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Fifty patients with localized prostate cancer, clinical stage T1-T2N0M0 were studied. The therapy started with androgen deprivation therapy for 3 months to reduce the volume of prostate about 35%. High-energy transurethral microwave thermotherapy (TUMT) was then performed. Transurethral resection of the prostate (TURP) was performed in radical fashion at least 3 months after TUMT to confirm the treatment effect. Thorough pathological study of all the TURP chips revealed no cancer cells in 39 of the 50 patients. Among 11 patients who revealed remnant of cancer cells, 4 patients were with viable cancer cells, and 7 were with devitalized cancer cells.

A total of 110 patients were treated with primary transitional cell carcinoma (TCC) of the urinary bladder from 1990 to 2000. During the follow-up period, which was for at least two years, four patients (3.6 percent) had subsequent upper urothelial cancer at an average of 61.5 months after initial treatment of the bladder tumor. Two of the four patients received transurethral resection several times, and the remaining two patients underwent radical cystectomy for the initial bladder tumor. The histopathological findings of subsequent upper urothelial cancer were almost the same as those for the initial bladder tumor. One patient had accompanying carcinoma in situ (CIS) and the other had adenocarcinoma with TCC. Since 1) high grade, 2) multiple, 3) recurrent and 4) occupational bladder tumors, 5) concomitant CIS, 6) vesicoureteral reflux and 7) tumor invasion of the intravesical ureters have been reported to be risk factors for developing subsequent upper urothelial cancer, patients with bladder tumors who have these risk factors should be followed-up closely.

A 53-year-old female visited our out-patient department complaining of right flank pain. Ultrasonography revealed a solid mass lesion in the lower pole of the right kidney and further evaluation was scheduled. A few days later, she suddenly felt pain at the abdominal enlarged mass. Computed tomographic (CT) scan revealed a huge retroperitoneal mass with heterogenous density. Spontaneous rupture of renal tumor was suspected and emergency nephrectomy was performed. The ruptured tumor was pale, elastic firm and invaded directly to the duodenum. Histopathological findings revealed fibrous cells with frequent nuclear mitosis. Smooth muscle actin was identified immunohistochemically. Therefore, the tumor was diagnosed as leiomyosarcoma. The patient died 2 months after operation due to perforation of the intestine.

To investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

A case of solitary metastasis with renal cell carcinoma to the thyroid gland is presented. The patient was a 54-year-old man found to have an abnormal mass in the neck. He had a past history of radical nephrectomy orignating from the right renal cell carcinoma 5 years earlier (pT2N0M0, G2 > 3, alveolar type, clear cell subtype). Ultrasonography revealed a tumor mass in the right hemithyroid gland. Right hemithyroidectomy was performed on April 19, 1995. Histopathologically, the removed thyroid tumor showed clear cell carcinoma. The possibility of a primary thyroid tumor was ruled out by immunohistochemical thyroglobulin staining, and the present case was thus diagnosed as of metastatic thyroid tumor of renal cell carcinoma. The present case is the 12th case of thyroid solitary metastasis of renal cell carcinoma reported in Japan to date.

A case of congenital penile curvature is reported. A 21-year-old man was admitted because of penile pain curvature to the left at the erection and the difficulty of intercourse. He had no signs of Peyronie's disease and no history of penile fracture so that he was considered to have congenital penile curvature. By Nesbit's method the curvature of the penis was appropriately corrected. There were no signs of recurrence at either 1 or 5 months after the operation.

A case of renal cell carcinoma (RCC) in a teenage patient is reported. A 13-year-old girl visited our hospital with the complaint of dyspnea and right abdominal mass. CT scan and chest X-P revealed a right renal tumor with multiple lung metastasis. Wilms' tumor was suspected and a combination chemotherapy consisting of actinomycin D and vincristin was performed. Since the tumor was insensitive to these agents, open biopsy was done. The pathological findings showed clear cell renal cell carcinoma. Despite the administration of alpha interferon, 5-FU and cimetidine, the disease was progressive and the patient died 5 months after diagnosis. It is important to consider the possibility of renal cell carcinoma in teenage patients with a renal mass, since more than 40% of the renal tumors in this age group are renal cell carcinomas.

A 37-year-old man was found to have large calcification in the left kidney in a health check. This calcification has not changed in size during 3 years with computerized tomographic (CT) studies. However, a suspicious lesion for a malignant tumor with the calcification was suggested by a magnetic resonance image (MRI) study. Thus, the patient underwent tumor enucleation and the histology showed the mixed typed renal cell carcinoma. Although it remains controversial, partial nephrectomy or tumor enucleation would be considered in a case of renal cell carcinoma with calcification, which is usually considered to have a favorable prognosis compared to that of a tumor without a calcification.

Transrectal ultrasonography (TRUS) has been used extensively to evaluate the lower urinary tract in males, including the prostate gland, seminal vesicles and ejaculatory ducts. Of 475 males who underwent TRUS at Kitasato University Hospital, 43 (9.1%) were found to have cystic changes of these structures. Most of these cystic changes could be identified as being of prostate origin, Wolffian duct origin or Mullerian duct origin by their sonographic appearance and location. Although most patients were asymptomatic, 8 of the 30 men with a complaint of hematospermia had a sonographic finding of cystic changes in the prostate (3 patients) or ejaculatory ducts (5 patients). Inflammation and allergic reaction have been suggested to be related to hematospermia, however, their mechanism remains to unclear. These findings suggest that cystic changes in the ejaculatory duct contribute to hematospermia.

Leiomyosarcoma of the prostate gland is rare, and only 44 of these neoplasms have been reported in Japan. We experienced a case in a 17-year-man suffering from leiomyosarcoma and lung metastasis. The patient was treated with chemotherapy consisting of cis-platin, etoposide and methotrexate. He improved considerably and was discharged after five months. However the disease recurred in the pelvis and the lungs. The patient was unresponsive to further chemotherapy and died six months later.

A case of renal oncocytoma found incidentally by routine medical checkups is reported. An asymptomatic 70-year-old male was found to have a right renal mass by abdominal ultrasonography. Selective renal arteriography supported the diagnosis of renal oncocytoma with a typical appearance of "spoke-wheel" pattern. Right radical nephrectomy was performed. However, in consideration of the possibility of renal cell carcinoma. The diagnosis of renal oncocytoma was finally confirmed pathologically. The present case represents the 58th renal oncocytomas reported in Japan as of December 1992.

We evaluated 63 patients with superficial bladder cancer (pTa, pTl) who were treated with instillation of bleomycin +/- bacillus Calmette-Guerin (BCG) and administration of uraciltfutraful (UFT) for prophylaxis of tumor recurrence after transurethral resection (TUR). The patients were randomly assigned to groups A and B after transurethral resection by the closed envelope method. Group A (34 cases) was designed as continuous diluted intravesical instillation of bleomycin (120 mg/2, 000 ml saline solution/day repeated for 3 days), instillation BCG (40 mg/40 ml saline solution/weekly 6 times) and UFT (400 mg orally/day for 2 years maximum). Group B (29 cases) was designed as the aforementioned minus BCG instillation. Cumulative non-recurrence rates in group A and group B were 80.1% and 72.1% at the time of three years, which revealed no significant difference between the two groups (p = 0.265, generalized Wilcoxon test). The high recurrent incidence of superficial bladder cancer is primarily due to the multifocal nature of the cancer or implantation of tumor cells at the time of the subsequent transurethral resection. The procedure was performed safely with no severe side effects. Our method might be useful to reduce the recurrences of superficial bladder cancer after transurethral resection of bladder (TUR).

We report here two cases of bladder cancer in patients with chronic renal failure who had been treated with hemodialysis. Case 1: A 58-year-old male on hemodialysis for 3 years visited with a complaint of gross hematuria. Transurethral resection of the bladder tumor (TUR-Bt) was performed and histopathological examination showed grade 1, stage pTa transitional cell carcinoma (TCC). The patient was followed for 4 years postoperatively without recurrence. Case 2: A 64-year-old male with hemodialysis for 1 week was referred to our department with a gross hematuria. TUR-Bt was conducted and histopathological findings showed grade 2, stage pT1b TCC. In April, 1992, he revisited our hospital with bladder tamponade due to massive hematuria, and TUR-Bt was performed. Histopathologically, the tumors were grade 2, stage pT2 TCC. He was followed for 1 year without recurrence.

We report a case (62-year-old male) of transitional cell carcinoma (grade 2) of solitary right renal pelvis which was successfully treated with tumor excision followed by bacillus Calmette-Guerin instillation therapy. He had a past history of left radical nephroureterectomy for renal pelvic tumor 11 years earlier. Kidney-preserved surgery with BCG instillation therapy is expected to be an alternative for radical forms of therapy, especially in the patients with a solitary kidney.

We present here a production of anti-bacterial zeolite balloon catheter and investigated its potential for controlling urinary tract infection. This anti-bacterial balloon catheter showed a bactericidal effect against Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli in vitro studies. The antibacterial effects were correlated with the concentration of anti-bacterial zeolite and size of catheter. We tried this catheter for 11 various urological patients who needed a long-term indwelling of a balloon catheter for lower urinary tract obstruction and neurogenic bladder. All patients were already indwelled silicon balloon catheter for 3 to 6 months and suffered with complicated urinary tract infection. Nine patients who had this anti-bacterial zeolite balloon catheter indwelled for 3 to 7 months and exchanged every 2 to 4 weeks, and no patient was taking antibiotics during this trial. Two patients (22.2%) showed good results by the urinary tract infection (UTI) criteria and 5 patients (55.4%) showed good effects by doctor's judgment. This anti-bacterial zeolite balloon catheter might be useful for patients who need long-term balloon catheter indwelling.

The AMS Hydroflex penile prosthesis was implanted in 34 organic impotence patients between June 20, 1986 and Aug. 6, 1990. Patients ages ranged between 26 and 71 with an average of 50.5. The causes of impotences were; 17 cases of post-radical pelvic surgery, 7 cases of injury, 6 cases of diabetes and 4 of others. First evaluation was made after 12 weeks of implantation in terms of patient satisfaction with sexual intercourse and post operative complication. Sixteen patients (47.1%) were highly satisfied with intercourse, 13 (38.2%) satisfied with intercourse, 2 (5.9%) slightly dissatisfied even with successful intercourse, 1 (2.9%) with no improvement and 2 (5.9%) could not follow. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 20 (58.8%), good utility in 11 (32.4%), slight utility in 1 (2.9%), no favorable in 1 (2.9%) and no judgement in 1 (2.9%). The overall effectiveness and safety of the Hydroflex was demonstrated based on the above findings. Long term evaluation was made from the initial implantation of the device up to the termination of the trial with average of 19.2 months and was mentioned altogether.

We reviewed the cases of incidental renal cell carcinoma that had been treated at the Kitasato University Hospital between July, 1971 and December, 1989. Forty one of the 170 (24.1%) cases were found without any direct signs of renal cell carcinoma. The patients were between 30 and 78 years old (mean 55.0 years) and consisted of 29 males and 12 females. Fifteen cases were detected at the general health check-up and the remaining 26 during the postoperative follow-up for other malignant tumors or other diseases. Twenty three cases were identified by ultrasonography followed by computed tomography (CT) and excretory pyelography in 4 cases each. Especially, the number of patients incidentally found by ultrasonography had increased in the recent 8 years. Urinalysis did not show any microhematuria in 31 of the 37 cases (83.7%), and no tumor mass could be detected by excretory pyelography in 3 cases. We believe that ultrasonography may be valuable as a screening modality for early detection of renal cell carcinoma and should be used as a screening method at the routine health check-up.

A randomized controlled phase III clinical trial comparing TAP-144-SR (TAP) and diethylstilbestrol diphosphate was conducted for patients with prostatic cancer. Patients with Stage B, C, or D disease, who were previously untreated, were enrolled. TAP-144-SR 3.75 mg was administered subcutaneously at 4-week intervals for 12 weeks (a total of 3 injections) in the TAP-144-SR group, while 100 mg of diethylstilbestrol diphosphate was administered orally three times a day (before meals) for 12 weeks in the control group. A total of 141 patients were enrolled using a centralized telephone registration system. Four of these patients were ineligible, and there were 3 drop-outs who never received drugs because they withdrew their consents to participate in the trial. These 7 were excluded from the evaluation, and as a result, 134 patients (66 in the TAP group and 68 in the control group) were evaluable in safety and efficacy. Between the two groups, there were no significant differences in patient characteristics, except the age distribution. Clinical response rates (CR+PR) in evaluable patients according to the criteria of Japanese Prostatic Cancer Study Group were 54.5% in the TAP group and 47.1% in the control group. In addition, the rates according to the criteria for Evaluating the Direct Response to Chemotherapy in Solid Carcinomas and NPCP criteria were 7.6% in the TAP group and 8.8% in the control group and 18.2% in the TAP group and 20.6% in the control group, respectively. Using any of the three criteria, there were no significant differences in response rate between the two groups. The incidence of side effects was 64.1% in the TAP group and 95.4% in the control group; the incidence being significantly higher in the control group (p less than 0.001; chi 2-test). Therefore, the overall safety was significantly greater in the TAP group than in the control group (p less than 0.001; chi 2-test). On the basis of the efficacy and safety the clinical usefulness rate of TA

Removal of renal cell carcinoma (RCC) extended into the inferior vena cava (IVC) can be a difficult operation. Between 1941 and 1989, 110 RCC patients were treated with radical operation and examined for tumor thrombus histopathologically. Twenty nine (26.3%) patients had invasion into the returning vein of tumor (Stage Vla), 12 (10.9%) in renal vein (stage Vlb) and the remaining 4 (3.6%) into IVC (stage V2). In one patient who had surgery under extracorporeal circulation, a thrombus was extended into the right atrium. In the remaining three patients, the RCC was confined to a small portion of the IVC and operated by caval sleeve resection. Radical operation in such patients free of any distant metastasis, may raise the survival rate.

The clinical efficacy of oxybutynin hydrochloride was studied on 21 patients with neurogenic bladder or unstable bladder complaining of urinary frequency, urgency and urgent incontinence. Oxybutynin hydrochloride (1 mg/tablet) was administered orally for 26.7 days, on average, 3 mg per day in 3 and 6 mg per day in 18 patients and the usefulness of this drug was assessed subjectively and objectively. Of 21 patients treated, 9 had neurogenic bladder and 10 had unstable bladder. Urinary frequency was normalized in 6 out of 16 (37.5%), urgency ceased in 6 out of 17 (35.7%) and urgent incontinence disappeared in 9 out of 14 (50%) patients. The mean volume at the first desire to void and the maximum cystometric capacity increased significantly on the cystometrogram after the administration of oxybutynin hydrochloride (p less than 0.01). Furthermore, the maximum vesical pressure decreased significantly (p less than 0.05). The maximum urinary flow rate increased slightly (p less than 0.1) and the residual urine volume significantly increased (p less than 0.05) after medication, although no changes were observed in tidal voiding volume or mean urinary flow rate. Of 20 patients, 9 showed improvement globally (45%), although no subjective or objective improvement was observed in 4 (20%) patients. Marked side effects were observed in 5 cases (two of acute urinary retention, each of increased urgency, residual urine and liver dysfunction), and side effects were seen in 10 of the 21 (47.6%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Two hundred and thirty one patients who underwent transurethral resection of a bladder tumor (TUR-Bt) at our hospital during the past 15 years were analyzed. There were 176 males and 55 females, and the average age at the initial TUR-Bt was 62 years old. Histopathologically, 225 cases were of transitional cell carcinoma, 4 cases of papilloma and 2 cases of squamous cell carcinoma. Grading and staging of 225 transitional cell carcinoma cases revealed grades 1, 2 and 3 in 32, 132 and 21 cases, and stages Ta, T1, T2, T3 and T2-4M1 in 48, 135, 20, 17 and 11 cases, respectively. The frequency of TUR-Bt varied from 1 to 10 times. Among the 231 cases TUR-Bt was done once, twice and three times in 149 (64.5%) and 41 (17.8%), and 22 (9.6%) cases, respectively and the total number of TUR-Bt was 400 times. The duration of the TUR-Bt operation was from 5 min. to 160 min. (mean: 32.4 min.) and the resected weight of tumor between 0.5 g and 85 g (mean: 5.4 g). As a complication of TUR-Bt, TUR-fulguration was necessary to control postoperative bleeding in 7 cases (1.7%), and blood transfusion was required in 13 cases (3.3%) during TUR-Bt. Postoperatively blood transfusion was required in 8 cases (2%), intraperitoneal perforation in 2 cases (0.5%), extraperitoneal perforation in 6 cases (1.5%) and hyponatremia in 1 case (0.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

To study the relationship between clinical features and prognosis of the bladder tumor, 325 patients who were treated in our hospital were analyzed. The overall 5-year and 10-year actual survival rates were 65% and 51%. There was no statistical significance in the actual survival rate between the single and multiple tumor group. Although, there was a significant difference in tumor size, tumor growing type and the mode of treatment. The ten-year survival rates for grades 1, 2 and 3 cases were 76%, 57% and 18%, respectively. There was a significant difference between grades 1 and 3 (p less than 0.001) and grades 2 and 3 (p less than 0.001). The ten-year survival rates for stages Ta, T1, T2, T3a, T3b and T2-4 M1 were 79%, 68%, 43%, 0%, 19% and 5%, respectively. There was a significant difference between the Ta, 1 and T2-4 group (p less than 0.001).

We analyzed 325 primary bladder tumor patients who were treated in our hospital during the past 15 years. There were 242 males and 83 females who were between 20 and 84 years old with an average age of 63 years old. The most frequent complaint was macroscopic hematuria in 76.9% of the patients (250/325). Cystoscopically, a single tumor was seen in 71%, the tumor was medium sized (1 to 3 cm) in 32%, and 56% were papillary tumors with a stalk. Histologically, 300 (92.3%) cases were transitional cell carcinoma. There were 42, 206 and 52 patients with grades 1, 2 and 3 transitional cell carcinoma and stage Tis, Ta, T1, T2, T3a, T3b, T2-4M1 and Tx were 2, 46, 151, 30, 15, 16, 37 and 3 cases each. Transurethral resection was performed in 231 (71.1%), partial cystectomy in 6 (1.8%) and total cystectomy in 44 (12.5%) cases each.

A multicenter clinical trial was carried out on 372 patients in double-blind conditions in order to determine the clinical effects of Ea-0643 (bunazosin hydrochloride) on voiding disorders in benign prostatic hypertrophy, compared with paraprost and placebo. Of the 372 patients, 129 were assigned to bunazosin hydrochloride, 118 to paraprost and 125 to placebo. The improvement rating for all five subjective symptoms improved with passage of time in all the bunazosin hydrochloride, paraprost and placebo groups. A higher improvement rating was obtained in the bunazosin hydrochloride group for retarded urination, urinary stream condition and abdominal pressure at voiding, while the improvement rating was higher for prolonged urination in the placebo group and for residual urine in the paraprost group, but there was no significant difference in improvement ratings between the groups. The daily frequency of voiding decreased to a significant extent in the bunazosin hydrochloride and placebo group at week 1, and there was a significant difference between the bunazosin hydrochloride and the paraprost groups and between the placebo and the paraprost groups. The improvement rating for conditions of voiding was higher with the bunazosin hydrochloride group, when "slightly or better improved" cases were taken into account, but there was no difference between the groups. As for objective symptoms, maximum and average flow rate, useful measures for clinical evaluation of drug effects on voiding disorders, were significantly increased, with a decrease to match in residual urine ratio in the bunazosin hydrochloride group. In terms of maximum and average flow rate bunazosin hydrochloride was significantly superior to paraprost at weeks 1 and 2 and superior to placebo at weeks 2 and 4 and at the final evaluation as well. In terms of residual urine ratio bunazosin hydrochloride was superior to both paraprost and placebo. The global improvement rating, as assessed by the U- and chi 2-t

Clinical results of 732 cases of transurethral resections (TUR) at the Ohita Urologic Hospital for the 8 years, from 1974 to 1982, are evaluated and analyzed. They consisted of 591 TUR's for benign prostatic hypertrophy, 45 for cancer of the prostate, 64 for bladder tumors and 32 for biopsies of various sorts. The weight of the tissue resected was 17.8 (2-92 g) grams on the average in benign prostatic hypertrophy, 17.5 g in cancer of the prostate and 4.0 g in bladder tumor cases. The time needed for the resecting procedure was 42.2 minutes on the average in prostatic hypertrophy, 40.8 minutes in cancer of the prostate and 26.6 minutes in bladder tumor cases. The major operative and post-operative complications consisted of 36 epididymites, 14 massive postoperative hemorrhages, 14 strictures of urethra, 12 perforations of prostatic capsule and 2 post operative stress incontinences. It is well known that the irrigating fluid used during TUR of the prostate is frequently absorbed into the patient's body in large amounts. Approximately one-half correction of the diluted serum sodium level by giving 20 ml (40 mEq) of 10% NaCI solution intravenously at each 10 liters of isotonic irrigating fluid during the resecting procedure is helpful in preventing the postoperative hyponatremic syndrome.

A case of prepenile scrotum associated with right undescendent testicle, seen in a 10-year-old Japanese male child, is reported, The surgical correction was successfully made by a technique described by Glenn and Anderson, This patient is the 16th reported case of prepenile scrotum so far appearing in the Japanese literature.

Fifty-eight of the 44, 698 patients seen at our Department, between 1972 and 1984 had a testicular tumor. The incidence rate was 0.13%. The mean age of these 58 cases was 28.6 years and two peak distributions, one in the 0 to 5 year and another in 26 to 30 year age group were observed. Among them, 54 patients (93.1%) had chief complaints of painless testicular swelling at initial examination. The vast majority of them had unilateral tumors; 28 in the right and 29 in the left. Only one patient had bilateral seminomas. Histologically, 30 of them (51.7%) were seminoma, 8 were embryonal carcinoma (13.8%), 2 were teratoma (3.5%) and the remaining 18 had tumors of double or multiple histological type. Most of the seminomas were treated by a combination of high orchiectomy and radiotherapy, and chemotherapy was done mainly for non-seminomatous cases. The 5-year survival rate calculated by the Kaplan-Meier method was 100% for patients with low stage (I, II) seminomas and 62% for those with non-seminomatous tumors.

One hundred and sixty-seven patients with newly diagnosed, previously untreated prostatic adenocarcinoma, during the period between July, 1971 and March, 1934, were studied. The histopathologic specimens of the prostate were classified by the Japanese General Rules of Prostatic Cancer (JGRPC) and by Gleason's classification. The number of patients with well, moderately and poorly differentiated prostatic carcinomas according to the JGRPC classification was 42, 74 and 51 respectively, and the number of the patients with Gleason's pattern 1, 2, 3, 4, and 5 was 24, 20, 32, 43 and 48, respectively. The number of patients with Gleason's score (primary plus secondary pattern) 2 to 4, 5 to 7 and 8 to 10 groups was 40, 76 and 51 respectively. There was no significant difference in survival rate between well and moderately differentiated groups, but the survival rate of the group with poorly differentiated tumor was significantly lower than that of the moderately differentiated (p less than 0.01) and well differentiated (p less than 0.001) groups. There was no significant difference in 10-year survival rate between the score 2-4 and score 5-8 groups, but the score 9-10 group had a significantly lower survival rate than the score 5-8 group (p less than 0.01) and score 2-4 (p less than 0.005) group. JGRPC and Gleason's classification are thought to be equally useful in estimating prognosis of prostatic cancer, but the former is more concise and easily applicable than the latter.

The concentration of Cefbuperazone (CBPZ) were determined by bioassay in the serum and prostatic tissue of 36 patients with benign prostatic hypertrophy, who underwent transurethral resection. One gram of CBPZ was injected intravenously prior to surgery. Pharmacokinetic analysis was performed using the two or three compartment model theory. The maximum serum level of CBPZ was 82.2 micrograms/ml at 30 min after the start of CBPZ administration and biological half-life was 97.3 min. CBPZ concentration in prostatic tissue reached a maximum level of 26.3 micrograms/g at 50 min following CBPZ administration. The prostatic tissue level was 28-40% of the serum level. These results suggested that intravenous administration of CBPZ would be extremely effective against pathogenic bacteria, particularly Enterobacter, E. coli, Klebsiella, Serratia, Proteus and Bacteroides, judging from its prostatic concentration.

Two cases of bilateral renal cell carcinoma are reported. The first case is of a 54-year-old male who visited our hospital on March 7, 1984 complaining of colicky pain in his left flank. Intravenous urography showed a large mass in the upper pole of the left kidney causing deformity and dislocation of the upper calyces. There were no remarkable findings in the right kidney. Abdominal CT-scan and arteriography revealed a round and hypervascular tumor with soft tissue mass density in the upper pole of both kidneys. Nephrectomy of the left and segmental resection of the upper pole of the right kidney were performed on April 11, 1984. The second case is a 47-year-old male who visited our hospital complaining of total gross hematuria. Intravenous urography showed a large soft tissue mass at the lower pole of the left kidney. Abdominal CT-scan revealed a large tumor mass associated with central necrosis in the left kidney and also a small tumor lesion at the center of the contralateral kidney. Bilateral nephrectomy was performed on December 19, 1984, and the patient was referred to hemodialysis treatment. The cut section of the nephrectomized right kidney specimen revealed multiple minor accessory tumors. Both patients have been doing well without any evidence of recurrence or metastasis.

Intracavernous injection of etilefrine hydrochloride (1 or 2 mg) was performed on four patients with fully erected penis after intracavernous injection of 40 mg of papaverine hydrochloride. One case needed three injections of etilefrine hydrochloride (1 mg), but the erection disappeared in the other three cases within 10 minutes after a single injection of 2 mg of etilefrine hydrochloride. The injection resulted in complete detumescence and relief of the erection in all cases. These observations strongly suggest that the intracavernous injection of etilefrine hydrochloride is effective in treating not only iatrogenic priapism but also priapism due to other etiologies. Also, it might be useful to control erection time after intracavernous injection therapy for impotence.

Two cases of carcinoma in a diverticulum of the bladder were experienced. The first case was of a 50-year-old male who presented in February, 1981, complaining of asymptomatic microhematuria. The excretory urogram revealed a diverticulum in the left lateral aspect of the bladder which was causing shift of the lower ureter to the median side. The cytology report of voided urine was class III. Diverticulectomy was performed and pathologic findings was a transitional cell carcinoma, grade 1, stage 0. The patient has been free of recurrence for the past 54 months. The second case was of a 67-year-old male with the chief complaint of pollakiuria. Non-papillary tumor in a diverticulum of the bladder was found by cystoscopy and computed tomography. Tumor biopsy and urinary diversion by ileal conduit were performed in the usual manner. The pathologic finding was transitional cell carcinoma of grade 11 malignancy. The patient died of intestinal obstruction on January, 19, 1984, about 15 months after the surgery. The 117 cases of carcinoma in a diverticulum of the bladder we found in the Japanese literature are reviewed briefly.

A double-blind placebo-controlled study of bunazosin for the treatment of symptomatic prostatism is reported, incorporating urologic departments of 25 hospitals. Four different doses of bunazosin hydrochloride was administrated orally to 174 patients having benign prostatic hyperplasia and 31 with bladder neck contracture for a period of four weeks; high dose group (45 patients, 3 mg/day for the first week followed by 4.5 mg/day for the next three weeks), middle dose group (45 patients, from 1.5 mg/day for the first week to 3.0 mg/day for the next three), low dose group (39 patient, 0.15 mg/day for the first to 1.5 mg/day for the next three) and a control group (40 patients, 0.125 mg/day for the entire four weeks). Subjective symptoms (urinary frequency, retarded urination, prolonged urination, condition of urinary stream and abdominal pressure at voiding) and objective signs (residual ratio, maximum and mean flow rate, voiding time) were observed and analyzed statistically. No bias in the background features was confirmed between any of the four groups. The subjective improvement rates evaluated by the attending doctors demonstrated a significant dose-dependent efficacy of bunazosin by H-test (p less than 0.01), although the objective improvement rates revealed no significant difference between any of the four groups. The global improvement rate evaluated by the same means demonstrated that the middle dose group was significantly superior to the control group (p less than 0.05 by U-test). According to each subjective symptom evaluated by the criteria of the drug efficacy, a dose-dependent significant (p less than 0.01) was noticed between the four groups in the improvement of the voiding condition. Although there was no significant difference by use of the H-test, the middle dose group had a significant superiority to the control group in the improvement rate of retarded voiding by use of the U-test (p less than 0.05). Only in the symptomatic cases of prolonged voi

During the 13 years from July, 1971 to August, 1984, 1896 patients were diagnosed as urolithiasis at our University Hospital. These cases were retrospectively analyzed. The male to female ratio was 2.4 to 1. The peak age incidence of urinary calculi occurred in the third decade. The ratio of upper urinary tract stones to lower urinary tract stones was 18 to 1. As to the laterality of the upper urinary tract stones, the ratio of left to right was 1.3 to 1. Analysis of the stone components revealed that the frequency ob calcium oxalate mixed with calcium phosphate and pure calcium oxalate was 80 percent and struvite, uric acid & cystinine were 14.1%, 2.6%, 1.6% respectively.

Between 1971 and 1984, 179 patients with prostatic cancer were admitted to our Hospital. These cases were studied retrospectively. The greatest number of patients were in their seventies. The patients ranged from 55 to 90 years old with an average age of 72.4 years. The most common symptoms were dysuria, urinary retention, pollakisuria and macrohematuria. About 76% of the chief complaints were related to urinary tract obstruction. There were 64 (35.8%), 21 (11.7%), 38 (21.2%) and 56 (31.3%) cases of stage A, B, C and D, respectively. Prostatic cancer was confirmed histopathologically at transurethral resection in 146 patients, transrectal needle biopsy in 25 patients, open prostatectomy in 3 patients, autopsy in 4 patients, and cryosurgery in 1 patient. The 1-, 3-, and 5-year actual survival rates of 162 cases were 89, 70 and 55%, respectively. The 5-year actual survival rate of stage A, B, C, and D was 72, 67, 55 and 34%, respectively. The 5-year actual survival rate for the cases treated with and without anti-androgen therapy was 72% and 73% for stage A, 66% and 75% for stage B, 58% and 44% for stage C and 37% and 12% for stage D, respectively. The cases treated with anti-androgen therapy was divided into the low dose (diethylstilbestrol less than 300 mg/day or hexestrol less than 30 mg/day) and high dose (diethylstilbestrol greater than or equal to 300 mg/day or hexestrol greater than or equal to 30 mg/day) groups.(ABSTRACT TRUNCATED AT 250 WORDS)

The patients with bladder tumor (11 tumor) were given intravesical Bacillus Calmette-Guerin (BCG) therapy. The concentration of BCG solution varied from 80 to 240 mg in 40 ml of normal saline. The intravesical instillation therapy with this solution was repeated 6 times at a week interval. Seven of the tumors showed excellent response and had completely disappeared upon endoscopic examination. All of the highly responded tumors were small papillary lesions of low grade and low stage of malignancy. Regarding side effects, irritable bladder occurred in 70%, elevation of body temperature of over 37 degrees C in 40% and gross hematuria in 30% of the patients. Among them, one patient was treated with INH (0.3 g/day) for 2 weeks with satisfactory remission of the symptoms. Though the number of cases and follow up period are not satisfactory enough, topical therapy with BCG can be said to be an effective therapeutic measure against early stage urotherial tumors.

Erythrocyte sedimentation rate (ESR), lactase dehydrogenase (LDH), carcinoembryonic antigen (CEA), haptoglobin, fibrinogen, CH50, Blc-globulin (C3), B1E-globulin (C4), T-cell, B-cell and phytohemagglutinin (PHA) were evaluated in 82 patients with renal cell carcinoma. Positive rates of ESR, LDH, CEA, haptoglobin, fibrinogen, CH50, C3, C4, T-cell, B-cell and PHA were 58.9, 27.1, 33.9, 21.9, 55.8, 34.2, 33.3, 34.8, 15.3, 8.0 and 39.1%, respectively. Positive rates of all serological tests in high stage (stage III and stage IV) renal cell carcinoma were higher than those of the low stage (stage I and stage II) group. Positive rates of ESR, fibrinogen, CEA, haptoglobin, C3 and C4 in the high stage group were 86.1, 81.8, 54.1, 57.1, 53.3 and 60.0% respectively. The level of ESR, LSH, CEA, fibrinogen, haptoglobin and CH50 were significantly elevated (p less than 0.001) above the normal value. Each serological test was not significantly elevated pre- or postoperatively, but in all serological tests, postoperative values were lower than the preoperative values. ESR (less than 100 mm/hour), and CEA in the positive group correlated significantly with poor prognosis (p less than 0.005). Haptoglobin and C3 in positive group also showed a significantly poor prognosis (p less than 0.05). In conclusion ESR and fibrinogen were thought to be useful for screening renal cell carcinoma patients ESR, CEA, haptoglobin, fibrinogen and C3 for estimation of staging, and ESR, CEA, haptoglobin and C3 for estimation of prognosis.

Eighty two cases of renal cell carcinoma, treated at our Department between July, 1971 and May, 1984, are reviewed. The highest incidence of this disease was seen in the 5th decade and the average age of the patients was 58.8 years. Male patients predominated over the female patients, the ratio being 1.6: 1. According to Robson's classification, thirty eight cases were in stage I, five cases in stage II, nine cases in stage III and thirty cases in stage IV. The overall survival rate at one, three and five years was 77, 58 and 48%, respectively. The most common symptom was macroscopic hematuria, followed by asymptomatic, lumbago and palpable mass. The site of distant metastases was most frequently in the lung, followed by the bone, liver and lymph node. There were no remarkable differences in the prognosis of stage I patients, between the group treated with preoperative renal arterial embolization and non-treated group. No remarkable difference was seen between the survival rate of the stage IV patients treated by nephrectomy and these not treated by nephrectomy. Renal arterial embolization was an effective therapeutic measure for patients with non-resectable stage IV renal cell carcinoma (p = 0.0647, compared with non-treated group).

Sixteen cases of primary renal pelvic tumor treated at our Department between July, 1971 and June, 1984, were reviewed. The sixth decade predominated over other age groups and occupied 47.3% of all cases (average: 63.9 years). The sex ratio was 4.3:1 with male patients predominating over female patients. The incidence of the affected side was equal; 8 cases in the right and 8 cases in the left renal pelvis. The most common initial symptom was macroscopic hematuria in 13 cases (81.2%), followed by flank pain in 2 cases (12.5%). The major findings in IVP were filling defect in 11 cases (68.7%) and non-visualizing kidney in 4 cases (25.0%). Positive urinary cytology was obtained in 6 cases (49.1%) by voided urine specimen and 4 cases (50.0%) by catheterized urine specimen. Histologically, all cases were transitional cell carcinoma; 11 of them were low stage and 5 were high stage at the initial diagnosis. Nine patients(56.1%) were treated by total nephroureterectomy associated with partial cystectomy. The over all survival rate at 1, 2, 3, 4 and 5 years was 86%, 78%, 78%, 68% and 68%, respectively, by the Kaplan-Meier method. The five year survival rate was 80% for the low stage group and 0% for the high stage group. (p less than 0.05, generalized Wilcoxon test). The five year survival rate was 83% for the low grade group and 40% for the high grade group. (p less than 0.05, Generalized Wilcoxon test) Among several factors, stage and grade of the tumor were the most influencing factors for prognosis.

Twenty-two cases of primary ureteral tumors treated at our Department between July 1971 and December 1984, were reviewed. The patients ranged from 28 to 83 years old (average 63.6 years). There were 17 males and 5 females (3.4:1). The affected side was predominantly the left (15) than the right (7). The most common site of the tumor growth was at the lower third of the ureter (14 cases, 63.6%). The most common initial symptom was macroscopic hematuria, which was seen in 17 cases (77.3%). The major finding of IVP was non-visualizing kidney in 11 cases (50.0%) and filling defect in 7 cases (31.8%). Positive urinary cytology was obtained in 9 cases (52.9%) by voided urine and 6 cases (66.6%) by catheterized urine. Total nephroureterectomy associated with partial cystectomy was performed in 14 cases (63.6%). Histologically, 19 cases were transitional cell carcinoma (86.8%). Associated growth of urothelial tumor in the bladder was found in 4 cases preoperatively and in 3 cases during the course of postoperative follow up. All of them were treated by transurethral resection. Overall survival rate at 1, 2, 3, 4 and 5 years was 84, 71, 55, 46 and 35%, respectively, by the Kaplan-Meier method. The five year survival rate was 54% for the low stage group and 0% for the high stage group; 54% for the low grade group and 26% for the high grade group. (p value = not significant, generalized Wilcoxon test).

Today, transurethral resection to superficial bladder tumors is an important method, although frequent recurrence is a problem. We examined whether the degree of progressiveness could be determined at the time of recurrence and therapeutic manner decided from only the grading. Forty four cases which had recurred over twice and in which grading was changed during recurrence were examined. Recurrence occurred twice in 19 cases, and 3 times in 13 cases. Two patients had the largest number of recurrences, i.e., seven. The patients were divided in 3 groups. The 1st group consisted of 25 cases not worsening in grade from initial and recent transurethral resection-bladder tumor (TUR-Bt). The 2nd group consisted of 9 cases who had progressing grading. The 3rd group consisted of 10 cases who died of carcinoma. In the first group, grading decreased in 17 cases. Eight cases in the 3rd group were grade 4. We found that recurrent cases of bladder tumor did not always progressive, grading, being rather decreased than progressing in group 1. However, most of the grade 4 cases died of carcinoma. In conclusion, recurrent TUR-Bt in low grade bladder tumor patients may not be progressive, but grade 4 cases at recurrence require radical operation.

Accurate clinical staging of bladder tumors is of utmost importance for selecting the most suitable treatment measure for each clinical case. We evaluated the diagnostic efficacy of pelvic angiography, transabdominal ultrasonography, transurethral ultrasonography and computed tomography for estimation of the extent of bladder tumor infiltration. During the past 12 years, we experienced 232 bladder tumor cases. Among them, 30 patients were evaluated with pelvic angiography, 52 with transabdominal ultrasonography, 14 with transurethral ultrasonography and 84 with computed tomography. Pelvic angiography enabled correct diagnosis in 24 of the 30 patients (80%), transabdominal ultrasonography in 8 of the 52 patients (15%), transurethral ultrasonography in 7 of the 14 patients (50%) and computed tomography in 62 of the 84 patients (74%). Combined examination with transurethral ultrasonography and computed tomography seems to be the most reliable method for estimation of the extent of bladder tumor infiltration.

Eighteen patients with advanced genitourinary carcinoma have been treated with cis-diamminedichloroplatinum (CDDP) since 1978, at our University Hospital. They were 3 patients with prostatic cancer, 3 patients with bladder cancer, 6 patients with testicular tumors, 5 patients with renal cell carcinoma and 1 patient with malignant pheochromocytoma. Four patients with testicular tumors were administrated CDDP, bleomycin (BLM) and vinblastine (VBL). A testicular tumor patient was given CDDP, vincristine and actinomycin-D, a bladder cancer patient was given CDDP, VBL and Pepleomycin as combined chemotherapy. The remaining 12 patients were treated only with CDDP. Five of the 6 patients with testicular tumor and a case of choriocarcinoma of left kidney showed an objective response. As side effects, bone marrow suppression was inevitable when VBL and BLM were given along with CDDP. Renal dysfunction was seen in 5 patients on whom BVP regimen was employed. Various degrees of nausea and vomiting were present in almost all patients during CDDP administration. The combination chemotherapy with CDDP appears to be effective in nonseminomatous testicular tumor. The effectiveness of CDDP against other genitourinary carcinomas may require further investigation.

Prostatic tissue levels and serum levels of Ceftizoxime (CZX), Cefoperazone (CPZ) and Cefotaxime (CTX), after intravenous administration were studied in 82 patients with prostatic hypertrophy, who underwent transurethral surgery. CZX was found to be the most effective for treatment of prostatic infection, since its prostatic tissue level was considerably higher than the others, satisfactorily above the MIC level of most bacteria. The prostatic tissue levels were not correlated with prostate size. The levels in fibromuscular hyperplasia were significantly higher than in glandular hyperplasia.

Avitene (Microfibrillar Collagen Hemostat) is a new absorbable topical hemostatic agent, of which action mechanisms are platelet entrapment and activation of platelet clotting factors. It was used clinically on 11 patients for bleeding during urological surgery; bleeding from renal beds, resectional surfaces of kidney, urethras and floor of the pelvis, prostatic capsule and renal pelvis. The patients were 9 males and 2 females aged from 30 to 71 years old. Avitene was applied directly to the source of bleeding in a dry condition after the treatment of large vessel hemostasis. Pressure was applied to the area, and after 3 to 5 minutes, the excess of this material was removed. Avitene was successful in rapidly controlling bleeding in all the patients. No patient had secondary bleeding and complications attributed to the use of this material. This study indicates that Avitene is very effective as a topical hemostatic agent, particularly in urological surgery.

Fm-7 (flavon 5, 7-disodium oxyacetate) was applied in the urological practice and the following results were obtained. 1) This was obviously effective in more than half of the cases with essential hematuria or hemospermia. 2) No side effect was encountered at all in 30 trial cases.

This report deals with a case of calcified tissue mass found in the lower pole of the left kidney in a 29-year-old Japanese female who was refered to us by a local physician under a diagnosis of left nephrolithiasis. Urological exam i n ation revealed an irregular shaped calcified mass projecting downward from the lower pole of the left kidney. The rest of the urinary tract appeared normal. Urinalysis and urine culture examinations including for tuberculous bacilli were all negative. Partial nephrectomy was performed on April 7, 1965, and the mass was remov e d with the surrounding kidney tissue of the left lower pole. The mass was irregular nodular shaped but well-encapsulated, measured as much as 2.0 x 2.2 x1.3 cm. It was moderately firm and, on section, disclosed greyish-white solid material, which was sharply circumscribed from the remaining portions of the kidney. It involved both the cortex and the medulla and encroached upon, but did not open into the renal pelvis. The histological findings consisted of extensive f i bruos tissue with marked calcium deposition and some epithelial cells forming tubular appearance. However, there were no evidence of definite tuberculous pathology, though it was deeply suspected. The postoperative course was uneventful and the pa t i ent has been in good health up to present and enjoying normal life.

Lower urinary tract infection, frequently troublesome and difficult to eradicate, has been considered as an almost inevitable complication following transurethral prostatic resection. In an effort to treat this complication after transurethral prostatic resection, achymotripsin enteric-coated tablet, a pancreatic proteolytic enzyme, was administered to twenty patients and the result was compared to that of twenty-one control patients. The administration of the a-chymotripsin enteric-coated tablet was, as a rule, started two weeks after the transurethral prostatic resection with a dosage of 2 tablets 3 times a day (1 tablet contains 100 Ch. Ti. of a-chymotripsin) and was continued as long as the urinary tract infection had persisted. The duratio n of postoperative urinary tract infection in the a-chymotripsin treated group was 8.5 weeks on the average (varied from 5 to 15 weeks) which was 3.1 weeks shorter than that of the control group (11.6 weeks on the average, varied from 6 to 19 weeks). No unpleasant side effect occurred in this series, except for one patient who complained of a mild degree of loss of appetite during the treatment with a-chymotripsin enteric-coated tablet, which disappeared soon after the completion of the treatment. In conclusion, the use of a-chymotripsin enteric-coated tablet was believed to be an effective therapeutic measure for combating urinary tract infection following transurethral prostatic resection.

Use of irrigating fluids are necessary and im p ortant, for transurethral prostatic resection. However, occurrence of side effects due to mostly changes in the electrolytes of the body fluids and complications well-known as TUR-reaction are not uncommon. In an attempt to prevent the so-called TUR-reaction, the following two kinds of mannitol solution for intravenous use were administered before, during and after the procedure. solution-I (M-I) Mannitol 15 % Glucose 5 % NaC1 0. 45 % solution-II (M-II) Mannitol 5 % Glucose 5 % NaC1 0. 25 % Clinical effectiveness of the solutions was evaluated by studying 15 recent cases of prostatic hypertrophy given our mannitol solutions (the first series), and 10 control cases of the same condition in which the TUR-procedure was performed using glucose or Ringer's solution (the second series). In the both series, " urigal " was used as irrigating fluid, which was put at the height of 60 to 80 cm. from the mid-bladder level. In the first series, the 15 patients studied were at first given 1 00 ml. of M-I for 15 to 20 minutes prior to the TUR-procedure, followed by administration of 300 ml. of the same for over an hour during the surgical procedure. Then after the surgery, M-II was given intravenously at the rate of 200 ml. per hour until 7 a.m. of the following day, the total of the solution being to be from 1, 800 to 4, 000 ml. The amount of tissue resected varied fro m 4 to 46 gm. and the operating time was mostly limited to one hour. In both of ne seri e s, serum electrolytes (Na, K, Cl, Ca), BUN and hematocrit were examined just before, immediately after, and further 4-, 8-and 24-hours after the completion of the TUR procedure. Urinary output via catheter was also measured every hour during the first 4 hours then every 4 hours during the first 24 hours after the surgery. The results obtained were as follows : The urinary output measured at a n one hour interval during the first 4 hours varied from 130 to 400 ml. The total of 4-h