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We compared the efficacy, safety, and patient preferences for two α1-adrenoceptor (AR) antagonists with different affinity for AR subtypes, naftopidil (Naf) and silodosin (Silo), for the treatment of male lower urinary tract symptoms associated with benign prostatic hyperplasia (male LUTS/BPH). New patients diagnosed with male LUTS/BPH were randomly divided into either the Naf-Silo group or the Silo-Naf group (Naf : 50-75 mg once daily for 2 weeks followed by 75 mg once daily for 4 weeks ; Silo : 2-4 mg twice daily for 2 weeks followed by 4 mg twice daily for 4 weeks). A survey was conducted to evaluate patient drug preferences after completion of the study and the reasons for the preferences. Naf and Silo improved the total International Prostate Symptom Score (IPSS) compared with baseline. There was no significant difference between Naf and Silo in improvement in the IPSS total score. Adverse effects were more frequent with Silo than with Naf (P=0. 002). No significant difference in patient preference for the drugs was observed. These findings indicate that Naf and Silo provide similar clinical efficacy, with no difference in patient preference for the drugs, although adverse effects were significantly more frequent with Silo than with Naf.

Inverted papilloma of the bladder is an uncommon urothelial neoplasm. Although it is traditionally regarded as a benign tumor, there are conflicting data on multiplicity, reccurence rate, and association with urothelial carcinoma. From 2005 to 2011, 14 cases of inverted papilloma of the bladder were diagnosed at our hospital. Clinical features of 14 cases were summarized. These patients ranged in age from 25 to 81 years (mean, 61 years). The most frequently occurring symptom was gross hematuria. Eleven bladder tumors arose from the trigone or near the bladder neck. One case was associated with urothelial carcinoma. One was suspected to be a case of tumor recurrence. All other patients were free of tumor recurrence during the mean follow-up of 16.4 months (range, 0-75 months). This study does not suggest the malignant potential of inverted papilloma. However, since inverted papilloma may correlate with urothelial carcinoma. Post-treatment follow up for inverted papilloma should include cystoscopic follow up.

A 67-year-old man received left radical nephrectomy for left renal cell carcinoma (RCC) (clear cell carcinoma, G2, pT3bN0M0). After 9 months, he presented with an acute onset of left extremity edema. A computed tomographic (CT) scan and magnetic resonance imaging reveal recurrent renal cell carcinoma in the inferior vena cava (IVC) and the left renal fossa, thrombus in the left external vein and acute pulmonary embolism. We performed treatment with sunitinib for 5 months after anticoagulant therapy for 3 weeks. A new CT scan showed disappearance of RCC in the IVC and reduction in the size of RCC in the renal fossa. Only 11 cases are reported as recurrent RCC in the IVC. We report the first case of recurrent intracaval RCC in which sunitinib treatment was effective.

A 39-year-old woman, who was followed because of a 4 cm asymptomatic angiomyolipoma (AML) in the left kidney, presented with an acute onset of lower left back pain in the 38th week of her first pregnancy. An ultrasound revealed an 8 cm mass suggestive of AML rupture and retroperitoneal hemorrhage. An emergency caesarean delivery was performed. A post-delivery computed tomographic scan confirmed the AML rupture and selective embolization was performed. This was a case in which the AML grew rapidly during the pregnancy ; therefore, we discuss the relationship between AML and pregnancy.

We report a case of segmental testicular infarction that is a rare and usually idiopathic. The patient is a 36-year-old man who presented with acute right scrotal pain and swelling. Scrotal ultrasound demonstrated a round hypoechoic lesion and magnetic resonance imaging (MRI) findings could not rule out intratesticular hemorrhage or necrotic tissue associated with malignant neoplasm. Therefore right high orchiectomy was performed. The histopathological examination revealed segmental infarction of the testis at the upper and middle pole with coagulation necrosis.

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH., 2006年11月～2007年10月の前立腺肥大症166例(年齢69.9±6.4歳)を対象にシロドシン服用後超早期での有効性を検討した。シロドシン8mg/日を2週間処方し、排尿症状日誌に国際前立腺症状スコア(IPSS)、QOLスコア、BPH impact indexを記入してもらい、効果判定を行った。その結果、IPSSは服用開始後1、2、3日目と低下し、いずれの観察日も開始時と有意差を認め、14日目は更に低下した。QOLスコアも同様に有意な低下を示し、IPSSとQOLスコアの相関関係を認めた。また、α1遮断薬から切り替えた患者とα1遮断薬を初めて服用した患者との比較では、両群とも服用後1日目からIPSSは有意に低下して14日目まで低下し続け、2群間に有意差は認めなかった。14日目の治療判定ではExcellent 25例、Well 99例、Poor 36例であり、Poor例はいずれの観察日もIPSSの低下を認めなかった。IPSSのサブスコアの排尿、蓄尿症状の変化量は服用後1日目より有意に改善し、蓄尿症状重症例においても同様に1日目より有意に改善効果を認めた。副作用は187例中23例(12.3%)に認め、下痢が11例5.9%と最も多く、重篤な副作用は認めず、高齢により高くなる傾向は認めなかった。以上よりシロドシンの早期からの効果が判明し、無効な症例では早い時点で適した薬剤・治療法の提供が可能になると考えた。

30歳女。腹痛・発熱・嘔吐を主訴とした。血液検査で炎症所見を呈し, 腹部CTでは左後腹膜腔に長径8cmの境界明瞭, 辺縁平滑な腫瘤を認め, 内部は樹枝状石灰化を伴っていた。血管造影では大動脈より直接分枝する栄養血管による濃染像を認め, 腹部単純撮影でも樹枝状石灰化を認めた。臨床的症状および炎症所見は保存的加療にて改善し急性胃腸炎が原因と考えられたが, 4ヵ月後に血流豊富な樹枝状石灰化を伴う後腹膜腫瘍を神経原性腫瘍や肉腫などの疑いで手術により一塊として摘除した。腫瘤の大きさは95×70×50mmであり, 組織学的にはリンパ節様構造を示しhyaline vascular型Castleman病と診断した。, A 30-year-old woman was hospitalized in our institute with fever up and abdominal pain. Computerized tomography showed a retroperitoneal mass (8 cm in diameter) with arborizing calcification, which was enhanced homogeneously in the arterial phase. The operation was performed and parthological diagnosis revealed hyaline vascular type Castleman's disease. This characteristic calcification pattern is considered unique to Castleman's disease, and could be useful for future diagnosis.

症例1:57歳男.食道癌で胸部食道全摘術を行い, 2ヵ月後CTで上右腎に楔状のlow density areaが出現, 増大した為, 経腰的単純右摘出術を行った.組織学的にsquamous cell carcinomaであり食道癌の右腎転移と診断された.3ヵ月後の現在生存中である.症例2:57歳男.胸部大動脈, 左房への直接浸潤を伴った食道癌の為, 放射線照射を行い1年6ヵ月後血尿, 右側腹部痛を訴え, CTで右腎に楔状のlow density areaが出現, 増大, 下大静脈内腫瘍塞栓を認め, 経腹的右腎摘出術, 下大静脈内腫瘍塞栓摘出術を施行, squamous cell carcinomaで食道癌よりの転移と考えられ, 2ヵ月後死亡した, We report 2 cases of esophageal cancer metastatic to the kidney. The first case was in a 57-year-old man who complained of severe right flank pain. He had underwent an operation for esophageal cancer 2 months previously. A computerized tomography (CT) scan revealed a wedge-shaped, low-density mass in the right kidney. Right nephrectomy revealed squamous cell carcinoma. He has remained free of recurrence 3 months postoperatively. The second case was in a 57-year-old man with esophageal cancer treated by radiation therapy. Severe right flank pain and gross hematuria appeared after 1 year. A CT scan showed a wedge-shaped, low-density tumor in the right kidney accompanied with a tumor thrombus in the inferior vena cava. Right nephrectomy as well as resection of the thrombus were performed. Pathological diagnosis was squamous cell carcinoma. He died of cancer 2 months postoperatively.

39歳男.Bellini管癌, 乳頭腺癌型(pT3bN2M0)の症例を報告した.被膜形成を認めず, 浸潤性の発育を示し, 非常に特徴的な肉眼・画像所見を示した.この所見は過去に報告されている腎発生の移行上皮癌と類似していた.左根治的腎摘除術術後の補助療法として尿路上皮癌に準じたMVAC療法を施行した, We report a case of Bellini duct carcinoma of the left kidney with invasive growth pattern. A 39-year-old man was admitted to our hospital with the chief complaint of gross hematuria. Ultrasonography showed left renal swelling but normal reniform configuration of the kidney was maintained. Computed tomography demonstrated a low density tumor infiltrating into the renal cortex and with tumor extension into the renal vein. Renal angiography revealed a hypovascular tumor. We suspected a left renal cell carcinoma with tumor extension into the left renal vein, and performed radical nephrectomy. Macroscopically, the resected kidney had a normal outer contour. The tumor with infiltrative growth pattern existed in renal medulla. Histopathologic examination revealed a papillary adenocarcinoma originated in Bellini duct (pT3bN2M0). The patient underwent systemic chemotherapy (M-VAC). This case showed invasive growth pattern, which were different from the usual renal cell carcinoma and Bellini duct carcinoma.

平成4年4月に手術した73歳男で, 組織学的にグレード3のTCC(移行上皮癌)であった.5年2月に肉眼的血尿を訴え, 静脈性腎盂造影で無機能右腎及びインディアン・パウチ内陰影欠損を認め, 血清CEA(癌胎児性抗原)・CA19-9値上昇のため, パウチ内結腸癌を疑った.パウチ内腫瘤の内視鏡的生検によりグレード2TCCと判明した.5年7月に右腎, 尿管, 及びパウチを一塊として摘出した.右腎・尿管の癌はグレード2TCCと診断された.術後21日に血清CEA・CA19-9値は正常範囲に戻った.右腎・尿管癌は組織化学的染色でCEA・CA19-9陽性であった.膀胱腫瘍でもCEA・CA10-9陽性細胞を認めた, A 73-year-old female with transitional cell carcinoma (TCC) of the bladder underwent total cystectomy and Indiana pouch replacement in April, 1992. Histological examination revealed grade 3 TCC. In February 1995, she complained of gross hematuria. Intravenous pyelography (IVP) revealed a right non-functional kidney and filling defect in the Indiana pouch. We suspected colon cancer in the Indiana pouch because the levels of serum carcino-embryonic antigen (CEA) and CA19-9 were elevated. Endoscopic biopsy of intrapouch tumor was done. Pathological examination revealed grade 2 TCC. In July 1995, right nephroureterectomy with resection of Indiana pouch was performed and the surgical specimen revealed renal pelvic and ureteral cancer, grade 2 TCC. The levels of serum CEA and CA19-9 returned to the normal range 21 days after the operation. CEA and CA19-9 histochemical stain of renal pelvic and ureteral cancer were positive. Also CEA-, CA19-9-positive cells were detected in the specimens of the bladder tumor from the total cystectomy performed in 1992. This rare case is discussed and the literature is reviewed.

Inverted papilloma of the bladder is an uncommon urothelial neoplasm. Although it is traditionally regarded as a benign tumor, there are conflicting data on multiplicity, reccurence rate, and association with urothelial carcinoma. From 2005 to 2011, 14 cases of inverted papilloma of the bladder were diagnosed at our hospital. Clinical features of 14 cases were summarized. These patients ranged in age from 25 to 81 years (mean, 61 years). The most frequently occurring symptom was gross hematuria. Eleven bladder tumors arose from the trigone or near the bladder neck. One case was associated with urothelial carcinoma. One was suspected to be a case of tumor recurrence. All other patients were free of tumor recurrence during the mean follow-up of 16.4 months (range, 0-75 months). This study does not suggest the malignant potential of inverted papilloma. However, since inverted papilloma may correlate with urothelial carcinoma. Post-treatment follow up for inverted papilloma should include cystoscopic follow up.

A 67-year-old man received left radical nephrectomy for left renal cell carcinoma (RCC) (clear cell carcinoma, G2, pT3bN0M0). After 9 months, he presented with an acute onset of left extremity edema. A computed tomographic (CT) scan and magnetic resonance imaging reveal recurrent renal cell carcinoma in the inferior vena cava (IVC) and the left renal fossa, thrombus in the left external vein and acute pulmonary embolism. We performed treatment with sunitinib for 5 months after anticoagulant therapy for 3 weeks. A new CT scan showed disappearance of RCC in the IVC and reduction in the size of RCC in the renal fossa. Only 11 cases are reported as recurrent RCC in the IVC. We report the first case of recurrent intracaval RCC in which sunitinib treatment was effective.

A 39-year-old woman, who was followed because of a 4 cm asymptomatic angiomyolipoma (AML) in the left kidney, presented with an acute onset of lower left back pain in the 38th week of her first pregnancy. An ultrasound revealed an 8 cm mass suggestive of AML rupture and retroperitoneal hemorrhage. An emergency caesarean delivery was performed. A post-delivery computed tomographic scan confirmed the AML rupture and selective embolization was performed. This was a case in which the AML grew rapidly during the pregnancy ; therefore, we discuss the relationship between AML and pregnancy.

We report a case of segmental testicular infarction that is a rare and usually idiopathic. The patient is a 36-year-old man who presented with acute right scrotal pain and swelling. Scrotal ultrasound demonstrated a round hypoechoic lesion and magnetic resonance imaging (MRI) findings could not rule out intratesticular hemorrhage or necrotic tissue associated with malignant neoplasm. Therefore right high orchiectomy was performed. The histopathological examination revealed segmental infarction of the testis at the upper and middle pole with coagulation necrosis.

A 30-year-old woman was hospitalized in our institute with fever up and abdominal pain. Computerized tomography showed a retroperitoneal mass (8 cm in diameter) with arborizing calcification, which was enhanced homogeneously in the arterial phase. The operation was performed and parthological diagnosis revealed hyaline vascular type Castleman's disease. This characteristic calcification pattern is considered unique to Castleman's disease, and could be useful for future diagnosis.

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH.

We report 2 cases of esophageal cancer metastatic to the kidney. The first case was in a 57-year-old man who complained of severe right flank pain. He had underwent an operation for esophageal cancer 2 months previously. A computerized tomography (CT) scan revealed a wedge-shaped, low-density mass in the right kidney. Right nephrectomy revealed squamous cell carcinoma. He has remained free of recurrence 3 months postoperatively. The second case was in a 57-year-old man with esophageal cancer treated by radiation therapy. Severe right flank pain and gross hematuria appeared after 1 year. A CT scan showed a wedge-shaped, low-density tumor in the right kidney accompanied with a tumor thrombus in the inferior vena cava. Right nephrectomy as well as resection of the thrombus were performed. Pathological diagnosis was squamous cell carcinoma. He died of cancer 2 months postoperatively.

We report a case of Bellini duct carcinoma of the left kidney with invasive growth pattern. A 39-year-old man was admitted to our hospital with the chief complaint of gross hematuria. Ultrasonography showed left renal swelling but normal reniform configuration of the kidney was maintained. Computed tomography demonstrated a low density tumor infiltrating into the renal cortex and with tumor extension into the renal vein. Renal angiography revealed a hypovascular tumor. We suspected a left renal cell carcinoma with tumor extension into the left renal vein, and performed radical nephrectomy. Macroscopically, the resected kidney had a normal outer contour. The tumor with infiltrative growth pattern existed in renal medulla. Histopathologic examination revealed a papillary adenocarcinoma originated in Bellini duct (pT3bN2M0). The patient underwent systemic chemotherapy (M-VAC). This case showed invasive growth pattern, which were different from the usual renal cell carcinoma and Bellini duct carcinoma.

For the purpose of adhesion of the tunica vaginalis in scrotal hydrocele, we used fibrin adhesive, Bolheal. Between September 1993 and December 1994, 13 patients with scrotal hydrocele received occlusion therapies using Bolhead. The therapy was effective in 1 of the 6 patients (17%) administered 2.4 mg of fibrinogen and 750 units of thrombin into the vaginal cavity after aspiration of fluids, and in 5 of the 7 patients (71%) administered 240 mg of fibrinogen and 7.5 units of thrombin. Therefore, fibrin adhesive may be useful in the treatment of scrotal hydrocele.

A 73-year-old female with transitional cell carcinoma (TCC) of the bladder underwent total cystectomy and Indiana pouch replacement in April, 1992. Histological examination revealed grade 3 TCC. In February 1995, she complained of gross hematuria. Intravenous pyelography (IVP) revealed a right non-functional kidney and filling defect in the Indiana pouch. We suspected colon cancer in the Indiana pouch because the levels of serum carcino-embryonic antigen (CEA) and CA19-9 were elevated. Endoscopic biopsy of intrapouch tumor was done. Pathological examination revealed grade 2 TCC. In July 1995, right nephroureterectomy with resection of Indiana pouch was performed and the surgical specimen revealed renal pelvic and ureteral cancer, grade 2 TCC. The levels of serum CEA and CA19-9 returned to the normal range 21 days after the operation. CEA and CA19-9 histochemical stain of renal pelvic and ureteral cancer were positive. Also CEA-, CA19-9-positive cells were detected in the specimens of the bladder tumor from the total cystectomy performed in 1992. This rare case is discussed and the literature is reviewed.

陰嚢水瘤の治療にフィブリン接着剤を使用して検討した.トロンビン100倍希釈群で71%の有効率がえられ, 有用な治療法になりうることが示唆された.明らかな副作用は認めなかった, For the purpose of adhesion of the tunica vaginalis in scrotal hydrocele, we used fibrin adhesive, Bolheal. Between September 1993 and December 1994, 13 patients with scrotal hydrocele received occlusion therapies using Bolhead. The therapy was effective in 1 of the 6 patients (17%) administered 2.4 mg of fibrinogen and 750 units of thrombin into the vaginal cavity after aspiration of fluids, and in 5 of the 7 patients (71%) administered 240 mg of fibrinogen and 7.5 units of thrombin. Therefore, fibrin adhesive may be useful in the treatment of scrotal hydrocele.