 疼痛がみられるようになり入院となった.画像所見等により傍尿道嚢胞の診断で嚢胞摘出術を施行した.嚢胞周囲剥離時に嚢胞壁を損傷し排膿がみられたが尿道との交通は認められなかった.摘出標本の病理組織学的所見では嚢胞壁は重層扁平上皮に被覆されており, 上皮下には軽度の単核細胞の浸潤が認められたが悪性所見はなく, epithelial inclusion cystと考えられた.術後経過は良好で術後9日目に退院し, その後再発はなく尿道狭窄や尿失禁といった合併症も認めていない.自験例は分娩等の後天的原因が推察されたが, 成人女性の傍尿道嚢胞は日本で43例目と考えられた, The patient was a 36-year-old woman with a chief complaint of pain of the urethral meatus. A cyst existed just below the urethral meatus. The paraurethral cyst was removed completely. Histologically, the cyst was lined by stratified squamous epithelium. According to the criteria proposed by Das, paraurethral cysts are classified into 4 groups: epithelial inclusion cysts, Mullarian cysts, Gartner duct cysts, Skene duct cysts. In this case, the cyst seemed to be an epithelial inclusion cyst. In the Japanese literature, paraurethral cysts have been incompletely classified from an etiological perspective. Differential diagnoses based on the histological findings of the cysts may be important to determine the etiology.

再発性蓚酸Ca結石患者10名, 対照健常者15名でoxalate influx rateを測定した.赤血球膜においては, 患者で亢進した.ラット小腸刷子縁膜ではNa-蓚酸共輸送系の存在が示唆された.塩化Naと蓚酸の同時摂取は蓚酸の腎負荷を増加させる, Oxalate transports on membranes of red blood cell, intestinal epithelium and proximal tubule cell were reviewed, and the new findings about oxalate transport across these membranes are reported. Red blood cell oxalate influx rate in a group of recurrent calcium oxalate stone formers was significantly higher than that of a control group. In the red blood cells of mammals, the band 3 protein transports oxalate. Although abnormal influx rate of red blood cells might be recognized as an expression of somatic cell abnormality of oxalate transport in some recurrent stone formers, the band 3 protein is not related to oxalate transport in both kidney and intestine. The study using brush border membrane vesicles suggested the presence of Na-oxalate co-transport. In humans, sodium intake increased the oxalate/creatinine ratio of urine. This indicated that excessive sodium intake might be a risk factor of stone formation. Further study of oxalate transport of both kidney and intestine will be required to elucidate an etiology of calcium oxalate nephrolithiasis.

腎細胞癌95例について, 男女比は3:1, 平均年齢は男女共に61歳であった.主訴は血尿が最も多く44名, CT, USの普及による偶然発見者は18例あった.5年, 10年の生存は49名, 35名で, stage別の5年生存は1:35/42名, 2:4/8名, 3:4/21名, 4:1/24名となった.生存率は, 1)リンパ節転移の有無で有意差あり(P, A retrospective study was carried out on 95 patients affected with renal cell carcinoma (RCC) between January 1973 and December 1988. Male to female ratio was 3 to 1 and the average age was 61 years. Hematuria was the most common initial symptom (44 patients, 46.3%), followed by incidental findings (18 patients, 18.9%). Five- and 10-year survival rates for all patients with RCC were 51.9 and 37.1%, respectively. Five-year survival rates for stage I, II, III, and IV were 82.7 54.7, 20.0, and 4.7%, respectively. Statistical analyses identified variables that significantly influenced survival, including lymph node metastasis (p less than 0.01) and distant metastasis (p less than 0.01). Cell type and renal vein involvement did not influence survival significantly. The three different forms of therapy (mitomycin therapy vincristine therapy and immunological therapy) did not influence survival significantly, but the beneficial effect of VBL therapy was obtained.

対象は再発性蓚酸カルシウム結石患者群10名, 健康対照群18名である.1)陰イオン交換系阻害剤であるDIDSの存在下では赤血球内への蓚酸輸送は大きく阻害され, RBC oxalate influxはband 3 proteinを介した現象であると考えられた.2) RBC oxalate influx rateに影響を与える因子は反応系の温度, 反応系のpHであり, 反応温度を0°C, その時のpHを7.4とした条件下でRBC oxalate influx rateの測定が可能であった.3)健常対照群および蓚酸カルシウム結石患者でRBC oxalate influx rateを測定した結果, 有意差を認め, 尿路結石患者の一部には体細胞膜での蓚酸輸送異常の存在する可能性も考えられた, We established a method of human red blood cell oxalate influx rate under the condition of steady state exchange. Using this method we measured the influx rate in 10 patients with recurrent calcium oxalate nephrolithiasis and in 18 controls. DIDS inhibited oxalate flux across the human red blood cell membrane. This result suggested that band 3 protein mediates oxalate transport. Oxalate influx rate depended on reaction temperature and pH of reaction buffer. Although the oxalate influx rate in 4 degrees C could not be determined under an initial condition rate, the measurable condition was in 0 degrees C of reaction temperature. Consequently we measured the oxalate influx rate under the condition of 0 degrees C reaction temperature and 20 ml volume of washing buffer. The mean oxalate influx rate was significantly higher in patients with nephrolithiasis than in controls (-1.00 +/- 0.19 vs. -0.78 +/- 0.14).

1987年までの11年間に経験した腎盂尿管腫瘍60症例(男:47, 女:13, 平均年齢65歳)の臨床的検討を行った.1) Gradeとstageの間に高い相関をみた.2) Gradeおよびstageと転移の間に相関をみた.3)膀胱内再発を11例に認めた.4) Grade 1, grade 2およびgrade 3の5年生存は, それぞれ5/5例, 18/31例, 6/21例であり, grade 1とgrade 2, grade 1とgrade 3の5年生存率の間にそれぞれ有意差をみた.5) pT1以下, pT2, およびpT3の5年生存はそれぞれ18/20例, 2/10例, 8/20例(pT4は, 全例8ヵ月以内に死亡)であり, pT1以下とpT2, pT1以下とpT3の3年および5年生存率にそれぞれ有意差をみた.6) Category A, B間の5年生存率には有意差をみなかった.7)術後, 化学療法および放射線療法併用群の予後は良好であった.本検討より上部尿路上皮腫瘍のgradeおよびstageがその予後を左右するものと思われる, The 60 cases of primary renal pelvic and ureteral tumors treated at Mie University hospitals between January 1977 and December 1987 were reviewed and factors predicting the prognosis were investigated. The patients consisted of 47 men and 13 women (3.6: 1.0). Their ages ranged from 38 to 82 years with a mean of 65.2 years. According to Akaza's category classification of the ureteropelvic tumor, 42 cases were classified to category A, 15 cases category B and 1 case was classified to category C. Histologically, 59 transitional cell carcinomas and 1 squamous cell carcinoma were found. As to grading, 5 was G1, 31 G2, 21 G3 and 2 GX. As to staging, 20 were pT1, 10 pT2, 21 pT3, 3 pT4 and 6 pTX. Staging was correlated well with grading. Total nephroureterectomy with bladder cuff was performed on 39 patients and the other surgical treatments were done on 15 patients. Recurrence of the bladder tumor was found in 22.4%. The 5-year survival rate (Kaplan-Meier's method) was 47.8% for all of the patients. Among the patients with transitional cell carcinoma, the 5-year survival rate was 100% for G1, 57.6% for G2 and 28.6% for G3. As to staging the 5-year survival rate was 90.0% for below pT1, 20.0% for pT2 and 41.1% for pT3. The results from the present study suggest the prognosis is decided by grade and stage in pelvic and ureteral tumors, and it is wanted to develop a system of postoperative adjuvant therapy.

To determine the current status of urolithiasis in 1988, in comparison with that in 1985, we analyzed the 1937 patients of urolithiasis at 17 departments of urology in Mie Prefecture and 2 departments of urology in Wakayama Prefecture. The ratio of male to female patients was 2.6 to 1.0. Geographically, the number of urolithiasis patients was most frequently distributed in Matsusaka City. The frequency of urolithiasis in the urban area was almost the same as that in the rural area. Most of the stones (96.3%) were in the upper urinary tract. The frequency of lower urinary tract calculi tended to be high in southern Mie Prefecture. The ratio of the upper urinary tract calculi to the lower urinary tract calculi in the urban area was higher than in the rural area. The age distribution in males was in the forties, while that in females was in the fifties. The average age was 46.4 years old. The surgical treatment was performed in 671 patients (34.6%) and the extracorporeal shock wave lithotripsy (ESWL) was the most frequent mode of treatment (85.0%), followed by cysto-lithotripsy (4.2%) and percutaneous nephro-uretero-lithotripsy (2.4%). The most frequent component of the urinary tract calculi was calcium oxalate and/or calcium phosphate (81.7%). The stone patient increased in the number during the summer season (July, August and September). In conclusion, in 1988 when the ESWL treatment started in Mie Prefecture, the epidemiologic features of urolithiasis was characterized as follows: the number of patients increased and the broad application of the ESWL treatment resulted in the decreased number of patients with spontaneous discharge and the increased number of patients with recurrent stones and with bilateral or multiple complex stones.

A 50-year-old woman was admitted for the treatment of retroperitoneal tumor. Enhanced comtuted tomography showed a low density mass between the left kidney and psoas muscle. Magnetic resonance imaging revealed a high intensity and homogeneous mass on T1-weighted sequence, and a low intensity and heterogeneous mass on T2-weighted sequence. Surgical exploration revealed that the tumor was adherent to the left kidney and en bloc excision of the tumor and the left kidney was performed. Histopathological diagnosis was leiomyoma originating from the renal capsule.

Bethanechol chloride, a cholinergic agent and bunazosin hydrochloride, an alpha adrenergic blocking agent were administered orally to 28 patients with neurogenic bladder due to peripheral nerve disorders. To compare the effect of the two drugs, one of the drugs was initially administered orally for 2 weeks, and then both of them were administered for the next 2 weeks. Since there were some significant differences in the patient background between the two groups, it was difficult to compare the two drugs. However combined use of these drugs resulted in both objective and subjective good responses in those patients.

前立腺癌ではGSが予後とよく相関するとして欧米で用いられ, 一方, 本邦では1985年に前立腺癌取扱い規約において独自の組織分類法(規約分類)が提唱され, 以下両者を比較した.規約分類とGSはよく相関し, ともに臨床的病期とよく一致した.しかし規約分類における高分化腺癌と中分化腺癌の間, 高分化腺癌と低分化腺癌の間, GS 2-4とGS 5-7の間, GS 2-4とGS 8-10の間では生存率において有意差異がみられた.臨床病期別に規約分類の分化度別癌死率をみると, 各stageにおいて分化度と癌死率の間には直線的な関係がみられた.規約分類をさらに随伴病変の分化度により分類すると, 低分化な成分を含む程に癌死率は高位を示す傾向にあった, To evaluate the correlation between the histological grade and the prognosis, we reviewed 100 cases of prostatic cancer according to the Japanese General Rules of Prostatic Cancer (JGRPC) and Gleason grading system. The study led to the following results: (1) There was a close relation between the JGRPC grade and Gleason score (GS). (2) The JGRPC grade and Gleason score were equally concerned with the clinical stage. (3) There were significant differences in survival rate between well and moderately, well and poorly differentiated groups by the JGRPC grading system, and between GS 2-4 and GS 5-7, GS 2-4 and GS 8-10 groups by Gleason score. (4) In proportion to the JGRPC grade, the cancer death rate increased linearly in each stage. (5) When the patients were grouped according to their JGRPC grades of main lesion and accompanied lesion, the cancer death rate increased in the cases with lower differentiated elements. We conclude that the JGRPC grading system is easily comprehensible, and equal with the Gleason grading system to predict the prognosis of prostatic cancer.

A case of extragonadal germ cell tumor is reported. A 41-year-old man, an elementary school teacher, was referred to our department with left abdominal pain and gynecomastia on September, 1985. Laboratory examinations revealed markedly high levels of LDH, AFP and HCG-beta. IVP and abdominal CT disclosed dislocation of the left kidney and the large left retroperitoneal mass. The mass was supplied by the left lumbal arteries on the aortogram. Chest X-ray film showed multiple coin lesions in the bilateral lung fields. By percutaneous needle biopsy, the histological finding of the tumor showed choriocarcinoma. No abnormal findings were found in either testicle by the physical and ultrasonic examinations. This case was diagnosed as extragonadal choriocarcinoma with lung metastasis. After 3 courses of chemotherapy (PVB regimen), resection of the retroperitoneal residual mass and lymphadenectomy were performed. Postoperatively, the chemotherapy, CISCA II - VB IV regimen, was repeated. The patient was discharged after 7 months hospitalization. Now, 35 months after operation, tumor markers, chest X-ray and abdominal CT showed no evidence of recurrence of the tumor.

A case of renal cell carcinoma and bladder carcinoma associated with von Hippel-Lindau disease is reported. A 31-year-old female was referred to the Department of Urology for further examination of right renal mass which was incidentally found on abdominal computed tomography (CT). The patient was operated on spinal hemangioma in May 19 and July 8, 1975, on cerebellar hemangioblastoma in July, 1976 and June 10, 1981 and on cerebellar cyst in June 20, 1988. Angiography revealed three hypervascular renal tumors in the right kidney. Cystoscopy revealed a papillary bladder tumor (TCC Grade 1). Transurethral resection of bladder carcinoma was performed on July 28, 1988. Right radical nephrectomy and lymphadenectomy were performed on August 2, 1988. Histopathologically, the tumor was renal cell carcinoma of clear cell type (Grade 1). Postoperative course was uneventful and the residual kidney is being followed up in the outpatient clinic.

This is a case report on a patient with double cancer of kidney and urinary bladder. The patient was a 65-year-old female, and she was admitted with the chief complaint of gross hematuria and right flank pain. After careful examinations, she was diagnosed with right nonfunctioning kidney caused by invasive bladder cancer. Computerized tomography incidentally revealed a mass in the upper pole of the left kidney. Selective left renal arteriography showed stretched arteries and irregularity and tortuosity of the smaller vessels. She was diagnosed with double cancer of bladder and left kidney. Owing to the damage of the right renal function, left partial nephrectomy, total cystectomy, right nephroureterectomy and left ureterocutaneostomy were performed. According to DMSA scintigraphy measured 15 days later, the uptake value of the left kidney was 13.25%, compared to the preoperative value of 25.62%. To date, this case is 36th reported case in Japan.

The effect of intravesical combination chemotherapy on superficial bladder tumors was analyzed. Seventy-two patients were treated with intravesical instillation of the following anticancer drugs. MMC group: Mitomycin C (MMC) 10 mg and cytosine arabinoside (CA) 300 mg. ADM group: Adriamycin (ADM) 30 mg and CA 300 mg. PEP group: Peplomycin (PEP) 30 mg and CA 300 mg. MAC group: MMC 10 mg, ADM 30 mg and CA 300 mg. Antitumor effects in the MMC, ADM, PEP and MAC groups were evaluated in 16, 18, 17 and 21 patients and objective response (CR + PR) of tumor was observed in 87.5%, 50.0%, 35.3% and 28.6% of these patients. The papillary tumors, small tumors and low grade tumors responded better to these intravesical chemotherapies than the non-papillary tumors, the middle grade tumors and the high grade tumors. The recurrence rate in 72 patients was 6.9, 14.6 and 26.8% within 1, 2 and 3 years. No significant difference in the recurrence rate was observed between the MMC, ADM, PEP and MAC group, but the MMC group tended to have a lower recurrence rate than the other groups. The recurrence rate for the low grade tumors and the middle grade tumors was significantly lower than that for the high grade tumors and the small tumors. The major side effect of instillation therapy with these drugs was bladder irritation which appeared in 16.7% of all the patients (78 cases). In conclusion, intravesical chemotherapy is a useful approach for controlling superficial urinary bladder tumors, especially the combination of MMC and CA.

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 1985 to 1988.

A 72-year-old man was admitted to our hospital complaining of a penile mass. The local biopsy indicated an abscess formation in the corpus cavernosum. In spite of antibiotic treatment, the abscess cavity ruptured to the dorsal skin and the urethra. After cystostomy formation, dorso-caverno-urethral fistula was closed by conservative therapies. Although the patient was followed up with antibiotics on an outpatient basis, necrotic changes in the right foot were noticed and he was diagnosed with arteriosclerosis obliterance in the right lower leg. Therefore, he was referred to an orthopedic clinic for amputation of his right lower leg with cystostomy catheter. This is the 7th case reported in Japan.

Lymphocele after renal transplantation is a complication that often requires surgical treatment. We performed laparoscopic drainage for the postoperative lymphocele in two renal transplantation patients. The patients were suffering from perineal discomfort and urinary frequency due to the lymphocele after the renal transplantation. Percutaneous catheter drainages and injections of tissue sclerosing agents such as povidone-iodine solution and tetracycline were not effective. Then fenestration of the lymphocele by laparoscopic technique was done. This procedure made the lymphatic fluid free from the lymphocele in the retroperitoneal space to the peritoneal cavity following creation of a peritoneal window. There were no apparent complications. The patients were free from symptoms and had no relapse 10 months after the operation. We report the procedure and the results of the laparoscopic fenestration.

We report a rare case of renal cell carcinoma presenting as diplopia which was caused by a metastasis to the clivus. A 58-year-old man was admitted to our hospital with the chief complaint of diplopia. Head magnetic resonance imaging showed a mass in the clivus accompanied by bone destruction. Metastatic tumor to the skull base was suspected. Further examinations for the primary lesion revealed left renal cell carcinoma. He was relieved of diplopia by radiotherapy to the clivus and subsequently underwent left radical nephrectomy.

乳糜尿症及び左下肢浮腫がある45歳女で, 31歳時に帝王切開及び子宮摘出術を受けてから左下肢浮腫が出現した.ミクロフィラリアは検出されないので術後リンパ管腫症と診断された.腎盂内0.1～0.5%硝酸銀注入は無効であった.左鼠径リンパ節のdoxycyclineによる硬化療法後, 乳糜尿症は消失し, 左下肢浮腫は改善した.その後, 左下腿の余剰皮膚を切除した, A 45-year-old woman with left leg edema was admitted to our hospital because of chyluria from the previous year. Her left leg edema appeared after Caesarean section for her first delivery and hysterectomy at the age of 31. Because microfilaria was not detected, she was diagnosed with postoperative lymphangiomatosis. The instillation of 0.1-0.5% silver nitrate into the renal pelvis was not effective. We however, after percutaneous sclerotherapy to the left inguinal lymph nodes with doxycycline, the chyluria disappeared and her left leg edema improved. Then, the surplus skin of her left lower leg was resected. We considered percutaneous sclerotherapy to be a good procedure for chyluria due to postoperative lymphangiomatosis.

左水腎症の精査の為に入院した67歳男で, 2年前に直腸癌に対して前方切除, 1年前に孤立性肝転移に対して肝右葉切除, が行われていた.順行性腎盂造影で左尿管中部に陰影欠損が認められた.其の際に採取された腎盂尿の細胞診はクラスVであった.左腎尿管摘除が行われた.組織学的には転移性腺癌で, 尿管粘膜は無傷であった, A 67-year-old man was referred for further examination of left hydronephrosis. He had undergone anterior resection for rectal cancer 2 years previously and also right lobectomy for a solitary hepatic metastasis one year postoperatively. Antegrade pyelography demonstrated a filling defect in middle portion of the left ureter. Cytology of the aspirated urine was class V. Left nephrourete-rectomy was performed. Histologically metastatic adenocarcinoma with intact ureteral mucosa was demonstrated.

1)高Ca血症を伴う腎細胞癌の骨及び肺転移症例を報告した. 2)Pamidronate及びIFNαの投与により血清Ca値の改善, 骨溶解像の化骨化及び骨痛の消失を認めた.又, 肺転移は消失した. 3)多発性骨転移, 高Ca血症の症例に対しpamidronateの投与は有効であると思われた, Pamidronate is a second generation bisphosphonate used for treating tumor-induced hypercalcemia and for preventing the development of new bone metastasis. A 47-year-old man with renal cell carcinoma was admitted in our institution because of hypercalcemia with multiple metastasis in bone, lung and lymph nodes. After embolization of the right renal artery, the patient was treated with pamidronate and interferon-alpha. Intravenous pamidronate significantly reduced bone pain and normalized the serum calcium level. The pulmonary metastasis responded to interferon therapy after 2 months of therapy. Radical nephrectomy was then carried out. Paraaortic lymph nodes were found to be necrosed completely. Ossification of osteolytic lesions was observed after two months of therapy and metastatic lesions in the lung showed complete remission (CR) after six months of therapy.

60歳男.原発性膀胱腫瘍において, 上皮性腫瘍である移行上皮癌と, 非上皮性腫瘍である平滑筋腫が合併症例を報告した.本症例では膀胱内に突出した前立腺組織の為, 通常の硬性内視鏡検査が十分に施行できず, 軟性鏡を使って近接した2ヶ所に腫瘍片の指摘ができた, We report a case of leiomyoma of the urinary bladder associated with transitional cell carcinoma. A 60-year-old-male was referred to our hospital because of the complaint of dysuria and for detailed examination of left hydronephrosis. Drip infusion pyelography revealed left uretero-vesico junction stenosis. Flexible cystoscopy revealed benign prostatic hypertrophy and epithelial bladder tumor at the bladder neck and left ureteral orifice. The tumor was histologically diagnosed as TCC (transitional cell carcinoma). M-VAC chemotherapy (methotrexate 30 mg/m2, day 1, 15, 22, vinblastine 3 mg/m2, day 1, 15, 22, adriamycin 30 mg/m2, day 2, cisplatin 70 mg/m2, day 2) was performed as a neoadjuvant chemotherapy. However, since pelvic MRI revealed tumor invasion in to the muscle area, total cystoprostatourethrectomy and ileal conduit were done. Pathological examination of the tumor of left ureteral orifice revealed TCC, G2, INF beta, pT1, ly0, v(-), pN0, PM0. The tumor in the bladder neck was histologically diagnosed as submuscosal type leiomyoma. No cases of leiomyoma of the urinary bladder associated with transitional cell carcinoma have been reported in Japan.

Although renal cell carcinoma occupies clinically the majority of renal parenchymal mass lesions, indeterminate renal masses among renal cystic lesions and benign renal tumors have been frequently found with recent advances in renal imaging modalities. Renal mass lesions to be differentiated from renal cell carcinoma were focused on in the symposium and the points discussed were divided into four categories. 1. Indeterminate renal cystic masses, especially focused on multilocular cystic lesions and renal malignant lesions associated with acquired cystic disease of the kidney (ACDK) and von Hippel Lindau disease. 2. Angiomyolipoma and oncocytoma, as representative ones among a variety of benign renal tumorous lesions. 3. How to treat small renal masses serendipitously detected by abdominal CT and/or ultrasound, radical nephrectomy or renal parenchyma-preserving operation? 4. Feasibility of percutaneous ultrasound-guided fine needle biopsy for suspicious renal mass lesions. In this symposium, the diagnosis and treatment of various renal mass lesions other than renal cell carcinoma were mainly discussed and the important points to diagnose and treat patients with renal cell carcinoma have been clarified.

A case of retrovesical hemangiopericytoma is reported. The patient was a 44-year-old woman with right lumbago. Cystoscopy showed extra-vesical compression in the area from the trigone to right wall of bladder. The histological examination of the specimen obtained with ultrasound-guided transvaginal biopsy revealed hemangiopericytoma. Because of the invasion to the bladder mucosae, total cystectomy and ileal conduit were performed. The patient received postoperative irradiation of 3, 060 rad for pelvis. Eight months after operation, computerized tomography showed no evidence of local recurrence of the tumor.

We report a case of renal arteriovenous fistula, which was found during treatment for pyelonephritis. A 61-year-old woman was referred to our hospital because of lumbar backache and infectious fever. The computed tomographic scan showed right hydronephrosis and perinephritis. We treated her conservatively for pyelonephritis, but 5 days later, the contrast-enhanced computed tomographic scan showed retroperitoneal hemorrhage. Renal angiography demonstrated an arteriovenous fistula in the central portion of the right kidney. Superselective transcatheter arterial embolization of the AVF was performed. Hemostasis was possible by embolization. She has not had any recurrence of renal arteriovenous fistula. To our knowledge, this is the 5th report of a rupture in the retroperitoneum of an arteriovenous fistula, and renal arteriovenous fistula with the pyelonephritis is very rare.

A retrospective analysis was done on the outcomes of 278 patients who underwent radical prostatectomies at our institutions from November, 1994 to April, 2006. The treatment outcomes measured were disease-specific survival and prostate specific antigen (PSA) biochemical failure-free survival rates. Univariate and multivariate analyses were performed on patient age, clinical T-stage, Gleason sum at the time of prostate biopsy, PSA value before treatment, and any patient history of neoadjuvant hormone therapy. For all patients, the overall survival and the disease-specific survival rates at 10 years were 96.3 and 99.3%, respectively, with PSA biochemical failure-free survival rates at 5 and 10 years of 67.9 and 55.1%, respectively. On multivariate analysis, both the PSA values (> 20 ng/ml) and Gleason sums (> or = 7) were statistically significant independent risk factors for PSA biochemical failure after radical prostatectomy. Neoadjuvant hormone therapy was found to have no effect on PSA biochemical failure.

We performed a clinical trial on patients with upper urinary tract stone disease (renal stone disease) to prove the clinical equivalence as the target for removal of renal stones between the new formulation (miniaturized tablet) and the conventional formulation (capsule) of UROCALUN. The clinically effective rate of both formulations was the same at 70% (28 of 40 cases), and it was suggested that these two formulations possess the same clinical efficacy. Adverse drug reactions were observed in 10.0% (4 of 40 cases) with the tablet and 5.0% (2 of 40 cases) with the capsule. There were no significant differences between the two formulations in the incidence of adverse drug reactions, and there were no clinically significant safety problems. In the questionnaire survey for patients about medication compliance, we found that the patients felt the miniaturized tablets were much easier to swallow than the conventional formulation. In conclusion, it is suggested that the miniaturized tablet contributes to improve the medication compliance for patients and thus it is expected to improve the clinical efficacy.

We report a case of cystic renal cell carcinoma (CRCC). In general, computed tomography (CT) and magnetic resonance imaging (MRI) are sufficient for diagnosing renal cell carcinoma (RCC). However, we often have difficulty in diagnosing CRCC based on these modalities alone. In the present case, to assess the contrast-enhancement of the cyst wall and the septum, we evaluated the usefulness of CT arteriography (CTA) by selective injection of contrast material into the renal artery. We believe that CTA could be a valid option for preoperative radiological differentiation of CRCC.

A 60-year-old male was admitted with bilateral renal masses with a diameter of 50 mm (right kidney), and 15 mm (left kidney) found incidentally by computed tomography. Renal angiography demonstrated neovascularization in the lower pole of the right kidney, but no remarkable findings in the left kidney. We could not deny the possibility of bilateral renal cell carcinoma. Right radical nephrectomy and left partial nephrectomy were performed. The histopathological finding revealed diagnosis of right papillary renal cell carcinoma and left oncocytoma. To our knowledge, this is the third case of renal oncocytoma with synchronous contralateral renal cell carcinoma reported in Japan.

A 78-year-old female suffering from a cerebral infarction and subdural hematoma was referred to us due to a hard mass in the anterior vaginal wall which was disclosed during gynecological examination. An abdominal X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) showed that a large spindle-shaped stone, 60 x 42 mm in size, was impacting the urethra. It was impossible to catheterize the urethra. The stone gradually projected through the external urethral meatus and was removed by grasping and drawing with forceps. Another 83-year-old female with senile dementia was referred to us because of macrohematuria. An abdominal X-ray and CT showed the presence of two oval bladder stones, 32 x 24 mm and 30 x 21 mm in size. During a follow-up, one of the stones projected partially through the external urethral meatus and was removed by drawing with forceps. After a week, the other stone impacted the urethra and was removed in the same way. Both women were frail, bedridden institutionalized elderly with severe dementia, and their urination had been managed with diapers for years. As the proportion of elderly people in Japan rapidly increases, female urethral stones migrating from the urinary bladder, once very rare, may increase in number, to which we must pay attention.

One hundred and seven patients with prostate cancer were treated at Mie University Hospital during the past 12 years between 1988 and 1999. They were between 53 and 83 years old, with an average age of 70.8 years old. The clinical stage was defined as A, B, C and D in 3 (2.8%), 19 (17.8%), 50 (46.7%) and 35 (32.7%) patients, respectively. At initial diagnosis, the tumor was well, moderately and poorly differentiated adenocarcinoma in 26 (24.3%), 47 (43.9%) and 34 (31.8%) patients, respectively. The median follow-up period was 52.3 months. The overall 1, 3 and 5-year survival rates were 98.0%, 86.8% and 75.2%, respectively. The 5-year survival rates for stage A, B, C and D were 100%, 93.8%, 82.1% and 56.9%, respectively. A significant difference (p = 0.017) in 5-year survival rate was noted between stage C and D. The 5-year survival rate was 100% for well differentiated, 78.0% for moderately differentiated, and 53.2% for poorly differentiated adenocarcinoma. A significant difference (p = 0.0016) in the 5-year survival rate was noted between well differentiated and poorly differentiated adenocarcinoma. According to the therapy, the 5-year survival rate in stage C was 86.2% for the radical prostatectomy group and 84.0% for the endocrine therapy group. There was no significant difference between these 2 treatment groups. Endocrine therapies, classified into maximum androgen blockade (MAB) and endocrine therapy other than MAB were performed for stage D as an initial therapy. Although the prognosis in the patients treated with MAB was better than that with other endocrine therapies, there was no significant difference between these 2 endocrine treatment groups.

We report a case of transitional cell carcinoma in the left renal pelvis, which occurred in a 24-year-old man. He had been treated with cyclophosphamide (CPM) for a period of 27 months for retroperitoneal rhabdomyosarcoma diagnosed at the age of 10. At first 1.2 g CPM had been given twice intravenously for 3 months, followed by oral administration of 41 g CPM for 23 months. Drip infusion pyelography revealed a filling defect in the left renal pelvis. A left renal pelvic tumor was strongly suspected on computerized tomography and magnetic resonance imaging. Left nephroureterectomy was then performed. Histological diagnosis of the left renal pelvic tumor was transitional cell carcinoma, grade 2, pT1N0M0. No recurrence was defected 17 months later. This case seems to be the second case of cyclophosphamide-induced upper urothelial carcinoma reported in Japan.

The patient was a 36-year-old woman with a chief complaint of pain of the urethral meatus. A cyst existed just below the urethral meatus. The paraurethral cyst was removed completely. Histologically, the cyst was lined by stratified squamous epithelium. According to the criteria proposed by Das, paraurethral cysts are classified into 4 groups: epithelial inclusion cysts, Mullarian cysts, Gartner duct cysts, Skene duct cysts. In this case, the cyst seemed to be an epithelial inclusion cyst. In the Japanese literature, paraurethral cysts have been incompletely classified from an etiological perspective. Differential diagnoses based on the histological findings of the cysts may be important to determine the etiology.

A 74-year-old woman with diabetes mellitus had a high fever, and was treated with antibiotics and insulin in another hospital. She was referred to our department, because CT scan showed the right hydronephrosis and the abnormal gas shadow in the right renal calyces. Ureteral catheterization was performed on the right side and cloudy urine was drained. Urine culture yielded E. coli. Since submucosal emphysematous changes were demonstrated in the bladder mucosa by cystoscopy, she was diagnosed with emphysematous pyelonephritis with emphysematous cystitis associated with diabetes mellitus. Administration of antibiotics and insulin and the ureteral catheter drainage improved her condition immediately. Abnormal gas shadow on CT scan and submucosal emphysema on cystoscopy disappeared. We reviewed 110 cases of emphysematous pyelonephritis and 23 cases of emphysematous cystitis including our case in Japan, and report their clinical characteristics.

A 50-year-old woman was admitted for the treatment of retroperitoneal tumor. Enhanced comtuted tomography showed a low density mass between the left kidney and psoas muscle. Magnetic resonance imaging revealed a high intensity and homogeneous mass on T1-weighted sequence, and a low intensity and heterogeneous mass on T2-weighted sequence. Surgical exploration revealed that the tumor was adherent to the left kidney and en bloc excision of the tumor and the left kidney was performed. Histopathological diagnosis was leiomyoma originating from the renal capsule.

The possibility of bladder preservation by preoperative balloon occluded arterial infusion (BOAI) chemotherapy was studied in 111 patients with locally invasive bladder cancer. BOAI was performed by blocking the blood flow of the internal iliac artery and by performing intra-arterial infusion of adriamycin (50 mg/body) and cisplatin (100 mg/body). Before BOAI the clinical diagnosis was T2 in 36, T3a in 29, T3b in 27, T4 in 11 and after BOAI it was T0 in 1, T1 in 27, T2 in 25, T3a in 20, T3b in 20, and T4 in 10. Down staging was observed on diagnostic images in 46.6%. Thirty patients (27.0%) received transurethral resection of bladder tumor (TUR-Bt) and their bladder could be preserved. The 5-year cancer-specific survival rate was 100% in pT0 (n = 9), 97.5% in pT1 (n = 47), 79.9% in pT2 (n = 21), 80.0% in pT3a (n = 6), 39.9% in pT3b (n = 18) and 51.9% in pT4 cases (n = 9). For the bladder preservation, accurate staging diagnosis is required. Since 1992, endorectal magnetic resonance imaging (MRI) has been used in addition to imaging diagnosis for improving the accuracy of staging diagnosis. The accuracies of staging diagnosis with and without endorectal MRI were 62.5% and 44.0%, respectively. BOAI as a neoadjuvant chemotherapy has the possibility of bladder-preserving therapy in locally invasive bladder cancer. Also, the endorectal MRI can improve the accuracy of staging diagnosis, which is important for the bladder preservation.

We retrospectively studied the staging accuracy of endorectal magnetic resonance imaging (MRI) in comparison with transrectal ultrasound examination (TRUS) for 71 localized bladder cancers and 19 localized prostate cancers (PC) radically resected. The accuracy of clinical staging for bladder cancer in endorectal MRI and TRUS was 85.9% and 69.2%, respectively. The presence or absence of the continuity of submucosal enhancement on T2-weighted MRI images could be useful for the staging of bladder cancer. The accuracy of the seminal vesicular invasion for prostate cancer in endorectal MRI and TRUS was 95% and 63%, respectively. To determine whether magnetization transfer contrast (MTC) provides additional information in the diagnosis of prostate cancer, the magnetization transfer ratios (MTRs) were calculated in 22 patients with PC, 5 with benign prostatic hyperplasia (BPH) and 4 controls. The mean MTR in the peripheral zone of the normal prostate (8.0% +/- 3.4 [standard deviation]) showed a statistically significant decrease relative to that in the inner zone of the normal prostate (27.4% +/- 3.4, p < 0.01), BPH (25.5% +/- 3.7, p < 0.01), pre-treatment PC (30.6% +/- 5.9, p < 0.01), and PC after hormonal therapy (20.3% +/- 6.3, p < 0.01). The mean MTR in pre-treatment PC was significantly higher than that in BPH, or in PC after hormonal therapy (p < 0.01). MTC was considered to be useful for conspicuity of prostate cancer lesion.

A 7-year-old boy had a fever of 39 degrees C. Abdominal computed tomography (CT) revealed marked left hydronephrosis with hydroureter. Percutaneous nephrostomy was performed. Salmonella infanitis was detected from the drainage urine. Cystourethrography after nephrostomy showed bilateral vesicoureteral reflex (VUR). On the left side, ureteropelvic junction (UPJ) stenosis was found. Left fistelography showed hydronephrosis, but the ureter was not visualized. A mechanism like a valve at the left UPJ was suggested; the bladder urine was able to ascend to the pelvis but not to be drained from the pelvis. The left renal function was not expected to recover from the findings of renal scintigram and CT. Left nephroureterectomy and right anti-VUR operation were performed. The extirpated renal and ureteral specimens revealed a nonpapillary tumorous structure like a valve at the left UPJ. The histological examination of the valve-like structure revealed the presence of two muscle layers without an adventitia folded at the UPJ.

A 72-year-old man was admitted to our hospital complaining of a penile mass. The local biopsy indicated an abscess formation in the corpus cavernosum. In spite of antibiotic treatment, the abscess cavity ruptured to the dorsal skin and the urethra. After cystostomy formation, dorso-caverno-urethral fistula was closed by conservative therapies. Although the patient was followed up with antibiotics on an outpatient basis, necrotic changes in the right foot were noticed and he was diagnosed with arteriosclerosis obliterance in the right lower leg. Therefore, he was referred to an orthopedic clinic for amputation of his right lower leg with cystostomy catheter. This is the 7th case reported in Japan.