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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., 限局性前立腺癌(T1c-T2bN0M0)と判定した50例(年齢70.8±6歳)を対象にアンドロゲン抑制療法 (ADT)による前立腺体積縮小後に経尿道的前立腺高温度療法(TUMT)を施行し、3ヵ月後に経尿道的前立腺切除術(TURP)を行った。切除による線維被膜の全切片の病理組織検索を行い3種構成の治療成績を検討した。前立腺の縮小効果についてADT開始後12週間後の前立腺体積は平均23.4ml、 34.7%の縮小を認め、次いでTUMTとADTの継続により更に縮小し12週間後には平均19.0mlとなり、TURP切片の全重量は平均11.6gであった。血清PSA値はADT施行12週後に平均0.2ng/ml以下となり約98%の低下を認め、さらにTUMT施行12週後は全例が0.1ng/ml 以下となった。ADTの終了後平均33ヵ月(19-46ヵ月)を経てTURP施行後6ヵ月におけるPSA値は50例中48例が4.0ng/ml以下に留まった。TURPによる切片の病理組織学的検査結果は全症例が線維細胞による置換を主とする退行変化を顕著に認め、39例に前立腺癌組織の遺残は認めなかった。他の11例中7例は退行変化を示し自然消滅の可能性が大であると判定されたが、前立腺癌細胞を認めた4例も組織学的には悪性度は低下傾向で低分化型およびGleason score 8以上のものは無かった。全例に中断を要するADTによる合併症は認めなかった。前立腺癌細胞の低分化型は高分化型より高温度に対する耐久性は弱い可能性があると考えた。

手術後2年以上経過観察した初発原発性膀胱移行上皮癌110例(15～88歳)を対象に, 膀胱癌術後に発生した上部尿路上皮癌の発生起源, 危険因子について検討した.4例(3.6%)に上部尿路上皮癌が続発し, 先行した膀胱癌と続発した上部尿路上皮癌は病理組織学的にほぼ一致していた.続発性上部尿路上皮癌の危険因子としては, 高異型度, 多発性癌, 再発の繰り返し, 職業性膀胱癌, 上皮内癌(CIS)の存在, VURの存在, 膀胱壁内尿管への浸潤などが考えられた, 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.

右側腹部痛を主訴とした53歳女で, 超音波検査は右腎下極に充実性腫瘤病変を示し, 数日後, 突然増大した腹部腫瘤に痛みを感じた.CTは不均質な密度の巨大な後腹膜腫瘤を描出した.腎腫瘍を自然破裂が疑われ, 緊急腎摘出が行われた.破裂腫瘍は蒼白, 弾性硬で, 十二指腸に直接浸潤していた.組織学的に大部分の領域で中等度の核異型を示し, 高頻度の核分裂像が認められ, 免疫染色で腎平滑筋肉腫と診断された.術後2ヵ月に腸穿孔により死亡した, 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.

37歳男.全周を石灰化で覆われた腎細胞癌の1例.腎辺縁に位置し石灰化で完全に覆われた腎細胞癌の場合, 一部の症例においては, より侵襲の少ない腫瘍核出術が適応になりうると考えられた, 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.

ビカルタミド1日1回50mg群, 80mg及び100mgを12週間投与する3群比較の無作為化非盲検試験を実施した. 1)登録症例は124例で, 適格例は122例であった. 2)総合効果における奏効率は50mg群, 80mg群及び100mg群でそれぞれ50.5%, 61.0%及び53.7%であった. 3)PSAに対する奏効率は50mg群, 80mg群及び100mg群でそれぞれ84.2%, 92.7%及び97.6%であった. 4)副作用発現率は3群ほぼ6割で副作用による中止例は80mg群の1例のみで, 安全度において3群間に有意差はなかった.主な副作用は乳房腫脹, 乳房圧痛等であった, 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.

前立腺とりわけ射精管の拡張は決して稀ではなく, 血精液症, 前立腺肥大症, 前立腺癌の症例にしばしば合併し, 時に, 前立腺, 射精管などの嚢胞性変化が不妊症の原因となりうることがわかった。特に血精液症の原因の一つとして, 射精管の構造異常が深くかかわっている可能性が示唆された, 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.

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 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.

1)表在性膀胱癌63症例に対してTUR-Bt後3日間のブレオマイシン持続膀胱内灌流, BCG膀胱内注入, UFT経口投与による再発予防の有用性を封筒法によるrandomized studyによって検討した。2)BCG投与群34例, BCG非投与群29例の3年非再発率は, おのおの80.1%, 72.1%と両群ともに高い再発防止効果がえられた。3)3年非再発率は, BCG投与群の方がBCG非投与群よりも勝っていたが, その差は推計学的に有意ではなかった。4)BCG投与による副作用は76.5%に認められたが, いずれも軽度から中等度のもので重篤のものではなかった。5)TUR-Bt後3日間のブレオマイシン持続膀胱内灌流, BCG膀胱内注入およびUFT経口投与による集学的再発予防法は, 単剤による再発予防法に比しより効果が期待できる方法と思われた, 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).

1)抗菌ゼオライトカテーテルを試作し基礎的・臨床的にその効果について検討した.2)組織移植試験, 急性毒性試験, 発熱性物質試験, 溶血性試験において毒性は認められなかった.3)抗菌性試験では, 緑膿菌, 黄色ブドウ球菌, 大腸菌の順に抗菌性が認められ, その効果は抗菌ゼオライト含有濃度およびカテーテル面積に比例していた.4)長期留置例9例に最低3ヵ月間2～4週毎に本カテーテルを交換, 留置し, 従来型シリコーン製尿道バルーンカテーテルと交換前後の尿沈渣, 尿培養, 血算, 血液生化学, 自覚症状などについて比較検討した.5) UTI学会効果判定基準で9例中2例, 主治医判定9例中5例に効果が認められた, 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.

1)初回治療をうけた170例の腎細胞癌中41例が無症状で発見され, そのうち30例がstage T2b以下の早期癌であった.2) 23例が超音波検査にて発見された.3)画像診断法で発見された37例中31例は, 尿沈渣で顕微鏡的血尿はみられなかった.4)超音波で発見された23例中3例は, IVPでは腫瘤の存在は診断できなかった, 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.

器質性インポテンス患者34名に対しAMSハイドロフレックスをインプラントして12週後, 1)満足度:非常に満足, 性交可能16例, 性交可能で満足13例, 性交可能でやや不満2例, 改善なし1例, 不明2例, 2)有用度:極めて有用20例, 有用11例, やや有用1例, 好ましくない1例, 判定不能1例, 3)副作用:海綿体膿瘍で抜去の1例, 平均19.2ヵ月中感染糜爛で抜去2例となった, 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.

TAP-144-SRの前立腺癌に対する比較対照試験をリン酸ジエチルスチルベストロールを対照薬として行った.有効性では, 前立腺癌の判定基準の適格例で, TAP群54.5%(36/66), 対照群47.1%(32/68)のPR例が得られ, 両群間に有意差はみられなかった.病巣別効果や自他覚症状に対する効果でも両群間に差はみられなかった.PAPなど腫瘍マーカーに対して対照群の方が有意に優れる効果を示した.内分泌効果では両群とも全例で血清testosteroneがcastration levelに低下した.安全性については, 副作用発現率はTAP群64.1%(41/64)に対し, 対照群は95.4%(62/65)と有意に高く, 対照群で4例が副作用のため試験が中止された.主治医判定による全般安全度では"問題あり"と判定された症例はTAP群6.3%(4/64), 対照群36.9%(24/65)であった.主治医判定による有用度では"有用"以上でみると, TAP群65.6%(42/64), 対照群52.3%(34/65)であった, 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 TAP-144-SR was significantly higher than that of diethylstilbestrol diphosphate (p = 0.038; U-test). In conclusion, TAP-144-SR was confirmed to be more useful than diethylstilbestrol diphosphate as a standard drug for hormonal therapy of prostatic cancer.

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.

1)原発性膀胱腫瘍325例全体の2, 4, 6, 8, 10年生存率は77%, 68%, 62%, 58%, 51%であった.2)男女比と腫瘍数別で生存率に有意差は認められなかったが, 腫瘍が大きくなるにつれ, 発育形態が非乳頭状や広基性になるにつれ, 全摘群, 悪性度が高くなるにつれ, 浸潤度が進行するにつれ生存率が有意に低下した, 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.

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)

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)

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.

13歳女に発生した腎細胞癌.Wilms腫瘍, 腎細胞癌の両腎腫瘍中に占める腎細胞癌の割合は, 11～15歳において, 既に44.4%に達しており, この年齢においてはWilms腫瘍と約同頻度で腎細胞癌も認められることを留意する必要がある, 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 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.

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.

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.

前立腺肥大症174例, 膀胱頸部硬化症31例, 計205例の前立腺症患者に対して, α-交感神経遮断剤である塩酸ブナゾシンを投与してその有効性と至適投与量を検討した.対象症例を4群に分け, 塩酸ブナゾシンの投与量は, 高用量群では初めの1週間を3 mg/日, その後の3週間を4.5 mg/日とした.以下同様に中用量群は1.5 mg/日から3 mg/日, 低用量群は0.15 mg/日から1.5 mg/日, 対照群は0.15 mg/日のままとした.その結果, 本剤による自覚症状を中心とした臨床的有効性が認められた.立ちくらみなどの副作用に注意しつつ, 少量から投与を開始して3 mg/日まで漸増投与することが望ましいと考えられた, 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 voiding, were dose-dependent significant differences observed between all four groups by use of the H-test (p less than 0.05). On the other hand, there was no significant difference between the four groups in the subjective or global improvement rates. Judging from the real data and the graded classification of objective signs, the high and middle dose groups were significantly superior to the control in terms of voiding time, and the high and low dose groups were the same as the control for residual urine ratio.(ABSTRACT TRUNCATED AT 400 WORDS)

1)膀胱腫瘍にてTUR-Btを施行した197例中72例に再発を認めた.2)再発例72例の悪性度についてみると, 悪性度の変化しなかったもの34例(47.2%), (再発経過中一度も悪性度の変化しなかった例28例, 再発経過中変化したが, 初回時および最近のTUR-Btにて変化した例6例), 増悪したもの16例(22.2%), 軽減したもの22例(30.6%)であった.3)悪性度の変化した44例を3群にわけ検討した.再発途中悪性度は変化したが, 初回TUR-Bt時と最近のTUR-Bt時に変化のなかった例あるいは悪性度の低下した例25例, 増悪例9例, 癌死例10例であった.4)第3群(癌死例)についてみると, 再発経過中grade 4に変化した例が7例認められた, 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.

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.

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.

1)最近13年5ヵ月間に経験した原発性尿管腫瘍22例の平均年齢は63.6歳で, 男性は女性の3.4倍であった.2)主訴は肉眼的血尿が17例ともっとも多く, ついで顕微鏡的血尿の2例であった.3)患側は左側15例と多く, 発生部位としては下部尿管が14例であった.4)尿細胞診では, 自然尿の場合17例中5例, 逆行性腎盂造影時におけるカテーテル尿で9例中3例, 両者を併用した場合は19例中9例がclass 4以上を示した.5) IVP所見では, 無造影腎11例, 陰影欠損7例, 水腎症2例の順であった.6)病理組織学的には, 移行上皮癌19例, 扁平上皮癌1例, 粘膜下脂肪腫1例, ポリープ1例であった.7)膀胱腫瘍の併発が, 術前に4例, 術後に3例認められた.8)手術としては, 腎尿管摘出術兼膀胱部分切除術が16例ともっとも多かった.9)尿管原発性悪性腫瘍20例の1年生存率は84%, 3年生存率55%, 5年生存率35%であった.10)予後を判定する因子としては, grade, およびstageが重要であり, high gradeもしくはhigh stageの症例では, いずれも予後不良の症例が多かった.またIVP所見にて無造影腎は予後が不良であった, 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).

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.

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.

前立腺癌3例, 膀胱癌3例, 腎癌5例, 悪性褐色細胞腫1例, 睾丸腫瘍6例の2A以上の遠隔転移を有する進行性悪性腫瘍の18例に対しCDDPを主体とする化学療法を行なった.単独よりも多剤併用時の方が, 効果は優った.前立腺癌3例, 膀胱癌3例, 腎癌5例には効果が認められなかったが, 睾丸腫瘍の6例中4例にPR, 1例にCRが認められた.副作用としては, 悪心, 嘔吐(体重減少), 腎機能障害などが主であった, 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.

1)インポテンスの4例に対して塩酸パパベリン40 mgを陰茎海綿体内へ局注後, 30分目ないし80分目の完全勃起状態に対して塩酸エチレフリン1 mgないし2 mgを局注し, 勃起状態の消退が得られた.2)塩酸エチレフリンの使用量は塩酸パパベリン40 mg局注の場合2 mgが適当量と思われた.3)塩酸エチレフリン局注後, 全例とも特に副作用は認められなかった, 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.

1)最近13年間に経験した16例の原発性腎盂腫瘍の平均年齢は63.9歳で, 男性は女性の4.3倍で, 患側に左右差は認められなかった.2)主訴は肉眼的血尿が13例ともっとも多く, ついで側腹部痛の2例であった.3) IVP所見としては, 陰影欠損が68.7%ともっとも多かった.ついで無造影腎が25%で, 造影群に比し予後不良であった.4)尿細胞診では, 自然尿では46.1%, RP時におけるカテーテル尿では50.0%の陽性率であった.5)手術法としては, 腎尿管摘出術兼膀胱部分切除術が9例ともっとも多く施行された.6)病理組織学的には全例が移行上皮癌で, stageとgradeがよく相関し, いずれも予後を決定する重要な因子であった.7)膀胱腫瘍併発の1例において術前と術後に1回ずつ経尿道膀胱腫瘍切除術を施行した.8)原発性腎盂腫瘍16例の1年生存率は86%, 3年生存率78%, 5年生存率68%であった.9) Low stage群とhigh stage群, low grade群とhigh grade群はp, 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.

1)膀胱腫瘍10例(11腫瘍)に対してBCG 30 mgから240 mgによる膀胱腔内注入療法を施行した.2) 11腫瘍中7腫瘍に腫瘍消失, 4腫瘍に20～80%の腫瘍縮小効果が認められた.3)腫瘍の大きさ別では米粒大腫瘍の4腫瘍は全例消失し, 小指頭大の腫瘍では5腫瘍中3腫瘍が消失し, 残りの2腫瘍にも著明な縮小が認められた.4)悪性度の判明した8腫瘍についてみるとGrade 1は5例中4腫瘍全例が消失, 1腫瘍が50%縮小し, Grade 2は3腫瘍が20～80%の腫瘍縮小を認めた.5)副作用としては, 膀胱刺激症状を10例中7例(70%), 発熱4例(40%), 血尿3例(30%)を認めた, 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.

TUR-P施行82例を対象に, CZX, CPZ, CTX各2 g投与による前立腺組織内移行につき検討した.組織内濃度はCZX, CPZ, CTXの順に高かったが, 各剤とも前立腺組織内で有効濃度を維持し, 細菌性前立腺炎に対し有用と思われた.腺腫の大きさと各薬剤の前立腺組織内移行度間には相関はなかったが, 組織検査上, 筋性肥大を示した例で移行が高かった, 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.

北里大学病院泌尿器科にて経験した睾丸腫瘍について臨床的統計的観察を行った.1) 1972年7月より1984年12月までの12年5ヵ月間に58症例を経験したが, この間の外来患者は44, 698人であり睾丸腫瘍患者は0.13%を占めた.2)年齢は1歳から63歳の間に分布し, 平均28.6歳であった.初発年齢としては0～5歳と26～30歳の二峰性分布が認められた.3)主訴としては, 無痛性睾丸腫大が54例(93.1%)と大半を占めていた.4)患側は右28例(48.3%), 左が29例(50%), 両側性が1例(1.7%)であった.5)組織分類別ではセミノーマが30例(51.7%), 胎児性癌8例(13.8%), 奇形腫2例(3.5%), 複合型が18例(31.0%)であった.6)治療法としては, セミノーマに対してはそのほとんどに高位除睾術と放射線療法を施行した.非セミノーマに対しては, 高位除睾術と化学療法を組み合わせて施行したものが多数を占めた.7) Kaplan-Meier法による5年生存率は, stage 1.2のセミノーマは100%, 非セミノーマは62%であった, 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.

1971年7月から13年間に経験した179例の前立腺癌症例中病理組織学的に当科にて確定し得た167例について悪性度の面から検討した.前立腺癌取扱い規約分類はGleason分類に比し簡明であり, かつ浸潤度, 予後とも高い相関関係が得られた, 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.

過去13年間に腎細胞癌と診断した82例について臨床統計的観察を行った.1)男女比は1.6:1で男子に多く, 年齢は50歳代がもっとも多く, 平均年齢は58.8歳であり, 患側左右比は差を認めなかった.2)初発症状としては, 肉眼的血尿が82例中37例(45%)ともっとも多く認められたが, 無症状の症例が11例(13.4%)に認められた.転移部の症状を初発症状としたものは5例(6%)であった.3)浸潤度別ではstage 1が82例中38例(46%), stage 4が30例(37.6%)と大半を占めていた.4)初診時, 転移部位としては肺が18例ともっとも多く, ついで骨10例, 肝9例の順であった.5)予後についてみると全体の1年, 3年, 5年実測生存率はそれぞれ77%, 58%, 48%であった.stage 4における腎摘群および非腎摘群の比較では有意差を認めなかったが, 非腎摘群に対する動脈塞栓術の有無による比較検討では, 動脈塞栓術併用群に予後の延長が認められた, 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).

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.

1971年7月以降13年間の179症例について検討した.1)受診時年齢は70歳代が46.9%で最も多く, 平均年齢72.4歳であった.2)初診時の主訴としては, 尿路閉塞症状が76%を占めていたが, 遠隔転移部の症状を主訴としたものが8.9%に認められた.3)組織診断の手段としては, TURが81.6%, 針生検術14.0%の順であった.4) Stage分類では, stage A 64, stage B 21, stage C 38, stage D 56例であった.5)死亡症例66例の死因は, 癌死31, 他癌死10, 心筋梗塞8, 脳血管障害5, 肺炎6例であった.なお心血管障害8例中, 抗男性ホルモン剤を投与されていたものは6例であった.6)自験例全体の実測生存率は, 1年89%, 3年70%, 5年55%であり, stage別5年生存率は, stage A 72%, B 67%, C 55%, D 34%であった.7)抗男性ホルモン剤投与の有無による生存率を各stage別に比較検討したところ, stage B, C, D群において投与群の生存率が延長する傾向が認められた.9)抗男性ホルモン剤投与群において, 投与量別にその生存率を比較検討したところ, stage Aでは少量投与群, stage B, Dでは大量投与群の予後が良好である傾向が認められた, 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)

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.

1) 1971年から1984年までの約13年間に北里大学病院泌尿器科における尿路結石症患者1, 876症例を集計し検討した.2)全症例中, 男性は1, 318例, 女性は558例で, 男性は女性の約2.4倍であった.3)年齢別頻度では, 30歳代, 40歳代, 50歳代, 20歳代の順で多くみられた.4)上部尿路結石と下部尿路結石の比は, 18:1であった.5)上部尿路結石の左右差は1.3:1で左側に多かったが, 女性の腎結石の症例では左右差は認められなかった.6)結石成分は, Ca-OxとCa-Pの混合結石とCa-Ox結石が多く, 両者で全体の80%であった.7)結石成分は, 各年齢層で大きな違いは認めなかった, 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.

Urobiotic is a combination of antibiotic (oxytetrac y cline HC1) , chemotherapeutic (sulfamethizole) and analgesic (phenazopyridine HC1) agents designed specifically for urinary tract infections. Tw e nty patients with various urinary tract infections were treated with "Urobiotic" in this study. The dosages were 1 capsule 4 times daily in 8 cases and 2 capsules 4 times daily in the remaining 12 cases, both of which continued for 5 to 7 days. The effects thus attained are summarized as follows : In patients with acute cystitis, "Urobiotic" was noted to be effective in 4 out of 5 cases in which 4 capsules daily were given, and in all of 6 cases in which the dosage was 8 capsules daily. In chronic urinary infections, consisting of 6 cases of chronic cystitis and 3 cases of chronic pyelonephritis, "Urobiotic" was noted to be not effective in all of 3 cases in which the dosage was 4 capsules daily, but effective in 4 out of 6 cases in which 8 capsules daily were given. As side effects, mild gastric discomfort was noted in only 1 patient who was given 8 capsules daily. In con c lusion, "Urobiotic" was believed to be an effective remedy not only for acute cystitis, but also for chronic urinary tract infections. Dosage recommended is 8 capsules daily.

This report deals with a case of giant calculus arising in the urinary bladder of a 59 years old Japanese male, who had had a history of urinary frequency and discomfort for the previous 7 years. The calculus weighed 900 grams and the main component of which was uric acid calculus. The calculus divided into two parts with a smooth flat surface and each of them had its own nucleus. The domestic literature s have been reviewed and 39 cases of giant vesical calculus, weighing more than 200 grams, have been tabulated in weight order. The largest vesical calculus reported in Japan has been of 910 grams in weight, and this case is placed next to it.

This report deals with a case of rhabdomyosarcoma arising in the retro v esical space of a 11 months old female infant. The tumor, 4.2 x4.0 x2.7 cm in size, 40 grams in weight, with marked adhesions to the surrounding tissue was removed surgically togather with regional lymphnodes. Histological diagnosis was rhabdomyosarcoma and metastases were seen in regional lymphnodes. The postoperative course so far has been uneventful and the patient was discharged on 40 th postoperative day, after irradiation therapy with 60Co. The domestic literatures have been reviewed and 11 cases of retro p eritoneal rhabdomyosarcoma have been tabulated (table 2).

This report deals with a case of leiomyoma arising i n the right retroperitoneal space in a 74 years old Japanese female. The tumor, 840 grams in weight, 15 x 18 x 13 cm in size, with irregular nodular surface and partly adhered to vena cava, was successfully removed together with a part of the wall of vena cava. The postoperative course was uneventful and the patient has been in good health up to the present time, that is for about a year after surgery without any evidence of recurrence. The domestic literatures hav e been reviewed and 15 cases of smooth muscle tumors of the retroperitoneal space were collected and tabulated (Table 2). Twelve of them were malignant (leiomyosarcoma) while the remaining three were of a benign nature.

1) Furadantin was used in 47 patients with various urinar y tract infections. The dosage was 100 mg four times a day for seven days in average. Bacteriological and clinical cure were obtained in 12 patients, improvement in 19 patients but no change was observed in 16 patients. 2) Furadantin was highly effective to the patients with Escherichia or Staphylococcus infection but was not effective to those with Pseudomonas or Candida infection. 3) Unpleasant side-effects developed in 9 of 47 patients. The r e actions were mostly mild and gastrointestinal but severe headache, tinnitus, nausea and vomiting developed in an exceptional patient and, was forced to discontinue the dosage. 4) Furadantin Sensi-Disc test, was performed on 165 bacterial strains isolated from the patients with urinary tract infection and was found to be highly sensitive to Staphylococcus, Escherichia, Streptococcus viridans and Streptococcus hemolytics, relatively sensitive to Streptococcus faecalis, Corynebacterium, Klebsiella, Alkaligenes faecalis, Citrobacter etc., and resistant to Pseudomonas, Proteus, Cloaca and Candida. 5) Furadantin was found to be sensitive to 5 6% of the total 165 bacterial strains by the sensi-disc test, and when it was compared to those of the other antibiotics or chemotherapeutics, it was next to Kanamycin (73%) and was superior to Chloromycetin (49%), Erythromycin (34%), Streptomycin (30%), Terramycin (27%), Penicillin (27%), and Sulfisoxazol (6%). 6) The excretory concentration of Furadantin into the urine following the oral administration of Furadantin 100 mg was determined by bacteriological assay and it demonstrated the maximun concentration in three hours, then a rapid fall in the next hour and below the minimum inhibitory level after five hours. As a conclusion, we believe that Furadantin is an effective chemotherapeutic agent for combating urinary tract infections.

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.

Thirty-one patients with various urinary tract infec t ions were treated with Cephaloridine. A single dose of 500 mg was administered intramusculary for five to nine days and its results were evaluated. In seven cases of acute cystitis, Cephaloridine was highly effective and bacteriological cure was obtained in five of them. In twenty-four cases of various chronic urinary tract infections, Cephaloridine was effective in fifteen cases (bacteriological cure in four cases, improvement in eleven cases), but was not effective in the remaining nine cases. Bacteriological study reveale d that Cephaloridine was effective in the treatment of urinary tract infections caused by E. coli, Proteus, Klebsiella, Staphylococcus and Enterococcus, and was not effective in those caused by Pseudomonas. Cephaloridine sensi-disc test w as performed on 119 bacterial strains isolated from the patients with various urinary tract infections and was found to be highly sensitive to E. coli, Enterococcus and Staphylococcus, relatively sensitive to Proteus and Klebsiella, and resistant to Pseudomonas. Unpleasant side effects developed in two of the total sixty-one patients who were administered Cephaloridine at our hospital. The reactions were rather severe revealing allergic exanthema associated with facial edema, chill and dyspnea, but was subsided shortly after the administration of an anti-histamic drug.

The urinary excretion of Furadantin following the oral a d ministration of enteric coated tablet 100 mg was determined by bacteriological assay and the result was conpaired with those of the uncoated tablets 100 mg, 150 mg and 200 mg. The excretion of Furadantin enteric coated tablet into the urine was apparently slower than those of the uncoated tablets but reached to sufficiently high level in one hour and kept the effective level for eight hours. Twenty-five patients with various urinary tract infections were treated with Furad a ntin enteric coated tablet 100 mg q.i.d. for seven days in average. Bacteriological and clinical cure were obtained in 3 patients, improvement in 12 patients and no improvement in 10 patients. Mild gastric discomfort and anorexia were observed in 3 of 25 patients during the treatment with Furadantin enteric coated tablet. But the reactions were apparently milder than those of the uncoated tablet and none of our patients war forced to discontinue the treatment.