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A 26-year-old man was introduced to our hospital with a complaint of macrohematuria. Endoscopic examination showed a small tumor in the anterior urethra. Microscopic examination of a biopsy specimen taken under lumbar anesthesia showed amyloid deposition in the urethral submucosa. On Congo red staining, amyloid was visualized as orange material, showing characteristic birefringence under polarized light. Amyloidosis of the urethra was diagnosed. Because the patient refused to undergo duodenal or rectal biopsy, the possibility of systemic amyloidosis could not be completely excluded. No recurrence has been noted since the endoscopic examination, and no further symptoms have been reported.

We treated a case of retroperitoneal liposarcoma arising from the renal capsule by operation and adjuvant radiation. A 61-year-old woman was referred to our department for treatment of a right renal tumor revealed by computed tomography (CT). CT, magnetic resonance imaging and angiography demonstrated a large renal tumor with fat tissue, fed from the renal capsular artery. Right radical nephrectomy was performed on February 4, 2003. The tumor was diagnosed histopathologically as well differentiated liposarcoma arising from the renal capsule. The surgical margin was positive. Therefore, the patient was given 50 Gy of radiation postoperatively. There have been only 18 reports of liposarcoma arising from the renal capsule in Japan.

Acute pulmonary thromboembolism (APTE) and deep venous thrombosis (DVT) are categorized into venous thromboembolism. APTE is one of the most critical post-operative complications because of its high mortality. Meanwhile, DVT is responsible for more than 80-95% of APTE cases. APTE occurred in 6 patients and DVT in 3 patients in the post-operative period during the past eleven years at our hospital. The median age of these patients, 5 men and 4 women, was 62 years (45-77). In many cases, the course of APTE showed a rapid progression. Four of the six patients with APTE died, and two of these four patients died within a few hours following the onset. Once it occurs, it is often lethal. Therefore, the prevention of thromboembolism is most important. In this study, we examined these 6 APTE cases and 3 DVT cases and discussed low dose heparin and intermittent sequential pneumatic compression (ISPC), prophylaxis against APTE in the post-operative period. We have been using ISPC for the high-risk group of thromboembolism in the post-operative period since 1999. In addition to using ISPC, we have been administering low dose heparin since November 2001. These 3 cases of DVT occurred regardless of adoption of ISPC. However, there were no cases of APTE after adoption of ISPC, and no cases of DVT or APTE after adoption of ISPC and administration of low dose heparin.

A 80-year-old female with insulin-dependent diabetes mellitus (IDDM) visited our hospital on November 24, 1999, because of nausea, vomiting and macrohematuria. Cystoscopy demonstrated a diffuse hyperemic mucosa and gas-filled vesicles in the submucosa. Despite treatment with antibiotics, infection was not controlled and metabolic acidosis was increased. Simple cystectomy and ureterocutaneostomy were performed. Histological examination showed whole mucosal necrosis and vacuolation with aerogenesis in the submucosa and muscle layer of the bladder. Urine and mucosal surface cultures revealed Escherichia coli infection. After operation, the general condition was improved. Thirty six cases of emphysematous cystitis have been reported in Japan including this case. Successful treatment with cystectomy under the life threatening condition was reported for the first time.

We report a case of uretero-external iliac artery fistula. A 60-year-old female was referred to our hospital complaining of intermittent gross macrohematuria. She had undergone radical hysterectomy, radiation therapy and chemotherapy for advanced cervical cancer 2 years ago. The patient had a 7 Fr ureteral double-J stent for left hydronephrosis. Retrograde urography showed a filling defect (8 mm in diameter) of the left ureter. A contrast-enhanced computed tomographic scan showed left hydronephrosis and hydroureter but no evidence of fistula formation or extravasation. A pelvic arteriography revealed a pseudoaneurysm of the left external iliac artery at the crosspoint between the left ureter and the iliac artery. Surgical repair of the left uretero-external arterial fistula was successfully performed as well as left nephroureterectomy. The possibility of fistula formation between ureter and artery should be kept in mind in patients with long-term indwelling ureteral stents and history of radiation therapy.

Neobladder using a detubularized intestinal segment was constructed in 74 cystectomized patients between October 1986 and July 1994. There were 65 males (87.8%) and 9 females (12.2%) with an average age of 63 years (range 36 to 77 years). The mean follow-up period was 35 months (range 7 to 85). Problems of postoperative care assessed were continence, renal function, metabolic consequences, neoplasms and other complications. Moreover, the impact of these problems on the quality of life was evaluated by a self-administered questionnaire. Continence in the daytime was achieved in 70/74 (94.6%) patients. Nocturnal incontinence was noted in 15/74 (20.3%) patients. Serum BUN and creatinine levels were maintained within normal limits. Metabolic acidosis (base excess < -5.0 occurred in 7/74 (9.5%) patients, 4 patients of whom needed alkalizing agents. Colon adenomas in neobladder were found and resected in 3 patients. The other postoperative complications were stone formation in neobladder in 4 (5.4%), urethral stricture in 7 (9.5%) and ureteral stenosis in 3 (4.1%) patients respectively, which were satisfactorily corrected by endourological procedures. As to quality of life assessment, the majority was satisfied, whereas 11% of the patients reported emotional distress and limitations in the usual physical activities by nocturnal incontinence. Our finding suggest that nocturnal incontinence is the most important problem and we need longer follow-up to evaluate the problems of metabolic consequences and neoplasms of the urinary tract.

A 62-year-old man presented in 1987 with hematospermia. No abnormal findings were observed by cystourethroscopy. Ultrasound showed the enlargement of the right seminal vesicle. The right seminal vesicle could not be visualized by seminal vesiculography. Computed tomographic scan revealed a homogeneous mass at the right dorsolateral aspect of the prostate. Surgical exploration was performed. The prostate and bilateral seminal vesicle were resected. Pathological diagnosis was adenomyosis of the right seminal vesicle.

A new alpha 1-adrenergic receptor antagonist, KT-611 (naftopidil) antagonized dose dependently the contraction induced by agonists, noradrenaline and phenylephrine in the human prostatic tissue. KT-611 at a dosage of once or twice a day was evaluated for its effects on 49 patients with benign prostatic hypertrophy. The drug improved subjective and objective symptoms significantly. The residual urine was reduced in volume and percentage significantly. The average and maximum flow rates increased significantly. The optimal dosage was presumed to be in the range of 25 to 75 mg once a day or 25 to 100 mg twice a day. Adverse reactions and abnormal laboratory findings were all slight. KT-611 was concluded to be useful in the treatment of patients with benign prostatic hypertrophy.

Bladder replacement using a detubularized right colonic segment was successfully performed on 22 male patients with bladder cancer after radical cystectomy. There were 10 early postoperative complications and one of them required reoperation. Urodynamic studies, performed on 16 patients, showed a low pressure reservoir at a large capacity without any involuntary spikes in every case. Of the 16 patients, 4 were nocturnally enuretic and 1 was partially continent. The other 11 patients (68.8%) were totally continent and voiding well, except one who was on intermittent self-catheterization. The incidence of urinary reservoir infections in patients treated with colon bladder replacement was investigated in 18 patients. The incidence rate of bacteriuria was 5.6% and the positive rate of pyuria was 27.8%. The detection rate of bacteriuria and pyuria was significantly low in patients after colon bladder replacement. These findings indicate that colon bladder replacement can be an ideal option for selected patients with bladder cancer.

Two patients with bladder cancer underwent construction of continent urinary reservoir using the in situ appendix as a catheterizable stoma after total cystectomy. Urodynamic study revealed that the reservoir had a large capacity of 500-800 ml and low pressure without the involuntary pressure spikes was maintained. X-rays of the reservoir showed no reflux. The patients achieved complete day and night-time continence.

A 26-year-old male with urachal abscess was demonstrated. Ultrasonography, CT and MRI revealed that there was a mass at the supravesical region, which was connected to the umbilicus. However, a differential diagnosis as to whether the mass was a tumor or an abscess was difficult from these examinations. Thus we performed an open biopsy. A pathological examination revealed no malignant change in the biopsy specimen. On the other hand, the pathological diagnosis of a follicular tumor located at the roof of the urinary bladder was TCC G2, but we considered that, this change was a reactive hyperplasia with dysplasia resulting from chronic inflammation of urachal abscess. Thus, the complete excision of urachal abscess and partial cystectomy were performed. The serial sections of the bladder wall revealed no malignant changes. We reviewed similar cases reported in our country and discussed various factors causing urachal abscess, especially related to the infectious root.

Endometriosis of the urinary tract is uncommon. A thirty-year-old woman was referred to our hospital, complaining of macrohematuria. Intravenous pyelography (IVP) showed bilateral hydro nephrosis. Cystoscopic examination revealed a mass around the bilateral ureteral orifice. Danazol therapy was commenced. After 6 months of therapy, IVP showed the improvement of hydronephrosis of left kidney and cystoscopy revealed the resolution of most of the mass in the bladder. For definite diagnosis and treatment, danazol therapy is considered to be effective for endometriosis, but if secondary fibrosis has occurred, surgical treatment may be necessary.

Vesical malacoplakia is a relatively rare disease and commonly diagnosed by characteristic cystoscopical findings and histological determination using biopsy specimen. We report here a case of a 53-year-old housewife, with atypical cystoscopical findings, which looked like carcinoma in situ, and in which randomized biopsy helped to make the final diagnosis. This case was successfully controlled by anti-bacterial agents.

We report a case of a metastatic urinary bladder tumor from gastric remnant carcinoma. On August 23, 1984, a 70-year-old-woman visited us with the complaint of dysuria. She had undergone gastrectomy for gastric ulcer 25 years earlier. Cystoscopy revealed a non-stalk tumor in the dome of the bladder and the examination of the upper gastro-intestinal tract revealed gastric remnant carcinoma. We treated her with adriamycin, cis-diamminedichloroplatinum and mitomycin C but unfortunately she died of cachexia two weeks later. An autopsy revealed that the urinary bladder tumor was a signet ring cell carcinoma, metastasized from gastric remnant carcinoma.

A 68-year-old woman was hospitalized complaining of right flank pain. The excretory pyelogram revealed that the right kidney was hydronephrosis, and a retrograde pyelogram showed stringy filling defects in the middle portion of the right ureter. Suspecting a right ureter tumor, a right ureteronephrectomy was performed. The pathological diagnosis was ureteral cholesteatoma which is a rare condition with reports of only 9 cases in the Japanese literature. Although the possibilities of malignant change has been debatable, long term follow up would be mandatory.

For the fundamental study of the targeting cancer chemotherapy against choriocarcinoma using the anti-human chorionic gonadotropin beta subunit (hCG beta) antibody-conjugated-liposome containing anticancer drugs, we evaluated the specific accumulation of the antibody to the choriocarcinoma tissue and the uptake of liposome by choriocarcinoma cells. In vivo, the mice bearing human choriocarcinoma were injected anti-hCG beta antibody (30 micrograms/body) and the localization of the antibody in the tumor and other mouse organs were investigated by the PAP method. The antibody specifically accumulated to the choriocarcinoma tissue within 4 hours after the injection of the antibody, and gradually increased. In vitro, cultured BeWo cells were exposed to the liposome containing adriamycin, the antibody conjugated liposome containing adriamycin or the adriamycin alone, respectively, for 2 hours. Then the uptake of the adriamycin by the tumor cells was studied under fluorescent microscopy. The nuclear accumulation of adriamycin was clearly observed in the tumor cells exposed to the liposome containing adriamycin or the antibody conjugated liposome containing adriamycin, whereas only faint cytoplasmic accumulation of the adriamycin without any nuclear accumulation was observed in the cells exposed to the adriamycin alone. These results indicate that the liposome is a good carrier of anticancer drugs for immunotargeting chemotherapy.

Although ileal conduit diversion is widely accepted in the treatment of the patients undergoing radical cystectomy, many patients would prefer other alternatives which allow continence. and urination through the urethra. We describe a new procedure in which a segment of detuburalized right colon is used as a continent reservoir. Eight patients, 7 after radical cystectomy for bladder cancer and one after total exenteration for rectal cancer, have undergone colon bladder replacement. New created bladder had a capacity of 300 to 600 ml. All patients could pass urine through the urethra but one is on self-catheterization. Five of the 8 patients had no residual urine. Three months after operations 4 were totally continent and 3 were satisfactorily dry during daytime but slightly enuretic. Excretory urography showed no abnormalities in their upper urinary tract. Considering the "quality of life' of a patient, this procedure can be an ideal option for selected patients.

An extremely rare case of renal leiomyoma presenting as a cystic mass, involving the upper pole of the right kidney in a 59-year-old woman, complaining of right flank pain is reported. Some discussion regarding pathogenesis of leiomyoma with cystic change, diagnostic feature, malignant potential of leiomyoma and others was done. Since 1948, 19 cases including our own case of renal leiomyoma have been reported in the Japanese literature.