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施設入居者夫婦10組(男性平均年齢74歳, 女性平均年齢72歳)の性生活の実態調査について, 男性性機能の自信度や満足度を中心に検討した.半数のカップルで性交が認められ, 現在の性生活を満足していた.性交の満足度については勃起維持頻度と維持困難さが, 勃起維持の自信度については勃起維持困難さが一番強く関係し, これは加齢に伴い低下していた.また, 高齢夫婦のコミュニケーションには性行為コミュニケーションも必要であることが示唆された, A questionnaire study was conducted on sexual life such as intercourse frequency, libido and erectile function and degree of satisfaction of sexual life in aging couples. Half of them had sexual intercourse and satisfaction of life. According to multivariate analysis using stiffness of penis at erection, erection maintained, and difficulty of maintenance of erection state, there was a significant relationship between satisfaction of sexual life and frequency of erection maintained or difficulty of maintenance of erection state, and also between confidence on erection and difficulty of maintenance of erection state. These values became lower because of aging. We concluded that sexual communication was needed in the life of aging couples, and an urologist should have a role in consulting on aging life.

ラットでの性ホルモン誘発非細菌性前立腺炎モデルを用い, 既報の抗炎症作用を病理組織学的に確認すると共に, その作用機序究明の一環として, cernitin pollen-extract(CN)の炎症性サイトカイン(IL-1β, IL-6及びTNF-α)に対する作用を検討した.その結果, 対照群で認められた前立腺組織中のIL-6及びTNF-αの増加を用量依存的に抑制した.この抑制作用がCNの抗炎症作用に重要な因子であると推測された, Cernitin pollen-extract (Cernilton, CN) is a preparation made from eight kinds of pollen and has been used for various prostatic diseases in Japan and Europe. We reported previously that CN possessed a recovery action on the sex-hormone-induced nonbacterial prostatitis in rats. To clarify the possible mechanism of action of CN, we investigated the effects of CN on inflammatory cytokines (IL-1 beta, IL-6 and TNF-alpha) in the same model. Aged Wistar rats were castrated and injected 17 beta-estradiol (0.25 mg/kg/day, s.c.) for 30 days. CN (630 and 1, 260 mg/kg, p.o.) or testosterone (2.5 mg/kg, s.c.) was administered for the last 14 days of the treatment of 17 beta-estradiol. In control rats, prostatic IL-6 and TNF-alpha contents were increased approximately 2-3 fold, and acinar glandular inflammation and stromal proliferation were found histopathologically, as compared with those of intact rats. On the other hand, CN decreased the increased contents of cytokines in a dose-dependent manner. The histopathological changes mentioned above were restored in rats treated with 1, 260 mg/kg. Testosterone also ameliorated them significantly. These results indicate that CN has an anti-inflammatory action, and that the inhibitory effect of CN on the prostatic inflammatory cytokine is an important factor in its action.

当科で施行した腎部分切除術7例(男6, 女1, 41～70歳)について検討した.術後観察期間は4～92ヵ月であった.両側腎癌の1例は術後にインターフェロンαによる補充療法を追加したが, 術後25ヵ月後に遠隔転移により癌死した.残り6例は局所再発及び遠隔転移を認めず生存中である.画像診断の発達により増加してきた偶発腎細胞癌に対しては, 対側腎正常例でも積極的に腎保存術を選択して良い治療成績が報告されている.今後も, elective indicationである腎細胞癌に対しては症例を選んで腎保存術を行っても良いと考えられた, From Sept. 1991 to Jan. 1999, we performed partial nephrectomy on 7 patients with renal cell carcinoma. The indication was imperative for 3 patients, and elective for 4 patients. The 3 imperative cases consisted of bilateral renal cell carcinomas, a polycystic kidney disease and a contralateral atrophic kidney. All 4 patients with elective indication revealed renal cell carcinoma with a normal functioning contralateral kidney. The tumor size ranged from 1.3 cm to 6.0 cm (2.7 cm on average). The mean clamping time of renal artery was 22 minutes and mean blood loss was 400 ml. The pathological stage was pT1a in 6 patients and pT1b in one patient. Postoperative follow-up ranged from 4 months to 92 months (mean: 43 months). One patient with bilateral renal cell carcinoma died of metastases to the lungs and brain at 25 months postoperatively. The remaining 6 patients are alive without recurrence and metastasis. We obtained a good postoperative course in our selected patients with low stage. Thus it was considered that partial nephrectomy is effective against small renal cell carcinoma.

1997年5月～1998年2月の間に腎結石40例, 尿管結石40例(男性60例, 女性20例)についてドルニエリソトリプターコンパクトを用いた治療を行った.結石のサイズは5～80mmであった.大多数の症例は無麻酔で行ったが, 3例に硬膜外麻酔を必要とした.また4例に尿管ステント留置後に治療を行った.全ての症例において結石砕石は認められた.1ヵ月後の評価では砕石効果と完全排石率は91%と54%, 又, 3ヵ月後の評価では砕石効果と完全排石率は91%と68%であった.腎盂腎炎や腎周囲血腫, 大量の血尿等の重篤な副作用はみられなかった.ドルニエリソトリプターコンパクトは腎尿管結石の治療において安全で砕石効果が優れていると考えられた, Between May 1997 and February 1998, 40 cases of renal stones and 40 cases of ureteral stones in 60 males and 20 females were treated with the Dornier Lithotripter Compact. The size of the stones ranged from 5 mm to 80 mm. Three patients required epidural anesthesia and 4 patients required a ureteral stent. Fragmentation of the stones was observed in all patients. After 1 month, the efficacy and stone free rates were 91% and 54%, respectively. After 3 months, they were 91% and 68%, respectively. There were no serious side effects such as pyelonephritis, perirenal hematomas, and massive hematuria. In conclusion, the Dornier Lithotripter Compact proved to be a safe and highly effective lithotripter for the treatment of renal and ureteral stones.

症例1は41歳女, 主訴は頻尿.超音波検査, 点滴注入腎盂造影, CTなどで膀胱左前壁に大きな充実性腫瘍を認め, MRIのT1強調像では内部均一な低信号, T2強調像では内部不均一な低信号の腫瘍であった.膀胱鏡では大きな粘膜下腫瘍を認めた.膀胱部分切除を行い, 以後36ヵ月間, 再発, 転移をみない.症例2は32歳男, 主訴は肉眼的血尿.膀胱の超音波検査とMRIで前壁に大きな腫瘍が見られた.膀胱鏡では前壁に粘膜下腫瘍を認めたが, 尿細胞診では悪性所見は無かった.生検試料では粘膜に炎症反応を見るに止まった.膀胱部分切除を行い, 29ヵ月間再発, 転移を見ない.両腫瘍の組織診断は膀胱の平滑筋腫であった, We report 2 cases of leiomyoma of the urinary bladder. A 41-year-old female visited our hospital with the complaint of pollakisuria. A solid tumor of the urinary bladder was found by ultrasonography. A large shadow defect at the left-anterior wall was shown by drip infusion pyelography (DIP). Computed tomographic scan (CT) and magnetic resonance imaging (MRI) also revealed a large tumor. T1-weighted image revealed a homogeneous low intensity tumor and T2-weighted image disclosed heterogeneous low intensity tumor. Cystoscopy revealed a large submucosal tumor. Partial cystectomy was performed, and she has had neither recurrence nor metastasis for 36 months. A 32-year-old male was referred to our hospital with the complaint of macrohematuria. A solid tumor of the urinary bladder was found by ultrasonography. A shadow defect was not clearly detected by DIP. A large tumor was detected on the anterior wall by MRI. T1-weighted image showed a homogeneous low intensity tumor and T2-weighted image disclosed a high intensity tumor. Cystoscopy revealed a submucosal tumor on the anterior wall. Urine cytology did not suggest a malignancy. The biopsied specimens revealed only an inflammatory change in the mucosa. Partial cystectomy was carried out. He has had neither recurrence nor metastasis for 29 months. Histological diagnosis in both cases was leiomyoma of the urinary bladder.

21例の女子尿道症候群症例の尿中IL-6, IL-8の測定を行い, インターロイキンの検出率の違いや抗菌剤治療前後での変化について推計学的検討を加えた.これら女子尿道症候群症例中1例にIL-6を, 8例にIL-8が検出され, その値は41.1pg/mgCr, 13.3～560pg/mgCr(平均108.7pg/mgCr).IL-6やIL-8が検出された9症例に対し, スパルフロキサシン 100mgを服用させ, 自覚症状を調べたところ, インターロイキンは測定されなくなり7症例では自覚症状の改善がみられた.残り2名にインターロイキンが検出されたが, うち1症例に症状の改善がみられた, Interleukin-6 (IL-6) and interleukin-8 (IL-8) are important mediators of an inflammatory response. We measured creatinine-collected urinary levels of IL-6 and IL-8 by an enzyme-linked immunosorbent assay in 21 women with urethritis syndrome as well as 20 age-matched healthy women. Urine samples were collected before treatment and after 7 or 14 days of oral administration of sparfloxacin (100 mg once daily). Urinary IL-6 level was elevated in a patient with urethritis syndrome (41.1 pg/mgCr), while urinary IL-8 levels were elevated in 8 (range 13.3 to 560 pg/mgCr). On the other hand, none of the healthy controls showed any detectable urinary level of IL-6 and IL-8. Of the 9 patients with elevated urinary IL-6 or IL-8, symptomatic improvement was obtained after chemotherapy in 8 and urinary interleukins became undetectable in 7. Urinary IL-6 and IL-8 seem to have some role in the induction of urinary symptoms.

NPTはそのパターン分類の解析と他の勃起機能検査との総合的判断により, 器質的勃起障害と心因性勃起障害の鑑別だけでなく, 器質的勃起障害の原因疾患の診断, 治療法の選択などにも役立つ, In 43 men who required further examination of erectile function, we analyzed the relationship between the various factors including hormone levels, penile blood pressure index (PBPI), shape of the arterial wave, erection period after prostaglandin E1 injection and dynamic cavernosography/metry, as well as the patterns of nocturnal penile tumescence (NPT) with rigidity. Normal, dissociation, short episode, low amplitude and flat trace patterns, which were classified by Kaneko, were observed in 11, 8, 11, 2 and 11 men, respectively. Uncoupling was not observed in any men. There were no differences in the levels of prolactin and LH among the 6 patterns. A high FSH level was seen in men with a flat trace pattern; a low level of free testosterone ( < 12.2 pg/ml) was seen in men with dissociation, low amplitude and flat trace patterns, and low PBPI ( < 0.75) in men with flat trace pattern; and an arteriosclerotic shape of the arterial wave was seen in men with short episode and flat trace patterns. Each erection period immediately after prostaglandin E1 injection in men with dissociation, short episode, low amplitude and flat trace was shorter compared with cases with a normal pattern. Venoocclusive dysfunction was observed in 5 men with a dissociation pattern and 6 men with a flat trace pattern. In conclusion, an integral analysis of pattern of NPT with rigidity and other examinations are useful for differentiating organic impotence from psychogenic impotence and for accurately diagnosing pathophysiological disorders of organic impotence and underlying diseases.

17例の慢性非細菌性前立腺炎にスパルフロキサシンでの治療を行い, 精液中のサイトカイン(IL-1β, IL-6 TNF-α)を測定した.健常男子11例の精液と比べた結果, 健常男子では1例にTNF-αが検出されたが, 他のサイトカインはまったく検出されなかった.慢性前立腺炎では何等かのサイトカインが検出され, 特にIL-6やTNF-α値の検出される頻度はそれぞれ10例中6例(60%)と有意に高かった.慢性前立腺炎での精液中IL-1β, IL-6, TNF-α値の平均値(範囲)はそれぞれ28pg/ml(27-29), 110pg/ml(25-476), 25pg/ml(6-113)であった.これらのサイトカイン値はスパルフロキサシンでの治療にて症状改善と共に正常化した, The detection of various cytokines; interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), was studied in patients with nonbacterial prostatitis (NBP), and the clinical efficacy of sparfloxacin was also reported. The seminal plasma of 11 normal men and 10 patients with NBP were examined for the cytokines. There was no IL-1 beta or IL-6 in the seminal plasma of normal men. TNF-alpha was detected in only one normal man. In the seminal plasma of the patients, IL-1 beta was detected in 2 out of 10, and IL-6 was also detected in 6. TNF-alpha was detected in 6 out of 10 patients with NBP. The rate of detection of IL-6 and TNF-alpha was significantly higher in the patients with NBP than in normal men. The average levels (range) of IL-1 beta, IL-6 and TNF-alpha were 28 pg/ml (27-29), 110 pg/ml (25-476) and 25 pg/ml (6-113), respectively. After treatment with sparfloxacin at a dose of 100 mg to 200 mg per day, their symptoms disappeared. The number of leukocytes in the seminal plasma decreased to the normal level and these cytokines were not detected. The favorable clinical effect was achieved in 13 of the 17 patients (76%). These findings suggested that the cytokines have an important role in the pathogenesis of prostatitis and that the level of the cytokines are useful indicators in patients with prostatitis, particularly with NBP.

1) 55歳以上の尿潜血反応陽性18名をGFR 60ml/min以下と以上の2群に分け検討した。2)尿中排泄が造影後有意に増加したのは, 尿中γ-GTPは両群とも, 尿中ALBとNAGは腎機能正常群のみに認められた。近位尿細管β2-MG再吸収能は腎機能障害群のみ造影4日目まで一過性に低下傾向を示したが, 6日目には軽快していた, We assessed the nephrotoxicity of a non-ionic contrast medium, Iohexol, in 18 elderly patients. They were divided into two groups. Group 1 consisted of 12 patients with glomerular flow rate (GFR) above 60 ml/min/1.73 m2 (range 69-136; average 96) and group 2 consisted of 6 patients with GFR below 60 ml/min/1.73 m2 (range 38-59; average 49). Urine samples, collected before, immediately after, and on the third and sixth days after drip infused pyeloureterography (DIP) were analyzed for gamma-glutamyl transpeptidase (gamma-GTP), N-acetyl-beta-D-glucosaminidase (NAG), beta 2-microglobulin (beta 2-MG) and albumin. In group 1, immediately after DIP, the urinary excretion of albumin, gamma-GTP and NAG were significantly increased (p < 0.01, p < 0.01, p < 0.01). In group 2, immediately after DIP, the urinary excretion of gamma-GTP and beta 2-MG were significantly increased (p < 0.01, p < 0.1). The gamma-GTP and NAG values in both groups suggest that the damage of proximal tubules cells will not continue for more than 4 days. However, as for the reabsorption of beta 2-MG on proximal tubules, in group 2 the value did not return to the pre DIP level until 6 days after DIP. We believe it is important to postpone injection of non-ionic contrast medium within 6 days of its last usage.

Case 1. A 55-year-old male visited our hospital complaining of dysuria and two-staged micturition. Physical examination revealed a fist sized, elastic soft mass in the left inguinal region. Upright drip infusion pyelography (DIP) showed left inguinal hernia of the bladder. Retrograde urethrography showed bladder neck contracture and a diverticulum. Cystoscopy revealed a indentation in the left bladder wall. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. From these findings, diagnosis was made as bladder hernia and bladder neck contracture. Resection of thin portion of the bladder wall and hernia repair, accompanied by prostatectomy, was performed. Case 2. A 37-year-old male visited our hospital with the history of ureteral stone and chronic prostatitis. Upright DIP incidentally revealed the small right inguinal bladder hernia. Because he had no complaint of dysuria and two-staged micturition, he was observed without surgical treatment.

1)9例のインポテンス患者に塩酸パパベリンを第一選択として陰茎海綿体内自己注射法を指導したところ, 自己注射が技術的に困難であった1例を除いた8例全例で挿入可能な完全勃起を認め, 性交可能となり本人およびパートナーの満足がえられた。2)1例で勃起機能が回復し治癒し, 射精は3例に認められた。なお, 観察期間中自己注射484回施行で副作用は認めなかった, From December 1989 to September 1992, nine patients with impotence were instructed to perform intracavernous self-injection of vasoactive drugs. At first 40 mg of papaverine hydrochloride was used in all patients and the response on erection was evaluated. If the response did not show sufficiently functional erection, a mixture of 40 mg of papaverine hydrochloride and 1 mg of phentolamine mesylate or 20 mg of prostaglandin E1 was reinjected. Eight patients had achieved full erections and vaginal penetrations without noteworthy complications during the follow-up period. Out of eight patients, three patients were able to ejaculate and one patient showed recovery of erection. No major side effects were seen. In conclusion, intracavernous self-injection is a useful modality for impotence.

We report a case of milk of calcium renal stone within a calyceal diverticulum in the patient with left ureteral tumor. The patient was a 77-year-old-man with the chief complaint of asymptomatic microscopic hematuria. A plain film revealed round opaque calcific densities in the left kidney in the supine position and a dense crescent-shaped shadow with a horizontal border in the upright position. An intravenous pyelography showed left hydronephrosis and calculi within a calyceal diverticulum. Computed tomography in the supine position revealed layering of the calcifications in cystic lesion of the left kidney accompanied by left hydronephrosis due to a soft mass in the left ureter and a right renal cyst. Retrograde pyelography revealed a filling defect of the middle portion of the left ureter. Under the diagnosis of milk of calcium renal stone and left ureteral tumor, left total nephroureterectomy and partial cystectomy was performed. Pathological findings indicated transitional epithelium of the diverticulum wall and grade 1 transitional cell carcinoma of the left ureteral tumor.

A 74-year-old male with the chief complaint of painless enlargement of a mass in the scrotum was diagnosed as having a giant epidermoid cyst on July 8, 1991. He had no past history of injury or pain of the scrotum. Magnetic resonance imaging (MRI) of the scrotum demonstrated a well-circumscribed homogeneous mass, and was distinguished from both normal testes. Under the diagnosis of intrascrotal epidermoid cyst, the mass was resected surgically. The mass measured 23 x 15 x 15 cm, and it contained liquids. The pathological diagnosis was epidermoid cyst of the scrotum.

1)テラゾシンの前立腺肥大症に伴う排尿障害に対する臨床効果および副作用について, 91例, 18施設の多施設臨床試験を実施した.試験は1週間以上の観察期, 6週間の治療期とし, 観察期および治療2週目, 4週目, 6週目に自覚症状, 他覚所見(尿流量率, 排尿量, 残尿量)の変化を評価した.超音波断層法, 尿道造影, CTスキャンなどで前立腺の推定重量を求め, 前立腺の大きさと本剤の効果についても検討した.観察期にはプラセボ錠を投与し, 治療は塩酸テラゾシン1 mg/日を初期投与量とし2週目で自覚症状が改善以上であれば1 mg/日の投与量を維持し, やや改善以下であれば2 mg/日に増量, 4週目で改善以上であれば2 mg/日の投与量を維持し, やや改善以下であれば4 mg/日に増量し, 6週目に最終効果判定をする.1 mg→2 mg→4 mgの漸増法とした.2)自覚症状の累積改善率は, 1 mg/日では18.5%, 2 mg/日までで55.6%, 4 mg/日までで65.4%であった.観察期の自覚症状の強いものの方が症状の改善度が高く, 治療終了時には自覚症状スコアは観察期のスコアにかかわらずほぼ同じレベルに収束した.3)自排尿量, 最大尿流量率, 平均尿流量率, 残尿率, ノモグラムスコアは, いずれも治療後有意に改善した.残尿量, 排尿開始までの時間については有意差はえられなかった.前立腺重量と最大尿流量率, ノモグラムスコアの改善度の間に有意な相関は認めなかった.他覚所見の累積改善率は, 1 mg/日では13.2%, 2 mg/日までで42.1%, 4 mg/日までで50.0%であった.4)全般改善度の累積改善率は, 1 mg/日14.5%, 2 mg/日までで50.0%, 4 mg/日までで61.8%であった.5)副作用は, ふらつき6件, 立ちくらみ2件, 耳鳴り, むかつき, かすみ目各1件の計11件(10例)で, 発現率は11.6%であった.5例は臨床上問題なく服薬を継続し, 1例は減量して服薬を継続した.服薬を中止したのは4例, 4.7%であった.本薬に起因すると思われる臨床検査値異常は認められなかった.拡張期血圧の有意な低下を認めたが, 収縮期血圧, 脈拍に有意な変動を認めなかった, In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.

616件の手術を行いその内TUR-Pが177件を占めた, A clinical statistic survey was made on the operations at our department between 1988 and 1990.

腎細胞癌の治癒的切除術施行例44例を対象にrIFNα-2b投与に関する臨床的検討を行った.1) 44例のstage分類(Robson)は1が29例, 2が15例であった.2)適格例42例中, 再発が認められた症例は5例であり, うち2例が死亡している.再発から死亡までの期間は2ヵ月と6ヵ月であった.3)適格例の42例中, 死亡例は3例であり, 累積生存率は1年生存率97.6%, 2年生存率89.7%であった.4) IFN初期治療終了後のIFNαおよびIFNγ産生能は前者においてすべて低下(4/4)し, 後者においては3例が上昇(3/4), 1例が正常値を示した.5) 2-5AS活性は評価できた4症例において, いずれもrIFNα-2b投与により上昇が認められた.6)副作用を認めたものは24例であり, 発熱が22例と最も多く, その他に白血球数減少, 肝機能障害などを認めたが, 多くは投与継続が可能であり副作用による中止例は5例であった.7)抗rIFNα-2b抗体について22例で継続的に測定したが, いずれも測定限界値未満であった, A clinical trial using interferon alpha 2b (IFN alpha-2b) for prophylactic therapy was done on 44 patients who had received nephrectomy for renal cell carcinoma. Principally, the daily intramuscular injection of 3 of 6 million units of IFN alpha-2b was done for 4 consecutive weeks after 2 weeks postoperatively and thereafter followed by injection once every 2 weeks. The clinical evaluation was done for the recurrence rate, the survival rate, the IFN alpha and IFN gamma producing ability, the activity of 2', 5' oligoadenylate synthetase (2-5AS) and the side effect. Out of 44 cases entered, 42 were completely evaluable and recurrence was observed in 5 (11.9%) of the 42 cases. The recurrence rate was 5.5% and 16.4%, at the first and second year, respectively. Three (7.1%) of the 42 patients died. The survival rate was 97.6% at the first year, 89.7% at the second year for the followup study. The IFN alpha producing capacity was low in all of the 4 evaluable cases. The IFN gamma producing capacity was high in 3 cases and normal in 1 case. 2-5AS, the enzyme produced by IFN, was activated by IFN alpha-2b administration in all of the 4 evaluable cases. Side effects were observed in 24 (54.5%) of the 44 cases. The main side effect was fever. Leucopenia, general fatigue, appetite loss, temporary elevation of liver transaminase were also observed. However, there were only 5 cases (11.4%) in which administration of IFN alpha-2b had to be discontinued.

膀胱保存手術後の術後再発予防に対するHCFUの効果およびHCFUとSLAの併用効果を検討した.1) 57例の膀胱手術後の再発は1年2例, 2年15例であった.2) 87例を対象として, 封筒法にてHCFUおよびSLA併用群とHCFU単独群での再発予防効果は, 1年以上で併用群で成績が良好であった.3)副作用は11例にみられたが, 重篤な副作用は1例もなかった, To treat superficial bladder cancer or invasive bladder cancer presenting as a solitary tumor, conservative therapy such as transurethral resection of bladder tumor or partial cystectomy has long been carried out. We studied the effect of 1-hexylcarbamoyl-5-fluorouracil (HCFU), and the effects of the combination of HCFU and 2.5-di-O-acetyl-D-glucaro-(1-4)(6-3) dilactone (SLA) which is an anti-beta-glucuronidase agent, for preventive therapy. In the patients treated with HCFU, the recurrence rate was 3.6% and 26.6% one year and two years, respectively, after conservative operation. In the patients treated with both SLA and HCFU, the recurrence rate was lower than in those treated with HCFU one year or more after conservative operation, and a long-term preventive effect was expected for nondrinkers.

過去5年間にDornier社腎結石破砕装置HMIIIを用いてESWLを施行し, 追跡可能であった1, 200例の単一結石について検討した.1)長径20 mm以下の結石については, 腎盂・腎杯部で最も成績がよく84%の成功率をえた.成績不良部位は尿管で62%の成功率であった.2)尿管結石について検討するとin situ症例と尿管カテーテル使用症例の間には成績上, 差はないが, D-Jカテーテル留置症例では10 mmより大きな結石でin situ症例および尿管カテーテル使用症例に比し, 有意に成績は良かった.3)術前IV, We performed extracorporeal shock-wave lithotripsy (ESWL) on 1, 701 patients in a total of 2, 438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1, 200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

22例の症例についてmetallic spiralを用いた治療を試みた.その年齢は56～91歳(平従76.6歳)で, 原疾患としてはBPHで, 直腸癌術後および糖尿病性神経因性膀胱を合併したのがそれぞれ1例, 脳梗塞後が2例いた.それら症例の治療前の排尿状態は, 尿閉のため留置カテーテルがあった症例は16例, 排尿障害のある症例は6例であった.治療後の尿流量面からの評価では, 排尿量100～230 ml(平均172 ml), MFR 13～21 ml/秒(17.3 ml/秒), AFR 4～12 ml/秒(8.2 ml/秒)で, 残尿量も30 ml以下が20例, 200 mlが1例であった.このうち留置ステントの膀胱側への移動は6例見られたが4例は再度留置した.尿道ステントに伴う会陰部不快感は3例に見られ2例は抜去せざるを得なかった.尿失禁, 膿尿の持続や尿路感染症, 結晶の付着など特に治療を必要とする症例は観察されなかった, Treatment using a metallic spiral was attempted on 22 patients. They had urinary retention in 16 cases and dysuria in 6. In 21 of them, the spiral was successfully placed under transrectal ultrasound control. In all 21 patients, voiding was possible immediately after placement of the spiral. As for urodynamic study, urine volume was 100-230 ml (mean: 172 ml), maximum flow rate was 13-21 ml/sec (mean: 17.3 ml/sec), and average flow rate was 4-12 ml/sec (mean: 8.2 ml/sec). Residual urine volume was less than 30 ml in 20 patients and 200 ml in one. As for complications, proximal migration of the spiral was observed in 6 patients. In 4 of them, the new spiral was placed. Perineal discomfort was seen in 3 patients, in 2 the spiral was removed. Pyuria associated with bacterial infection did not continue after the treatment in patients having a catheter. Severe urge incontinence and encrustation were never seen. The above findings suggest that, though a longterm study has not done, this treatment could be an effective treatment particularly for the elderly patients with general complications and/or who require removal of an indwelling catheter for clinical or social reasons.

30例のバルーン非留置のBPH患者に計10回, 経直腸的温熱療法を行い, 自・他覚所見より短期および長期成績を検討した.1)短期成績としては, ほとんどの症例で治療後自覚症状の改善, とくに夜間排尿回数, 昼間排尿回数および尿線の改善がみられ, 1ヵ月間持続した.他覚所見としては, 残尿量, 最大尿流量率, 平均尿流量率の改善を多くの症例でみたが, 前立腺重量では治療前後で差はなかった.2) 6ヵ月の長期follow例では, 24例で自・他覚所見のいずれかで改善が持続し, 両方とも改善の持続した症例は16例であった.3)治療に伴う合併症としてはapplicator挿入時の痛みと温度上昇に伴う肛門内熱感程度で, 局所麻酔のみでapplicator挿入も容易で, 治療による肝, 腎障害などは全例でみられなかった.4)以上より, 合併症を有し手術困難なBPHに対し, 本治療法は有用な治療法の1つと考えられた, Transrectal hyperthermia was performed on 30 patients with benign prostatic hyperplasia twice a week for a total of ten times with the temperature of the prostatic tissue set at 43.0 degrees C. In our in vitro experiment using an agar phantom, the highest temperature was observed at approx. 1.5 cm from the point where the 915-MHz microwave was generated. Our histopathological study of the prostatic tissue, resected at open surgery after three days of hyperthermia, indicated that the effect of hyperthermia first occurred in the interstitial tissues, and then extended to the epithelial cells. Subjective symptoms and objective findings were evaluated. In almost all cases, improvement was observed in subjective symptoms after completion of the treatment. The residual urine volume improved significantly. Also, significant improvement was observed in our urodynamics study. In 16 out of 30 cases (53%), both subjective symptoms and objective findings were still improved after six months.

BPHに起因した排尿障害を有する40症例に対しlarge prostaic dilation catheterを使用した尿道拡張術を施行した.最長観察期間は22ヵ月, 平均観察期間は9.5ヵ月であった.1)術中の愁訴として, 尿意切迫感が32例にみられた.術後肉眼的血尿はほとんど全例でみられたが, 輸血などを必要とした例はなかった.2)拡張後, 残尿量は減少し, 平均尿流率, 最大尿流率も5.7から8.2 ml/sec, 10.4から15.6 ml/secへと改善していた.3) IT typeとIF typeに分類し検討すると, IF typeのBPHの方が高い臨床効果を示していた.尿閉21例中12例に留置カテーテルの抜去が可能であった.無効の症例はいずれも膀胱内に突出する中葉肥大を伴うのBPHであった, Transurethral balloon dilatation therapy was performed on 40 patients with benign prostatic hypertrophy (BPH) under local anesthesia. During the procedure, urinary urgency occurred in 80% of the patients. After prostatic dilatation, macrohematuria was observed in almost all patients. The longest follow-up period after dilatation was now 22 months, and the average was 9.5 months. After treatment, residual urine volume decreased, and average flow rate and maximal flow rate improved from 5.7 and 10.4 ml/sec to 8.2 and 15.6 ml/sec, respectively. Overall clinical efficacy was 67.5%. Urethral dilatation therapy was thought to be an effective and non-invasive therapy for BPH.

膀胱腫瘍12症例に対しHPC-PEP膀胱内注入療法を行い, 著効2例・有効5例・無効5例の結果を得た.血中にはいずれの時期においてもPEPは検出されず, 腫瘍内には投与7日目に平均0.36 μg/gr (0.11～1.02), 14日目に0.19 (0.1～0.27)認められた, Peplomycin emulsified in hydroxypropyl cellulosum (HPC-PEP) was prepared for intravesical chemotherapy. Clinical efficacy of HPC-PEP and tissue concentration of peplomycin (PEP) were studied in 12 patients with bladder tumor. Histopathology showed transitional cell carcinoma; 2 in grade 1, 8 in grade 2, and 2 in grade 3. The total volume of 30 ml HPC-PEP was prepared from a mixture of 2% HPC and 90 mg PEP in 15 ml saline, and was intravesically administered through a urethral catheter and retained for two hours. Clinical evaluation 7 days after the initial instillation demonstrated good tumor regression in 2, good response in 5, and no change in 5. The mean PEP level in tumor tissue was 0.36 microgram/gr after 7 days and 0.19 microgram/gr even after 14 days. These clinical observations and tissue levels of PEP suggest that HPC-PEP might be useful as an intravesical instillation agent for bladder tumor.

ESWLを施行し, 追跡可能であった911例の単一結石について, 1)男性では女性に比し, 尿管結石の頻度が高かった.2)腎盂・腎杯に存在する結石に対するESWLの成績が最も良好で, 20 mm以下で87%の成功率を得た.3) ESWL成績不良部位は尿管で, 嵌頓結石症例では結石サイズが小さくとも, TULやD-Jステントカテーテル留置下でのESWLを行うべきである, At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

The effect of ganglioside was studied in 6 diabetic patients with neurogenic bladder. Ganglioside is glycosphingolipids which seems to be involved in the processes of nerve growth, regeneration and tissue reinnervation. The treatment consisted in the daily intramuscular administration of 20 mg ganglioside. Clinical symptoms, vibration sensation and urodynamic studies were recorded at the beginning and 4 weeks later. The clinical responses assessed by subjective complaints and vibration sensation were effective, but no statistically significant difference in urodynamic studies was obtained. Side effects were not observed. In conclusion, ganglioside treatment seems to have a positive effect on diabetic neurogenic bladder.

前立腺肥大症に対するCernilton(R)の有用性を検討するため, Paraprost(R)を対照薬とする多施設二重盲検群間比較試験を行った.1)総投与症例数192例中, 総合効果は159例, 総合安全度は178例, 有用度は159例について集計解析した.解析対象例と除外・脱落例の症例の構成および患者の背景因子において両群間に偏りはみられなかった.2)委員会と主治医判定による総合結果, 患者の印象のいずれにおいてもCN群の成績はPP群より高かったが, 両群間に有意差はなかった.3)自覚症状全般改善度の推移において, 4週後の委員会判定による中等度改善以上の改善率でCN群はPP群より有意に優れていた.また排尿困難の有力な指標である苒延性排尿に対する改善率でCN群はPP群より有意に優れていた.4)他覚所見の計測値の検討では, CN群は残尿量, 平均排尿量率, 最大排尿量率, 前立腺重量(Thumann計測)において投与前後の比較で有意の改善が認められた.また残尿量の段階推移においてもCN群で有意の改善が認められた.5)副作用, 臨床検査値で新たな異常値の発現のいずれもCN群にはみられなかった.6)委員会判定による有用度は, CN群はかなり有用以上で49.1%, PP群は41.2%でCN群の成績はPP群より高かったが両群間に有意差はなかった, A multiple center double blind study was performed to study the effectiveness of Cernilton (CN) on benign prostatic hypertrophy in comparison to Paraprost (PP). Among a total of 192 patients, overall effect was studied on 159 patients, overall safety rate on 178 patients and rate of effectiveness on 159 patients. There were no differences between the two groups in the selected patients, criteria for exclusion and drop out cases or background data of the patients. Impression of patients and overall effect by committee and physician judgment were slightly higher in the CN group compared to the PP group, but there was no significant difference between the two groups. For the improvement in subjective symptoms, the rate of moderate improvement or more after 4 weeks by committee judgement was higher in the CN group compared to the PP group. The rate of improvement in protracted miction, which is an effective marker of urinary disturbance, was also higher in the CN group compared to the PP group. An analysis of objective symptoms showed a significant improvement in residual urinary volume, average flow rate, maximum flow rate and prostatic weight in the CN group. A significant improvement in the phased change of residual urinary volume was also seen in the CN group. No side effects or abnormalities in clinical test levels were noted in the CN group. By committee judgement, the rate of more than moderate effectiveness was 49.1% in the CN group compared to 41.2% in the PP group, but there was no significant difference between the two groups. By physician's judgment, the rate of more than moderate effectiveness was 49.4% in the CN group compared to 46.3% in the PP group, but there was also no significant difference between the two groups. These results suggested that Cernilton was an effective drug for benign prostatic hypertrophy.

We studied the efficacy of intravesical instillation chemotherapy of anticancer agents including cylocide (CA) in the prevention of recurrence of bladder tumor after surgery. Totally 60 patients with superficial bladder tumor were enrolled into the study. The patients were randomly assigned to either one of three groups: CA 300 mg alone, CA 200 mg + mitomycin C (MMC) 10 mg, and CA 180 mg + adriamycin (ADM) 20 mg. These drugs were initially instilled once a day for one week, and then once a month until 2 years after surgery. Thereafter, the patients were followed up without instillation. The cumulative non-recurrence rates in the CA group was 76.5, 60.0 and 60.0% at 1, 2 and 3 years after the removal of bladder tumor, respectively, while that in the CA + MMC treated group 90.9, 75.3, and 75.3% and that in the CA + ADM treated group, 95.1, 82.9 and 82.9%, respectively. The recurrence rate in the CA, CA + MMC and CA + ADM treated group was 35.3, 27.3 and 19.0%, respectively, the recurrence indices 1.84, 1.07 and 0.74, and the mean times between recurrence 10.8, 16.5 and 18.0 months, respectively. Side effects were noted in 3 of the 17 cases (17.6%) in the CA group, in 3 of the 22 cases (13.6%) in the CA + MMC group and in 3 of the 21 cases (14.3%) in the CA + ADM treated group. These data show that intravesical CA instillation in combination with MMC or ADM is more effective for the prevention of recurrence than that of CA alone.

43歳男.MRIで診断した下垂体微小腺腫による高プロラクチン血症に起因すると思われる43歳男性の乏精子症の1例を経験し, ブロモクリプチンがその治療に有効であった, We present an infertility male with prolactin level of 37.5 ng/ml. The patient had pituitary microadenoma detected by Gd-DTPA enhanced magnetic resonance imaging (MRI). After bromocriptine was administrated for 4 months, the size of microadenoma decreased, and sperm density and mortality improved. His wife became pregnant after 6 months. Dynamic MRI is a useful modality for detection of pituitary microadenoma, and bromocriptine is also useful for treatment of oligospermic patients with marginal hyperprolactinemia.

珊瑚状結石107例をESWL単独で治療したが, 4mm未満の結石サイズにまでした成功例は73例(68%)で, 不成功例は34例(37%)であった。結石別ではcalcium phsophate, calcium oxalate, magnesium ammonium phosphate, cytine, uric acidでそれぞれ34, 29, 38, 60, 75%であった。また120結石の珊瑚状結石に対する治療では腎瘻, TUL, 尿管ステントなどの補助療法が効果あった。治療期間は手術では1日であるが, ESWLでは平均18ヵ月, 治療費も手術より多かった。以上の事実はESWL単独治療の問題点を浮きぼりにした, We evaluated retrospectively 107 patients with staghorn calculi who underwent extracorporeal shock wave lithotripsy (ESWL) monotherapy from 1985 to 1990. The 107 patients consisted of 65 complete staghorn calculi and 55 partial staghorn calculi. Staghorn calculi required an average of 4.3 treatment sessions. Using a Dornier HM3 lithotriptor, the stone-free rate was 33% in patients with complete staghorn calculi, and 35% in patients with partial calculi. For stone evacuation following ESWL procedure, ureteral stenting, nephrostomy and transurethral lithotripsy were necessary. Four of the 21 patients who underwent ESWL monotherapy and were available for long-term followup showed stone growth, while all of the 10 patients who underwent open surgery during the previous 5 years became stone free. The average period of hospitalization and cost were 38.3 days and 700, 000 yen in patients who had received open surgery, and 25.8 and 1, 720, 000 yen in patients receiving ESWL monotherapy. In conclusion, ESWL monotherapy is useful, and if patients require complete removal of all stone fragments, a percutaneous lithotripsy should be performed following ESWL monotherapy.

A 30-year-old male patient without diabetes mellitus and tuberculosis was referred to our outpatient department for the purpose of further examinations of azoospermia. Transrectal ultrasonography revealed the bilateral calcifications of vas deferens. Kidney-ureter-bladder X-ray and computerized tomography revealed also the same findings. Seminal vesiculography revealed no obstructive sign of vas deferens. Histopathology of testes showed hypoplasia. Judging from these findings, we diagnosed the case as calcification of vas deferens associated with spermatogenic disturbance. Review of the 31 cases reported in the Japanese literature including our case was performed.

USAによる去勢術は, 従来のsurgical subcapsular orchiectomyとほぼ同様の効果のある術式と考えられた, We report a technique for performing subcapsular orchiectomy using the ultrasonic surgical aspirator (USA). The procedure was simple and safe, and was completed within one hour in 2 patients on whom it was carried out. Operative complications such as bleeding, postoperative pain and wound swelling were minimal, and compression dressings were not necessary. Postoperatively, the serum testosterone value was lowered to the castrate level. We conclude that subcapsular orchiectomy using USA is superior to conventional bilateral scrotal orchiectomy, and will be a useful option.

A questionnaire study was conducted on sexual life such as intercourse frequency, libido and erectile function and degree of satisfaction of sexual life in aging couples. Half of them had sexual intercourse and satisfaction of life. According to multivariate analysis using stiffness of penis at erection, erection maintained, and difficulty of maintenance of erection state, there was a significant relationship between satisfaction of sexual life and frequency of erection maintained or difficulty of maintenance of erection state, and also between confidence on erection and difficulty of maintenance of erection state. These values became lower because of aging. We concluded that sexual communication was needed in the life of aging couples, and an urologist should have a role in consulting on aging life.

From Sept. 1991 to Jan. 1999, we performed partial nephrectomy on 7 patients with renal cell carcinoma. The indication was imperative for 3 patients, and elective for 4 patients. The 3 imperative cases consisted of bilateral renal cell carcinomas, a polycystic kidney disease and a contralateral atrophic kidney. All 4 patients with elective indication revealed renal cell carcinoma with a normal functioning contralateral kidney. The tumor size ranged from 1.3 cm to 6.0 cm (2.7 cm on average). The mean clamping time of renal artery was 22 minutes and mean blood loss was 400 ml. The pathological stage was pT1a in 6 patients and pT1b in one patient. Postoperative follow-up ranged from 4 months to 92 months (mean: 43 months). One patient with bilateral renal cell carcinoma died of metastases to the lungs and brain at 25 months postoperatively. The remaining 6 patients are alive without recurrence and metastasis. We obtained a good postoperative course in our selected patients with low stage. Thus it was considered that partial nephrectomy is effective against small renal cell carcinoma.

Cernitin pollen-extract (Cernilton, CN) is a preparation made from eight kinds of pollen and has been used for various prostatic diseases in Japan and Europe. We reported previously that CN possessed a recovery action on the sex-hormone-induced nonbacterial prostatitis in rats. To clarify the possible mechanism of action of CN, we investigated the effects of CN on inflammatory cytokines (IL-1 beta, IL-6 and TNF-alpha) in the same model. Aged Wistar rats were castrated and injected 17 beta-estradiol (0.25 mg/kg/day, s.c.) for 30 days. CN (630 and 1, 260 mg/kg, p.o.) or testosterone (2.5 mg/kg, s.c.) was administered for the last 14 days of the treatment of 17 beta-estradiol. In control rats, prostatic IL-6 and TNF-alpha contents were increased approximately 2-3 fold, and acinar glandular inflammation and stromal proliferation were found histopathologically, as compared with those of intact rats. On the other hand, CN decreased the increased contents of cytokines in a dose-dependent manner. The histopathological changes mentioned above were restored in rats treated with 1, 260 mg/kg. Testosterone also ameliorated them significantly. These results indicate that CN has an anti-inflammatory action, and that the inhibitory effect of CN on the prostatic inflammatory cytokine is an important factor in its action.

We report 2 cases of leiomyoma of the urinary bladder. A 41-year-old female visited our hospital with the complaint of pollakisuria. A solid tumor of the urinary bladder was found by ultrasonography. A large shadow defect at the left-anterior wall was shown by drip infusion pyelography (DIP). Computed tomographic scan (CT) and magnetic resonance imaging (MRI) also revealed a large tumor. T1-weighted image revealed a homogeneous low intensity tumor and T2-weighted image disclosed heterogeneous low intensity tumor. Cystoscopy revealed a large submucosal tumor. Partial cystectomy was performed, and she has had neither recurrence nor metastasis for 36 months. A 32-year-old male was referred to our hospital with the complaint of macrohematuria. A solid tumor of the urinary bladder was found by ultrasonography. A shadow defect was not clearly detected by DIP. A large tumor was detected on the anterior wall by MRI. T1-weighted image showed a homogeneous low intensity tumor and T2-weighted image disclosed a high intensity tumor. Cystoscopy revealed a submucosal tumor on the anterior wall. Urine cytology did not suggest a malignancy. The biopsied specimens revealed only an inflammatory change in the mucosa. Partial cystectomy was carried out. He has had neither recurrence nor metastasis for 29 months. Histological diagnosis in both cases was leiomyoma of the urinary bladder.

Interleukin-6 (IL-6) and interleukin-8 (IL-8) are important mediators of an inflammatory response. We measured creatinine-collected urinary levels of IL-6 and IL-8 by an enzyme-linked immunosorbent assay in 21 women with urethritis syndrome as well as 20 age-matched healthy women. Urine samples were collected before treatment and after 7 or 14 days of oral administration of sparfloxacin (100 mg once daily). Urinary IL-6 level was elevated in a patient with urethritis syndrome (41.1 pg/mgCr), while urinary IL-8 levels were elevated in 8 (range 13.3 to 560 pg/mgCr). On the other hand, none of the healthy controls showed any detectable urinary level of IL-6 and IL-8. Of the 9 patients with elevated urinary IL-6 or IL-8, symptomatic improvement was obtained after chemotherapy in 8 and urinary interleukins became undetectable in 7. Urinary IL-6 and IL-8 seem to have some role in the induction of urinary symptoms.

We present an infertility male with prolactin level of 37.5 ng/ml. The patient had pituitary microadenoma detected by Gd-DTPA enhanced magnetic resonance imaging (MRI). After bromocriptine was administrated for 4 months, the size of microadenoma decreased, and sperm density and mortality improved. His wife became pregnant after 6 months. Dynamic MRI is a useful modality for detection of pituitary microadenoma, and bromocriptine is also useful for treatment of oligospermic patients with marginal hyperprolactinemia.

In 43 men who required further examination of erectile function, we analyzed the relationship between the various factors including hormone levels, penile blood pressure index (PBPI), shape of the arterial wave, erection period after prostaglandin E1 injection and dynamic cavernosography/metry, as well as the patterns of nocturnal penile tumescence (NPT) with rigidity. Normal, dissociation, short episode, low amplitude and flat trace patterns, which were classified by Kaneko, were observed in 11, 8, 11, 2 and 11 men, respectively. Uncoupling was not observed in any men. There were no differences in the levels of prolactin and LH among the 6 patterns. A high FSH level was seen in men with a flat trace pattern; a low level of free testosterone ( < 12.2 pg/ml) was seen in men with dissociation, low amplitude and flat trace patterns, and low PBPI ( < 0.75) in men with flat trace pattern; and an arteriosclerotic shape of the arterial wave was seen in men with short episode and flat trace patterns. Each erection period immediately after prostaglandin E1 injection in men with dissociation, short episode, low amplitude and flat trace was shorter compared with cases with a normal pattern. Venoocclusive dysfunction was observed in 5 men with a dissociation pattern and 6 men with a flat trace pattern. In conclusion, an integral analysis of pattern of NPT with rigidity and other examinations are useful for differentiating organic impotence from psychogenic impotence and for accurately diagnosing pathophysiological disorders of organic impotence and underlying diseases.

The detection of various cytokines; interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), was studied in patients with nonbacterial prostatitis (NBP), and the clinical efficacy of sparfloxacin was also reported. The seminal plasma of 11 normal men and 10 patients with NBP were examined for the cytokines. There was no IL-1 beta or IL-6 in the seminal plasma of normal men. TNF-alpha was detected in only one normal man. In the seminal plasma of the patients, IL-1 beta was detected in 2 out of 10, and IL-6 was also detected in 6. TNF-alpha was detected in 6 out of 10 patients with NBP. The rate of detection of IL-6 and TNF-alpha was significantly higher in the patients with NBP than in normal men. The average levels (range) of IL-1 beta, IL-6 and TNF-alpha were 28 pg/ml (27-29), 110 pg/ml (25-476) and 25 pg/ml (6-113), respectively. After treatment with sparfloxacin at a dose of 100 mg to 200 mg per day, their symptoms disappeared. The number of leukocytes in the seminal plasma decreased to the normal level and these cytokines were not detected. The favorable clinical effect was achieved in 13 of the 17 patients (76%). These findings suggested that the cytokines have an important role in the pathogenesis of prostatitis and that the level of the cytokines are useful indicators in patients with prostatitis, particularly with NBP.

Case 1. A 55-year-old male visited our hospital complaining of dysuria and two-staged micturition. Physical examination revealed a fist sized, elastic soft mass in the left inguinal region. Upright drip infusion pyelography (DIP) showed left inguinal hernia of the bladder. Retrograde urethrography showed bladder neck contracture and a diverticulum. Cystoscopy revealed a indentation in the left bladder wall. Urodynamic studies demonstrated organic obstruction in the lower urinary tract. From these findings, diagnosis was made as bladder hernia and bladder neck contracture. Resection of thin portion of the bladder wall and hernia repair, accompanied by prostatectomy, was performed. Case 2. A 37-year-old male visited our hospital with the history of ureteral stone and chronic prostatitis. Upright DIP incidentally revealed the small right inguinal bladder hernia. Because he had no complaint of dysuria and two-staged micturition, he was observed without surgical treatment.

From December 1989 to September 1992, nine patients with impotence were instructed to perform intracavernous self-injection of vasoactive drugs. At first 40 mg of papaverine hydrochloride was used in all patients and the response on erection was evaluated. If the response did not show sufficiently functional erection, a mixture of 40 mg of papaverine hydrochloride and 1 mg of phentolamine mesylate or 20 mg of prostaglandin E1 was reinjected. Eight patients had achieved full erections and vaginal penetrations without noteworthy complications during the follow-up period. Out of eight patients, three patients were able to ejaculate and one patient showed recovery of erection. No major side effects were seen. In conclusion, intracavernous self-injection is a useful modality for impotence.