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A 19-year-old man with abnormal findings on his chest X ray was referred to our hospital. A chest computed tomography scan revealed a 57 mm mass in the anterior mediastinum, and percutaneous needle biopsy was performed. Histopathological diagnosis was pure seminoma. Since the serum alphafetoprotein (AFP) level was normal and no abnormal findings were noted in the testis, the patient was diagnosed with mediastinal seminoma [International Germ Cell Consensus Classification (IGCCC) goodrisk group]. After three cycles of chemotherapy with bleomycin/etoposide/cisplatin [BEP], the tumor decreased in size to 32 mm, and a fluorodeoxyglucose-positron emission tomography scan indicated negative tumor findings. After four months, the residual tumor increased in size to 40 mm without any increase in the tumor marker levels. Surgical resection was performed, and the histopathological finding was only mature teratoma. Six months after the operation, there has been no recurrence.

An 83-year-old woman who was diagnosed with hydronephrosis on the right side was referred to our hospital. An abdominal computed tomography scan failed to reveal the cause of the hydronephrosis due to artifacts caused by her artificial hip joint. A subsequent magnetic resonance imaging scan revealed a ureteral herniation into the sciatic foramen. Retrograde pyelography demonstrated hydronephrosis and dilated ureter loopsthrough the sciatic foramen, known asa "curlicue sign". A ureteral stent was placed on her right side, and the ureter waslinearized. After the stent wasplaced, the hernia wasrepaired and the hydronephrosiswasres olved. The ureteral stent wasremoved 3 monthslater, and relapse of the ureteral sciatic hernia did not occur, even after 18 months.

We report a case of right essential renal hematuria treated by hydrogen peroxide instillation. A twentythree-year-old man visited our hospital with gross hematuria, urinary retention and right pelvic pain. Our diagnosis was right renal essential hematuria. A bleeding point was found in the right renal calix using a flexible ureteroscope. Bleeding was prolonged in spite of ureteroscopy and diathermy fulguration. We performed treatment with hydrogen peroxide instillation. The patient made a satisfactory recovery postoperatively, and no complications have been observed. Retrograde hydrogen peroxide instillation therapy is a useful treatment for essential renal hematuria that can not be coagulated with a ureteroscope.

We present a case of secondary extramammary Paget's disease around the cutaneous ureterostomy stoma after radical cystectomy. An 85-year-old man with bacillus calmette-guérin refractory high-grade urothelial carcinoma underwent radical cystectomy and cutaneous ureterostomy construction. After right ureter cancer diagnosis, he underwent right nephroureterectomy 3 years after the cystectomy. He developed refractory dermatitis around the cutaneous stoma 1 year after the nephroureterectomy. Skin biopsy revealed secondary extramammary Paget's disease, cured by skin excision around the cutaneous stoma and skin grafting. Multiple urothelial carcinoma metastases were detected 6 months later ; he died of urothelial cancer 1 month later.

Holmium laser enucleation of the prostate (HoLEP) is a standard surgical procedure for treatment of benign prostatic hyperplasia (BPH). A low incidence of postoperative urinary incontinence in association with anteroposterior dissection HoLEP was recently reported. We evaluated 66 patients with BPH who underwent anteroposterior dissection HoLEP from March 2013 to November 2014. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, maximum flow rate (Qmax), and post-void residual urine volume (PVR) were assessed preoperatively and at 1 and 3 months after treatment. The incidence of postoperative urinary incontinence, which was defined as the requirement of more than one pad per day, was compared between the first and second half of the patient population. Postoperative urination parameters (IPSS, QOL index, Qmax, and PVR) were significantly improved. The incidence of urinary incontinence at 3 months was significantly lower in the second half (4%) than first half (28%) of the patient population (p＝0.020). In conclusion, anteroposterior dissection HoLEP is an effective procedure for the treatment of BPH and can reduce the rate of postoperative urinary incontinence, even in low-volume institutes.

A 46-year-old man presented to our hospital for further examination following a positive fecal occult blood test. He also had a painless, palpable scrotal mass that had been present for several years, but he had not previously sought treatment. Colonoscopy demonstrated multiple adenomatous polyps and colon cancer ; when taken together with his family history, these findings led to the diagnosis of familial adenomatous polyposis. A computed tomography scan revealed a right intrascrotal tumor, and the patient was referred to our department. Together with digestive surgeons, we carried out scrotal mass resection and colectomy under general anesthesia. On scrotal exploration, a large, solid mass was identified ; it was separate from the testis and epididymis. Although the mass was adhered to the surface of the corpus cavernosum penis, we were able to completely resect the mass along with part ofthe corpus cavernosum penis. The tumor was composed ofabundant collagen fibers and mature fibroblasts. Histopathology revealed the right scrotal mass to be a desmoid tumor. The patient is alive with no evidence ofdisease 24 months after surgery.

We studied the short-term efficacy of alendronate, an oral bisphosphonates, on bone mineral density (BMD) during androgen deprivation therapy (ADT) in 45 nonmetastatic prostate cancer patients at the beginning of ADT (treatment group). All received alendronate five mg daily from the initiation of ADT. Lumber BMD was evaluated by dual energy X-ray absorptiometry, at baseline and after six months of treatment. Historical data on 24 patients with prostate cancer who received ADT without bisphosphonate administration were studied as controls (control group). BMD decreased in 13.9 and 45.8% of the patients in the treatment and control groups, respectively. Mean BMD changes in the lumber spine were +1.6 +/- 3.0% in the treatment group and -1.1 +/- 2.7% in the control group (p = 0.006). No pathological fractures occurred during the study period. No severe adverse effects were observed, but three patients could not continue alendronate treatment because of adverse events. Despite the short-term of this evaluation, our results showed that oral alendronate is an effective and safe treatment for preventing bone loss and increasing BMD in patients receiving ADT for prostate cancer., 目的:アンドロゲン除去療法は骨塩減少とそれに伴う病的骨折の潜在的な危険因子である。点滴ビスフォスフォネート製剤はアンドロゲン除去療法を受けている前立腺がん患者に対する骨塩量の減少を予防することが示されているが経口ビスフォスフォネート製剤については評価されていない。今回, われわれは経口ビスフォスフォネート製剤の1つであるアレンドン酸を骨転移を有しない前立腺がん患者に投与して骨塩量を測定し短期間での効果を検討した。対象と方法:治療群として45人の骨転移を有しない前立腺がん患者について検討した。アレンドロン酸を1日5mg経口投与し治療前, 治療半年後に腰椎の骨塩量を測定し比較検討した。対照群として24人の骨転移を有しない前立腺がん患者についても同様に検討を行った。結果:骨塩量の減少は治療群で13.9%, 対照群で45.8%に見られた。腰椎における骨塩量の変化は治療群で平均1.6%, 対照群で-1.1%であった(p=0.006)。治療期間内において病的骨折は認められず, 有害事象として重篤なものは認めなかったが副作用のため3例が内服継続困難であった。結語:短期間の検討であるにもかかわらず経口ビスフォスフォネート製剤であるアレンドロン酸は前立腺がん患者に対するアンドロゲン除去療法による骨塩量減少を予防するのに有効で安全な治療法であることが示唆された。(著者抄録)

症例1(70歳男性).右腰背部痛で近医を受診, MRIにて右大腿骨に転移性腫瘍, 膀胱内に浸潤性腫瘍を認め, 胸部写真では両肺野に転移性腫瘍も認められた.右大腿骨転移巣に放射線照射後に著者らの泌尿器科に転科, 画像所見および生検でTCC, G2-3, T4N0M1と診断しHD-MVAC療法3コースを施行した.その結果, 肺転移巣の消失, 骨盤前壁の腫瘍も縮小率57%を認め, 右腎尿管膀胱全摘出術ならびに左尿管皮膚瘻造設術を施行した.症例2(70歳女性).腰背部痛, 肉眼的血尿で近医エコーにて左水腎症と左尿管口付近に腫瘍を認め紹介入院となった.CTで左下部尿管より第4腰椎へ直接浸潤する5cmの腫瘍と大動脈周囲リンパ節転移を認め, 尿管癌 T4N1M1と診断しHD-MVAC療法を開始した.食指不振などから2コースで終了したが, 原発巣は64%, 転移リンパ節は67%の縮小率を認め, 腰痛は消退した, We report two cases of metastatic urothelial cancer treated with high-dose-intensity (HD) methotrexate vinblastine, doxorubicin and cisplatin (MVAC). After HD-MVAC, the size of primary and lymph node tumors decreased by 57-67% as compared with the standard M-VAC therapy. By shortening the dose interval, HD-MVAC may increase the anti-tumor effect without increasing side effects.

2002年9月から2003年8月までに多施設で行われた開放・体腔鏡下泌尿器科手術1, 353症例を対象として同一プロトコールによる抗菌薬の予防投与を行い, 術式別の周術期感染症発生率と抗菌薬予防投与法の妥当性を検討した.手術部位感染(SSI)発生率は清潔手術0.7～3.5%, 準清潔手術6.0～10.0%, 消化管利用膀胱全摘除術23.3%であり, 遠隔部感染(RI)発生率は清潔手術5%以下, 準清潔手術7.6～16.7%, 消化管利用膀胱全摘除術35.2%であった.SSI起炎菌の85.3%はグラム陽性菌でMRSAが58.8%を占め, RI起因菌はグラム陽性菌が若干多い傾向にあったが, 尿路感染ではグラム陰性菌と陽性菌がほぼ同数であり, 尿路感染, ドレーン感染からは高率にMRSAが分離された.また, 周術期感染症の危険因子には性別, 年齢, BMI, TP, 糖尿病, 手術時間, 出血量, 肺疾患が挙げられ, 感染症発症群の術後体温, 白血球数, CRPは高い傾向にあり, 特にCRPは周術期感染症予知の鋭敏なマーカーであると考えられた, In order to assess the ability of our protocol for antibiotic prophylaxis to prevent perioperative infections in urologic surgery, 1, 353 operations of open and laparoscopic urologic surgery conducted in 21 hospitals between September 2002 and August 2003 were subjected to analyses. We classified surgical procedures into four categories by invasiveness and contamination levels: Category A; clean less invasive surgery, Category B; clean invasive or clean-contaminated surgery, Category C; surgery with urinary tract diversion using the intestine. Prophylactic antibiotics were administrated intravenously according to our protocol, such as Category A; first or second generation cephems or penicillins on the operative day only, Category B; first and second generation cephems or penicillins for 3 days, and Category C; first, second or third generation cephems or penicillins for 4 days. The wound conditions and general conditions were evaluated in terms of the surgical site infection (SSI) as well as remote infection (RI) up to postoperative day (POD) 30. The SSI rate highest (23.3%) for surgery with intestinal urinary diversion, followed by 10.0% for surgery for lower urinary tract, 8.9% for nephroureterctomy, and 6.0% for radical prostatectomy. The SSI rates in clean surgery including open and laparoscopic nephrectomy/adrenalectomy were 0.7 and 1.4%, respectively. In SSIs, gram-positive cocci such as methicillin-resistant Staphylococcus aureus (58.8%) or Enterobacter faecalis (26.5%) were the most common pathogen. Similarly, the RI rate was the highest (35.2%) for surgery using intestinal urinary diversion, followed by 16.7% for surgery for lower urinary tract, 11.4% for nephroureterctomy, and 7.6% for radical prostatectomy, while RI rates for clean surgery were less than 5%. RIs most frequently reported were urinary tract infections (2.6%) where Pseudomonas aeruginosa (20.3%) and Enterobacter faecalis (15.3%) were the major causative microorganisms. Parameters such as age, obesity, nutritional status (low proteinemia), diabetes mellitus, lung disease, duration of operation, and blood loss volume were recognized as risk factors for SSI or RI in several operative procedures. Postoperative body temperatures, peripheral white blood counts, C reactive protein (CRP) levels in POD 3 were much higher than those in POD 2 in cases suffering from perioperative infections, especially suggesting that CRP could be a predictable marker for perioperative infections.

69歳女.2002年3月より左側腹部鈍痛と食欲不振があり, 腹部CTで巨大後腹膜腫瘤が認められた.入院時, 心窩部から左上腹部にかけ弾性硬で可動性のない巨大腫瘤を触知した.CTで左腎上極から中部外方に最大径5cmの内部壊死を伴う腫瘍性病変を認めた.また, 左膀大動脈リンパ節腫脹が認められ, 腫瘍の転移が疑われた.画像所見から腎外に発育した左腎細胞癌を疑い, 手術を施行した.経胸腹的に腫瘍に到達したが, 腫瘍は腹腔動脈を巻き込んでおり, 摘出は不可能と判断し, 生検のみを施行した.悪性リンパ腫あるいは形質細胞腫が疑われた.diffuse large B cell lymphomaとしてCHOP療法を施行したが, 1コース終了後のCTでNCであった.そのため病理組織標本を詳細に再検討した結果, non-secretary typeの髄外性形質細胞腫と診断した.VAD(vincristine, adriamycin, dexamethasone)療法を3コース施行し, 腫瘍の著明な縮小を認め, 腹部症状も消失した.8月から計49Gyの放射線療法を追加し10月退院, 治療1年2ヵ月後の現在, 腫瘍の進行は認めない, A 69-year-old woman visited a hospital with a complaint of left abdominal dull pain. A computed tomographic scan demonstrated a large tumor with central necrosis in the left retroperitoneum, and an angiography revealed hypervascular tumor which was fed from splenic, left renal, left gastric and left colic arteries. Renal cell carcinoma with extrarenal progression was pre-operatively suspected, and a resection was attempted. However, since the celiac artery was involved in the tumor, only a biopsy was performed. The histopathological finding of the biopsy specimen was a plasmacytoma. A combination of chemotherapy and radiation therapy resulted in a marked reduction of the tumor. There was no evidence of tumor progression one year after the chemotherapy.

腹腔鏡下前立腺全摘除術(LapRP)を施行した限局性前立腺癌15例を対象に, 早期成績を恥骨後式前立腺全摘除術(RRP)と比較検討した.LapRPに対して行った開放手術への移行は1例のみで, 大きな合併症はなかった.開放手術のRRPに比べて, 有意に手術時間は長かったが, 出血量は少なく, 術後の摂食や歩行開始時期も早く, カテーテルを早期に抜去できた.尿禁制は全例で保たれ, organ confinedな癌であれば, 根治性にある手術に成り得ることが示唆され, 限局性前立腺癌に対する治療の選択肢の1値に成り得る術式と考えられた, We herein report our experience and early results of laparoscopic radical prostatectomy in 15 cases of localized prostate cancer (11 T1c and 4 T2a tumors) performed between March 2000 and October 2001. The operative procedure was almost identical to the Montsouris technique. Conversion to the open procedure was required only in the first case because of a widely opened bladder neck that involved the ureteral orifice. No severe intraoperative or postoperative complications were observed. The mean operating time and blood loss was 383 minutes and 640 ml including intraoperative urine, respectively. Only one patient required blood transfusion. All 14 patients with a successful procedure could take fluid and walk freely on postoperative day 1. Twelve (86%) of the 14 patients could take food on postoperative day 1 and a Foley catheter was successfully removed on day 6 to 8 in 12 (86%) cases. Histologically, positive surgical margin was observed in 5 (33%) cases and all of them were considered non-organ confined (pT3 or more). Without adjuvant hormonal therapy, biochemical (PSA) failure was observed in 5 (36%) cases (median follow-up period: 11 months). Continence has been well maintained in 12 patients with no need for a pad by 3 months postoperatively and 2 patients are using only 1 pad/day for caution's sake. In terms of early postoperative recovery, intraoperative blood loss and maintenance of continence, laparoscopic radical prostatectomy may give a satisfactory result. Although long-term follow-up is required to assess disease control and maintenance of sexual function, laparoscopic radical prostatectomy may become an alternative for the treatment of organ-confined prostate cancer.

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