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Castration-resistant prostate cancer and multiple lymph node and ventral bladder metastases in an 87 year-old man progressed despite various systemic therapies, including chemotherapy. Because his prostate surgical specimen displayed a microsatellite instability (MSI) -high status, pembrolizumab 200 mg/body treatment was started. After six courses of treatment, his prostate-specific antigen (PSA) level decreased by 83% versus that at treatment initiation (from 408.78 ng/ml to 69.54 ng/ml), and the para-aortic lymph node metastasis was reduced in size on imaging. After 13 courses, his PSA level (462.59 ng/ml) exceeded that at the start of treatment, and progressive disease was detected on imaging. Although case reports of pembrolizumab for MSI-high prostate cancer remain few because of its rarity, it is an important therapeutic option and further clinical research is required.

A 59-year-old woman presented with a left adrenal tumor 4 cm in diameter. The ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy showed apparent accumulation in the left adrenal tumor. However, the patient had no sign or symptoms suggesting pheochromocytoma. No biochemical evidence of catecholamine excess was noticed. Computed tomography (CT) revealed relatively strong enhancement in the arterial phase, which persisted until the portal phase. The computed tomography (CT) and magnetic resonance imaging showed 2 liver nodule suspected to be metastatic tumors. No ¹²³I-MIBG accumulation was seen in these nodules. CT also showed thyroid nodules with calcification, which suggested papillary thyroid cancer. Based on the findings, open left adrenalectomy, partial hepatectomy and segmentectomy were performed under the clinical diagnosis of pheochromocytoma and metastatic liver tumors. Histopathological diagnosis was adrenocortical cancer. There was only lymphocyte infiltration in the liver nodules. Postoperative recovery was uneventful, and the patient underwent partial thyroidectomy 6 months later. The pathological diagnosis was papillary thyroid cancer. She has been without recurrence or metastases for 18 months after adrenalectomy. We found only 6 cases of MIBG scintigraphy-positive adrenocortical cancer in the literature. The mechanisms for MIBG uptake in adrenocortical cancer are discussed with a review of the literature.

A 62-year-old man was treated for castration-resistant prostate cancer (CRPC) ; however, his condition progressed. The patient planned to visit our department for treatment, including palliative care. However, he visited the emergency room with a complaint of a persistent nose bleed just before visiting our department. He had an active nose bleed, disseminated intravascular coagulation (DIC), and leukoerythroblastosis upon admission. After hospitalization, we performed a bone marrow puncture and biopsy to investigate the cause of the DIC, which revealed a dry tap and hypoplastic bone marrow. This was believed to be due to the progression of CRPC. He developed wheals upon receiving repeated platelet transfusions for the DIC. Although we administered antihistamine and steroids to control these side effects, he additionally developed chills and fever. Because of the difficulty in controlling side effects, we decided to use washed platelets. Thereafter, blood transfusions of washed platelets were performed without the occurrence of side effects. However, the patient died because of the worsening of his condition.

A 71-year-old man visited a local urologist with the complaint of continuous painful erection for three days. Penile cavernosal blood data showed acidosis and hypoxia. Thus he was diagnosed with ischemic priapism. After penile aspiration and injection of phenylephrine, erection was temporary improved. The blood platelet count was 94.5×104/μl and myeloproliferative disease was suspected. He was referred to our hospital and visited us the following day. Since priapism relapsed, we aspirated corpus cavernosum of the penis and injected phenylephrine which was successful. A bone marrow biopsy and genetic test were performed at the department of hematology and the diagnosis of essential thrombocythemia with JAK2 gene mutation was confirmed. By treatment with hydroxyurea, the blood platelet count decreased without priapism recurrence.

We report two cases of infected nonfunctioning kidney due to ureteropelvic junction (UPJ) stenosis treated by laparoscopic surgery. Patient 1 : A 78-year-old woman was referred to our clinic complaining of left flank pain and high fever up. Asymptomatic UPJ stenosis with mild hydronephrosis was diagnosed 9 years ago at our clinic. Therefore we followed her up with no treatment. Computed tomography (CT) scan revealed left severe hydronephrosis. Antibiotic chemotherapy was performed without percutaneous nephrostomy. Laparoscopic nephrectomy was performed with the resected renal size of 10 cm in greatest diameter and the operative time of 262 min. The pathological diagnosis was atrophic kidney with pyelonephritis. Patient 2 : A 28-year-old man was referred to our clinic complaining of left flank pain and high fever up. CT scan revealed a left severe hydronephrosis due to UPJ stenosis. Following percutaneous nephrostomy,antibiotic chemotherapy was performed. Laparoscopic nephrectomy was performed with the resected renal size of 6 cm in greatest diameter and the operative time of 140 min. The pathological diagnosis was atrophic kidney with pyelonephritis. Laparoscopic nephrectomy for infected nonfunctioning kidney due to UPJ stenosis is feasible and safe. With dense perinephric adhesions and failure to progress,we should consider early open conversion to reduce morbidity.

Retroperitoneal schwannoma is a rare tumor. Only 19 cases have been reported to be treated by laparoscopic surgery. We performed successful laparoscopic excision of retroperitoneal schwannoma using the four-trocar in three patients who had a left retroperitoneal mass. The patients were two women and one man. They were 62, 60 and 57 years old. The tumor was 70, 45 and 50 mm in greatest diameter and operative time was 204, 243 and 254 min. respectively. The pathological diagnosis of the tumor was schwannoma. There was no morbidity or mortality. Preoperative diagnosis of schwannoma is very difficult. However schwannoma is a benign tumor with a good prognosis. This laparoscopic excision for retroperitoneal schwannoma is effective and rather safe.

A 44-year-old man suffered from sleep disturbance, headache, lack of energy and appetite loss. His local doctor recommended he consult our clinic for further examination of late-onset hypogonadism. His aging males' symptoms (AMS) and international index of erectile function (IIEF-5) scores were 62 and 1, respectively. His biochemistry revealed 0.29 mIU/ml luteinizing hormone (LH), 1.36 mIU/ml follicular stimulating hormone (FSH), 0.16 ng/ml total testosterone (TT) and＜0.6 pg/ml free testosterone (FT). Male hypogonadotropic hypogonadism was suspected from these results, He was then referred to a neurosurgeon for discrimination of intracranial disease where magnetic resonance imaging (MRI) revealed multiple intracranial tumors. An open brain biopsy was performed, and germinoma was diagnosed. After 4 courses of anti-cancer chemotherapy, complete remission was achieved. He was followed up endocrinologically by administration of testosterone injections along with other endocrinology replacement treatments. However, MRI 3 months later revealed tumor recurrence in the left lateral ventricle, and he has been receiving radiation therapy.

A 63-year-female was referred to our department for close examination and treatment of a left adrenal tumor found by positron emission tomography and computed tomography. She underwent abdominal total hysterectomy and bilateral salpingo-oophorectomy for uterine leiomyosarcoma 19 years ago. After the operation, she received 2 resections for peritoneal recurrence and 7 resections for pulmonary metastases. Magnetic resonance imaging showed a heterogeneous mass with a diameter of 7 cm at the left adrenal grand. We carried out open adrenalectomy and pathological findings were a metastatic adrenal tumor from uterine leiomyosarcoma. No signs of recurrence or metastasis have been observed for 6 months after the operation.

A 29-year-old man had been treated for hypertension for 10 years. He suffered from speech disturbance caused by cerebral infarction, and further examinations were performed. Computerized tomography scan and magnetic resonance imaging revealed a left adrenal tumor 6 cm in size. The radioisotope (MIBG) accumulated in the left adrenal gland. The serum noradrenalin levels were high. Thus, the diagnosis of pheochomocytoma in left adrenal tumor was made. He noticed ejaculation disturbance 5 days after starting administration of doxazosin at the dose of 3 mg/day for pre-operative blood pressure control. Sperm was observed in the urine sampling obtained after masturbation, thus his ejaculation disturbance was considered to be retrograde ejaculation. Laparoscopic left adrenalectomy was performed. After the operation, his blood pressure normalized and the administration of doxazosin has not been necessary. He could perform ejaculation without any trouble after stopping doxazosin intake. The bladder neck conditions measured by ultrasonography were the same before and after the administration of doxazosin. The present case is a very rare case of ejaculation disturbance caused by non-selective alpha 1 blocker doxazosin.

A 67-year-old man was referred to our clinic with a complaint of macroscopic hematuria. He had been treated for schizophrenia in a psychology ward. Computed tomography (CT) scan revealed a left renal tumor 7 cm in size, well enhanced in early phase. Doppler ultrasonography indicated hypervascular left renal tumor. Laparoscopic radical left nephrectomy was performed under the diagnosis ofrenal cancer. Histopathlogical results showed a renal solitary fibrous tumor (SFT) with a hemangiopericytoma-like pattern. Renal SFT is an uncommon tumor. The present case is the 11th reported case of SFT with hemangiopericytoma-like pattern in the Japanese literature.

A 19-year-old male, who had undergone bilateral orchiopexy at 5 years of age in the Department of Pediatric Surgery, was referred to our clinic presenting with bilateral small testes. Bilateral testis volume was 4 ml involving a small penis and scant pubic hair per Tanner Stage 2. Serum luteinizing hormone, follicle stimulating hormone and testosterone levels were low. Results of hormonal loading tests, including luteinizing hormone-releasing hormone (LH-RH) and human chorionic gonadotropin (HCG), were positive. Brain computed tomographic scan revealed no abnormal findings. The diagnosis of male hypogonadotropic hypogonadism was rendered based on these data. Administration of LH-RH for 1 year was ineffective. Subsequently, HCG and human menopausal gonadotropin (HMG) treatments were initiated. The symptoms of male insufficiency improved; moreover, sperm formation was apparent following HCG and HMG treatments. The patient has received HCG and HMG injections for eight years; furthermore, his wife delivered a boy consequent to the first intracytoplasmic sperm injection.

The most basic treatment for late-onset hypogonadism (LOH) is hormone replacment therapy (HRT). In Japan, intra-muscular injection of testosterone (T) has been used for LOH treatment as HRT. Testosterone ointment (Glowmin) has been available for HRT from 1965 as an over-the-counter drug, and the profile of serum T levels and efficacy of testosterone ointment for LOH patients has been reported. In this study, we analyzed the relationship between the efficacy of testosterone ointment and LOH severity. Fifty LOH patients were treated with 6 mg of testosterone ointment per day. After 12 weeks of treatment, they were divided into 2 groups according to the severity of their LOH, serum total T and free T levels, measured by such means as total aging males' symptoms (AMS) score. The improvements of total AMS score, international index of erectile function 5 score and MOS 36-Item Short-Form Health Survey (SF-36) score were observed and analysis of variation was performed. Results showed that the symptoms in the more severe patients had a total AMS score improvement in 4 domains, AMS (psychological), SF-36 body pain (BP), social function (SF), role-emotion, compared to patients with slight LOH. While patients with normal serum T levels felt BP improvement as opposed to patients with low serum T levels, there was no significant difference in the other domains. In conclusion, testosterone ointment is considered to be effective in improving several elements of AMS and SF-36 in patients with a high AMS score.

We describe a case of bilateral tuberculous epididymitis that occurred two weeks after intravesical Bacillus Calmette-Guerin (BCG) instillation. A 72-year-old man received transuretheral resection of bladder transitional cell carcinoma in November 2000. Although he had no recurrence for about 4 years, cystoscopy revealed small papillary tumors in the bladder in September 2004. A course of 8 weekly intravesical instillations of BCG was started. After the second BCG instillation (160 mg) he had bilateral painful scrotal swelling. Although he was administered isoniazid (INH) and rifampicin (RFP), scrotal swelling got worse. Right orchiectomy and left epididymectomy was performed in December 2004. Histological diagnosis was bilateral tuberculous epididymitis. Postoperatively, he was administered INH and RFP and had no recurrence for 3 months.

A 60-year-old woman visited our clinic with a complaint of gross hematuria. She was under treatment for rheumatoid arthritis, amyloidosis and diabetes mellitus at the Departments of Orthopedic Surgery and Internal Medicine. The results of a urine analysis showed protein urine, glucose urine, hematopyuria and bacteriuria. The diagnosis of emphysematous cystitis was made from radiography, ultrasonogram and cystoscopic findings. Antibiotics were administered effectively. However, one month later, bilateral hydronephrosis was identified by a computed tomographic scan performed by the Department of Internal Medicine. The bilateral hydronephrosis was brought on by urinary retention caused by a neurogenic bladder disorder. Thus, an indwelling catheter followed by intermittent catheterization was performed and cholinergic medication prescribed successfully.

We report a case of port site metastasis of primary adenocarcinoma of the renal pelvis after a laparoscopic nephrectomy. A 76-year-old woman was admitted to our hospital with a complaint of anorexia, general malaise and left abdominal distension. Computed tomography revealed severe hydronephrosis in the left kidney. Laboratory examination revealed a high serum level of CA19-9 (155 U/ml). However, antegrade and retrograde pyelography revealed no filling defects and urine cytopathology for renal pelvis showed no malignancy. Thus, on the suspicion of a ureteropelvic junction stenosis, a laparoscopic nephrectomy was performed. There were some papillary tumors in the renal pelvis and a histopathological examination of the tumor revealed a papillary adenocarcinoma. Twelve months after nephrectomy, left iliopsoas muscle metastasis was found. Thus irradiation therapy with a total of 30 Gy was performed. However, 3 months later, the patient developed metastasis at the trocar site and the serum level of CA19-9 elevated to 6,720 U/ml. She died of multiple metastases from adenocarcinoma of the renal pelvis 4 months after port site metastasis.

We report a case of urachal actinomycosis with bone formation. A 76-year-old woman was admitted to our hospital with a complaint of gross hematuria. Cystoscopy revealed bleeding from the dome of the bladder wall. Magnetic resonance imaging revealed a mass extending from the dome of the bladder to just below the umbilicus. A urachal tumor was clinically suspected, and the mass was resected together with urachal remnant and part of the bladder wall. Pathological diagnosis of the specimen was actinomycosis. The bone tissue was found in the abcess. Actinomycosis is a chronic suppurative infection caused by Actinomyces israelii. Although urachal actinomycosis is a rare desease, it is important to recognize this uncommon intrapelvic infection as the differential diagnosis of any intrapelvic mass.

An 11-year-old boy visited our clinic complaining of recurrent epididymitis for 2 years. No abnormal findings were found in urine and blood sampling tests, ultrasonography of the urinary tracts or in a pelvic magnetic resonance imaging examination. Induration of the left epididymal tail, webbed penis and true phimosis were observed. Neither hypospadias nor chordee were identified, thus the diagnosis of "webbed penis without chordee" was made. The operation for webbed penis by transverse incision followed by longitudinal suture and dorsal incision for true phimosis was performed successfully. The postoperative course was uneventful and no recurrence of epididymitis has occurred.

A 69-year-old female visited our hospital with a chief complaint of macroscopic hematuria. A non-papillary broad-based tumor was found by cystoscopy. Excretory urography and computerized tomography revealed a large invasive tumor in the left wall of the urinary bladder. The histopathological diagnosis of bladder tumor obtained by transuretheral resection (TUR-Bt) was a sarcomatoid carcinoma composed of a urothelial cell carcinoma. One month after TUR-Bt, abdominal wall metastases were found. Thus total 50Gy of irradiation therapy was performed. However brain metastasis was also found and she died 3 months after TUR-Bt.

Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal region. We treated four cases of Fournier's gangrene from July 2002 to April 2003. All patients were male, ranging in age from 73-92 years old (80.5 +/- 6.5). They were admitted to our hospital complaining of perineal pain, scrotal swelling and high fever. Immediately, we started systemic chemotherapy with broad-spectrum antibiotics, and performed surgical debridements for all patients. Three patients made a full recovery, but one patient died of sepsis. These cases are presented with some notes on the relevant literature.

A 67-year-old male had been maintained on hemodialysis for 13 years because of chronic renal failure secondary to diabetes mellitus. The patient was referred to our hospital with sudden right flank pain. Computed tomography revealed multiple cysts in both kidneys and a right massive perirenal hematoma. Although there was no definite evidence of a renal tumor, a right nephretomy was performed. Histological study revealed acquired cystic disease of the kidney (ACDK) with a hematoma containing papillary renal cell carcinoma. He has been free of recurrence for 2 months. To our knowledge, this case is the fourth report of renal cell carcinoma in ACDK manifested by spontaneous rupture in the Japanese literature.

An 85-year-old male was admitted to our hospital with the chief complaint of a left hydronephrosis. Computed tomography (CT) revealed left hydronephrosis and a left ureteral tumor. We performed left nephroureterectomy. Microscopically, the neoplasm was composed of a mixture of transitional cell carcinoma and adenocarcinoma. To our knowledge, this case is the 14th report of mixed carcinoma of the upper urinary tract.

While a ureteral stone is a common disease, it occasionally causes urosepsis and septic shock. We analyzed 6 cases of septic shock due to urosepsis caused by a ureteral stone from August 1998 to September 2001. All patients were female, ranging in age from 38-76 years old (63.8 +/- 15.3). Stones ranged from 4 to 12 ml in size. The results of analysis of bacterial culture from blood and urine revealed E. coli in 4 cases, K. pneumoniae in 1 case and P. mirabilis in 1 case. Treatment, including intravenous transfusion, the administration of vasopressor drugs and antibiotics, and anti-disseminated intravascular coagulation (DIC) treatments were performed. Percutaneous nephrostomy in 4 cases and ureteral stent indwelling in 1 case were also used for the management of urinary tract. Extracorporeal shock wave lithotripsy (ESWL) was performed in 4 patients after improvement of general condition. Furthermore, the 3 most recent patients had also received therapy to remove endotoxins. All patients were diagnosed in a stone-free condition after a combination of these therapies. The mean recovery interval from shock condition to shock-free status seemed to be shorter in the patients that received the endotoxin removal therapy.

A 70-year-old male was admitted to our hospital with the chief complaint of a left intrascrotal mass. A painless, solid and elastic-hard mass was palpable in the left scrotum. The testis, epididymis and spermatic cord could not be palpated separately from the mass. Tumor resection was performed. The tumor was 13 x 7.5 x 3.0 cm in size and 285 g in weight. Histological diagnosis was schwannoma. To our knowledge, the case was considered as the sixth reported in Japan.

We report a case of carcinosarcoma of the urinary bladder. A 68-year-old man visited our hospital with complaints of asymptomatic macroscopic hematuria, cold sweat and general malaise. Excretory urography revealed a filling defect in the left wall of the bladder, and subsequent cystoscopy revealed a non-papillary sessile tumor. The tumor was transurethrally resected and its histology showed carcinosarcoma which was characteristics of a mixture of transitional cell carcinoma with spindle cell sarcoma. The patient underwent total cystectomy and his bladder was reconstructed with the ileum. Nevertheless, he died of multiple organ metastases 3 months after the surgery.

A right adrenal tumor was discovered incidentally in an ultrasonographic exam in a 45-year-old man. He was referred to our hospital for further examination and treatment of the adrenal tumor. The hormonal levels in his blood and urine were normal and hypertension was not observed. An ultrasonograph, computerized tomographic scan and magnetic resonance imaging showed a right adrenal tumor 7 cm in size. An adrenal hemangioma was most suspected, but a malignant tumor could not be excluded due to its size. Accordingly, a right adrenalectomy was performed. The histological diagnosis of adrenal hematoma was made. Adrenal hematoma is a rare disease in adults. It is very difficult to distinguish a large adrenal hematoma from a malignant tumor, the final diagnosis has to be made by histological study of the resected specimen.

A 79-year-old man visited our clinic with complaints of left scrotal swelling. Ultrasonography revealed solid tumor with heterogeneous echogenicity. No other abnormal findings were observed including tumor markers. However, the tumor was very large and the diagnosis of malignant testicular tumor could not be excluded. Therefore, orchiectomy was performed. Histological diagnosis was 820-gram epidermoid cyst of the left testis.

Between November 1997 and March 2001, 4 female patients from 44 to 65 years of age with a spontaneous rupture of the urinary bladder were analyzed. They complained of abdominal pain and had undergone an intra-pelvic gynecological operation (3 for uterine cancer, 1 for an ovarian cyst) several years before. The three with uterine cancer had also received radiation therapy. For their present condition, spontaneous urinary bladder rupture, their treatment was indwelling a urethral catheter. Two of them have had no recurrence of urinary bladder rupture after one month since having the urethral catheter indwelt. One, however, had to have the catheter re-indwelt due to unsuccessful suturing of the urinary bladder wall. The fourth patient had bilateral nephrostomy tubes due to severe radiation cystitis. Thus, one can infer that intra-pelvic gynecological operations and radiation therapy are major factors causing spontaneous urinary bladder rupture. While indwelling a urethral catheter may be effective for some patients with a spontaneous rupture of the urinary bladder, it may be very difficult to treat more complicated cases.

Twenty-three patients (6 men and 17 women) with renal angiomyolipoma (AML) were analyzed. They were divided into two groups; 9 patients in the operated group and 14 patients in the surveillance group. The operations for AML were performed on 3 patients suspected of having renal cancer or 6 patients with an AML more than 5 cm in size who had some symptoms as a result of the presence of the tumor. The patients in the surveillance group had tumor less than 4 cm in diameter, and did not have any symptoms. No changes in tumor size were observed during the intervals between observation checkups. The male to female ratio, the average age and the location of AML were not significant in either group. However, the tumor size was significantly larger in the operated group. Thus, the tumor size is considered to be an important factor when deciding the necessity of surgical treatments for AML. Pre-operative diagnosis and treatment strategies, including thin-section computed tomography and selective arterial embolization for AML were discussed.

A 70-year-old man with bladder cancer received a total cystectomy and an ileal conduit 64 months before he visited our hospital with complaints of lower abdominal pain, shaking and chilliness. Bilateral hydronephrosis due to an ileal conduit obstruction were observed on the ultrasonography. Bacterial culture from blood and urine samplings revealed E. coli. Under the diagnosis of urosepsis, the administration of anti-biotics and bilateral percutaneous nephrostomy were performed. However, he suffered from septic shock and disseminated intravascular coagulation (DIC). Therefore, the treatments for DIC were done, and they were effective. The obstruction of the ileal conduit was cured spontaneously. No recurrence or metastases were found on ultrasonography and computed tomographic scan for 12 months after these treatments.

A 69-year-old man visited our hospital with a complaint of dysuria. Intravenous excretory urography, ultrasonography and CT scan showed a tumor at the base of the bladder and the prostate. Transrectal needle biopsy revealed signet ring cell carcinoma. Radical cystectomy and ileal conduit were performed, and a histological diagnosis was a primary signet ring cell carcinoma of the bladder. No recurrence or metastasis was found either on ultrasonography or CT scan at 26 months after the operation. He suddenly suffered from severe abdominal pain, and died of hypovolemic shock by ileus as a late complication of an ileal conduit at 27 months after the operation. An ileus with extensive necrosis of small intestine and cancer recurrence at the junction of the ureter and ileal conduit were observed at autopsy.

A 71-year-old man visited our hospital with a complaint of a right intrascrotal mass. An elastic hard mass was palpable in the right intrascrotal extratesticular space. Ultrasonography, computed tomographic scan and magnetic resonance imaging showed a left intrascrotal extratesticular tumor. However, preoperative diagnosis was not decided. Tumor resection was performed, and the histological diagnosis was schwannoma. Intrascrotal extratesticular schwannoma is very rare, and this case was considered as the second report in Japan.

A 79-year-old woman was admitted with recurrent ureteral and bladder cancers. She had a horseshoe kidney with a non-functioning right renal unit. Fifteen months earlier, multiple urothelial tumors had first developed in the left upper ureter and bladder. Transurethral resection of bladder tumor (TUR-Bt) and partial ureterectomy (2 cm) had been performed. Presently, the recurrent tumors were located at the left lower ureter and bladder. Considering the high age of the patient, TUR-Bt and partial ureterectomy (5 cm) were performed. Besides urothelial cancers, she had been operated for carcinomas of the colon, uterus and stomach. Kidney-sparing therapy has successfully maintained her quality of life.

Between 1981 to 1991, 126 patients were diagnosed with prostatic cancer from histological reports. Stage D2 prostatic cancer was confirmed in 38 of these cases at the time of the initial diagnosis (group alpha). Of 38 patients in group alpha, 13 had recurrence of disease after a good response to the initial treatment, 19 had no recurrence after the treatment and the other 6 patients showed no response to the initial treatment for prostatic cancer. Seven patients showed progression of the disease to stage D2 during the observation period (group beta). These forty-five patients with stage D2 prostatic cancer were analyzed. Poorly differentiated adenocarcinoma was the most frequently observed histological grade, followed by moderately differentiated. The grade of the extent of the disease (EOD) on bone scan was classified as EOD I in 26, EOD II in 13 and EOD III in 4, with no significant differences in the survival rate found among these groups. The sensitivity rate of prostate specific antigen was higher than that of other serum tumor markers. Twenty-three patients died during the observation period. 18 of the 23 died of prostatic cancer.

We present a case of retroperitoneal Castleman's disease associated with bladder tumor. The patient was a 62-year-old man, who underwent partial cystectomy under a diagnosis of bladder tumor in 1989. Subsequently, recurrent bladder tumor was detected and he consulted the outpatient clinic at our University Hospital in November, 1990, at which time computerized tomography (CT) revealed a retroperitoneal tumor. From February, 1991 four courses of combined chemotherapy (methotrexate, vinblastine, pirarubicin, cisplatin) were administered for the tumor. The tumor reduction rate after the chemotherapy was 60% on CT, and retroperitoneal lymph node dissection and left nephroureterectomy were performed in July, 1991. Histological examination revealed Castleman's disease, hyaline-vascular type. Fifty-nine reported cases of retroperitoneal Castleman's disease in Japan are reviewed.

We report a case of spontaneous rupture of the renal pelvis and a case of spontaneous peripelvic extravasation, which were associated with ureteral stones. Case 1 was in a 73-year-old man with complaint of left flank pain. Excretory urograms showed left spontaneous rupture of the renal pelvis associated with left ureteral stone. Double-J ureteral stent was placed immediately and transurethral ureterolithotripsy (TUL) was performed after disappearance of extravasation. Case 2 was in a 34-year-old woman with complaint of left flank pain. Excretory urograms showed left ureteral stone and spontaneous peripelvic extravasation. The stone passed spontaneously and the extravasation disappeared with conservative therapy.

PPA, PHA and Su-PS skin tests were performed on 152 urogenital malignancy patients and the results obtained were analysed in terms of clinical course. The survival rate of 86 patients showing a positive response to the PPD skin test was significantly higher (P less than 0.005) than that of 65 patients showing a negative response to the PPD skin test. Among the 33 renal tumor patients, the positive rate of the 10 patients with stage I tumors to PPD skin test was significantly higher (P less than 0.05) than that of the 13 patients with stage IV tumors. In 68 bladder tumor patients, the response rate to PPD skin test in 47 patients with a low stage tumor was significantly high (P less than 0.05) compared with that in 21 patients with a high stage tumor. Out of 47 patients who died during the 84-month observation period, 10 (21.7%) and 3 (13.3%) showed a response change from negative to positive, in the PPD test and Su-PS test, respectively. It was assumed that 32 of the 46 patients (69.6%), 4 of the 6 patients (66.7%) and 17 of the 23 patients (73.9%) submitted to the PPD, PHA and Su-PS tests, respectively, showed a negative response at the time of their death.

Surgical tumor specimens from 67 urological malignancy patients were subjected to a human tumor clonogenic assay (HTCA) developed by Hamberger and Salmon. Appreciable growth of colonies was obtained in 20 of the 33 renal cancers, 20 of the 30 urothelial cancers and 1 of the 4 testicular cancers examined. Using HTCA, a plating efficiency ranging from 0.01 to 0.5% was obtained in these urologic malignancies. However, colonial growth adequate for chemosensitivity was obtained in 30 of these 67 patients. According to Von Hoff's definition, more than a 70% decrease in the plating efficiency after anticancer drug exposure was defined as susceptible. Susceptibility to vinblastine (VBL) was seen in 4 of the 11 patients with renal cancer. Susceptibility to cis-dichlorodiamine platinum (CDDP) was seen in 4 of the 15 patients with urothelial cancer, 1 of the 4 patients with renal cancer, and that to adriamycin (ADM) was seen in 3 of the 15 patients with urothelial cancer, 2 of the 10 patients with renal cancer and 1 patient with testicular cancer. For comparison, the ratio of IC90 to the peak plasma concentration of the drug tested was used as the "in vivo-in vitro therapeutic index (TI)". According to TI, susceptibility to VBL was seen in 3 of the 7 patients with renal cancer, and that to CDDP was seen in 2 of the 12 patients with urothelial cancer, and 1 of the 2 patients with renal cancer. Susceptibility to ADM was seen in 3 of the 15 patients with urothelial cancer, and 1 of the 6 patients with renal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemosensitivity tests to anticancer agents using human tumor clonogenic assay (HTCA), novel dye exclusion method (NDE assay), sub-renal capsule assay (SRCA), and chick embryo method (CE method) were utilized to measure the sensitivity of urological malignancies. Surgical tumor specimens from 67 patients with urological malignancies were subjected to HTCA developed by Hamburger and Salmon. An appreciable growth of colonies was obtained in 20 out of 33 renal cancers, 20 out of 30 urothelial cancers and 1 out of 4 testicular tumors examined and colonial growth adequate for chemosensitivity was obtained in 30 of the 67 patients. More than 70% decrease in the plating efficiency after anticancer drug exposure according to Von Hoff's definition, or more than 1.0 value of the "in vivo -in vitro therapeutic index" in terms of the ratio of IC90 to the peak plasma concentration of the drug tested was defined as susceptible. According to Von Hoff's definition, susceptibility to vinblastine (VBL) and cis-dichlorodiammine platinum (CDDP), was seen in 4 out of 11 patients with renal cancer, in 4 out of 15 patients with urothelial cancer and 1 out of 4 patients with renal cancer, respectively. With adriamycin (ADM) it was seen in 3 out of the 15 patients with urothelial cancer, 2 out of 10 patients with renal cancer and 1 patient with testicular tumor. According to TI, susceptibility to VBL was seen in 3 out of 7 patients with renal cancer, and with CDDP it was seen in 2 out of 12 patients with urothelial cancer, and 1 out of 2 patients with renal cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.

A soft agar colony formation assay, so called human tumor clonogenic assay (HTC assay) similar to that originally described by Salmon and colleagues, was utilized to measure the sensitivity of a total of 85 urologic malignancies including 36 urothelial cell carcinomas, 41 renal cell carcinomas, 5 testicular tumors, and 3 Wilms' tumors to anticancer drugs. In addition, the results obtained were compared with those of a novel dye exclusion method (NDE assay) described by Weisenthal and colleagues. The NDE assay was utilized to measure the sensitivity of a total of 63 urologic malignancies including 28 urothelial cell carcinomas, 25 renal cell carcinomas, 6 testicular tumors, and 4 Wilms' tumors to anticancer agents. In both assay series, the concentration of anticancer drugs tested was approximately one tenth of the maximum serum level achievable after single bolus injection. The colony forming rate inhibition of 70% or more in the HTC assay and the cell survival rate of 30% or less in the NDE assay were defined as "sensitive." Sixteen of the 36 urothelial cell carcinomas, 11 of the 41 renal cell carcinomas, and 1 of the 5 testicular tumors had both more than 30 colonies grown in control plates and enough cells in the specimens to provide at least one drug sensitivity testing. In urothelial cell carcinomas, 3 out of 13 tumors were "sensitive" to adriamycin, 3 out of 16 to cis-platinum, and 4 out of 15 to carboquone. In renal cell carcinomas, 2 out of 9 tumors were "sensitive" to adriamycin, 4 out of 11 to vinblastine, and none of 4 to Interferon alpha.(ABSTRACT TRUNCATED AT 250 WORDS)

Photodynamic therapy (PDT), using hematoporphyrin derivative (HPD) and the red light (wavelength 630 nm) of an argon-dye laser as the source of excitation energy was performed on 46 patients with superficial bladder tumors. Two methods of laser irradiation, (1) focal PDT using a 400 micron quartz fiber through a cystourethroscope in 22 patients with superficial bladder tumors and (2) whole bladder wall total PDT using a motor-driven laser light scattering device in 24 patients with multifocal carcinoma in situ and/or dysplasia of bladder mucosa associated with multicentric concurrent superficial tumors, were used. The patients in (2) had been referred for total cystectomy, and 19 of these 24 patients had a history of several transurethral resections, hyperthermia and/or instillation therapy. HPD 2-4 mg/kg was i.v. injected 48 to 72 hours before PDT. Judging from the results of 60 protrusions treated by focal PDT, the light power should be 200 mW/cm2 for 5-10 minutes or more and the total light energy should be 100 J/cm2 or more in tumors up to 2 cm in size. With focal PDT, 4 of the 22 patients had no recurrence with the mean tumor free time of 20.8 months. In 6 of the 24 patients treated with total PDT using 10, 20 or 30 J/cm2 of light energy, there was no recurrence with a mean tumor-free time of 7.5 months and there was no significant relationship between the recurrence rate and total light energy used.