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We report a patient with retroperitoneal myxoid liposarcoma recurrence who achieved remarkable improvements in performance status (PS) and maintained stable disease for approximately 5 months when treated with combination chemotherapy with gemcitabine (GEM) and docetaxel combination chemotherapy (GD). A 51-year-old woman was referred to our hospital with the chief complaint of a palpable mass in the left side of the abdomen. A retroperitoneal liposarcoma was diagnosed on the basis of magnetic resonance imaging and computed tomography results, and tumor resection was performed. The histopathological evaluation showed myxoid liposarcoma, which was classified as grade 2 according to the French Federation of Cancer Centers Sarcoma Group (FNCLCC) system.Two months later, the tumor regionally recurred as peritoneal dissemination with rapid growth. Five months after the surgery, the growing tumor caused appetite loss and pleural effusion in the left lung. GD was administered (800 mg/m2 GEM on days 1 and 8, and 60 mg/m2 docetaxel on day 8) and 4 cycles were administered.The resulting decrease in abdominal girth and in the amount of pleural effusion allowed the patient to regain her appetite, and the patient's PS greatly improved from 3 to 1.Initially, GD was shown to be effective for the treatment of leiomyosarcoma and pleomorphic sarcoma, and it is now recommended as one of the first-line regimens in the National Comprehensive Cancer Network guidelines for soft tissue sarcoma treatment. The patient in this case showed remarkable improvement in PS after tumor recurrence and maintained stable disease for some time, without severe adverse effects.

A 69-year-old man had undergone left ureteronephrectomy because of a left renal pelvic tumor, however the pathological diagnosis was inflammatory pseudotumor. About 1 year later, computed tomography showed a mass at the right kidney near the hilar. Ureterorenoscopy and urine cytology were performed, and their results showed no evidence of malignancy. He had been followed closely without therapy. The mass increased in size during follow-up, and we reviewed the surgical specimen of the left ureteronephrectomy. Immunohistochemical studies revealed diffuse infiltration by IgG4 positive plasma cell. His serum IgG4 was high. We diagnosed him as IgG4-related kidney disease. In response to treatment with corticosteroid, the size of the tumor and serum IgG4 levels decreased. Most reported cases of IgG4-related disease involving kidney have a history of prior pancreatic involvement. We report a rare long term follow-up case of IgG4-related kidney disease without pancreatic involvement.

The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) is the standard questionnaire that determines the degree of symptoms and efficacy of treatment in patients with chronic prostatitis/chronic pelvic pain syndrome. Because there was no officially approved Japanese version of the NIH-CPSI, the Japanese Urological Association (JUA) formed a committee to develop one chaired by Dr. Masayuki Takeda, who also chairs the special field of voiding function and neurourology in the JUA. Consequently, the committee produced a Japanese version, referring to previous proposals and the Japanese version of the International Prostate Symptom Score. The committee strongly expects that the Japanese version of the NIH-CPSI will be taken full advantage of in future clinical research.

Ductal adenocarcinoma of the prostate is a rare subtype of prostatic adenocarcinoma, defined by morphological criteria as one that has papillary or cribriform architecture composed of high columnar cells with pseudostratified nuclei. We clinically evaluated 7 cases of ductal adenocarcinoma of the prostate in our hospital. The median age was 69 years old and median initial serum PSA level was 22.8 ng/ml. Two cases presented with dysuria, two with macrohematuria and one with abnormality on chest radiograph. Five cases were diagnosed on prostate biopsy, one on TUR-P and one on radical prostatectomy. Two had pure ductal adenocarcinoma and five had mixed ductal adenocarcinoma. Four had metastatic disease, and were treated by hormonal therapy. Among three with non-metastatic disease, two underwent radical prostatectomy with adjuvant radiotherapy and one underwent external beam radiotherapy with hormonal therapy. Three cases with non-metastatic disease have no biochemical recurrence. Among four with metastatic disease, one underwent chemotherapy of Docetaxel and one had found a new lesion in lung.

We performed 82 cases of small incision radical prostatectomy from July, 2003 to September, 2009. There were 38 cases of cT1c, 41 cases of cT2, and 3 cases of cT3. Mean operative time was 222 +/- 31.7 (min.). Mean operative blood loss was 1,232 +/- 583 (ml). We evaluated factors predicting operative blood loss, such as prostate volume, body mass index (BMI), age, and preoperative PSA level. Group with smaller prostate volume and group with lower BMI showed significantly less blood loss compared to that of a higher group (p = 0.0009, p = 0.0014, respectively). Multivariate analysis showed that prostate volume and BMI were significant predictors for operative blood loss (p = 0.0005, p = 0.0122, respectively). Prostate volume and BMI may be a useful predictor for operative blood loss.

PURPOSE: To examine clinical features of the patients of interstitial cystitis (IC) undergoing hydrodistension at our institution. MATERIALS AND METHODS: We retrospectively evaluated 52 IC patients who underwent hydrodistension between July 2002 and December 2004. Transurethral coagulation (TUC) of Hunner's ulcer (HU) was subsequently performed for patients with HU (ulcer type). Descriptive statistics of the patients' characteristics and outcomes were provided and compared between ulcer type and nonulcer type IC patients. RESULTS: Of the 52 patients, 44 (85%) were female and 8 were male. Mean symptom duration at diagnosis was 59 months (range 2 to 388). Mean patient age was 55 years (range 24 to 78). Of them, 92% reported urinary frequency, 54% bladder or lower abdominal pain and 40% voiding difficulty. The daily voiding frequency was 19 times (range 8 to 52) and mean bladder capacity by voiding log was 100 ml (range 33 to 260). The mean of bladder capacity at hydrodistension was 580 ml (range 220 to 880). All the patients showed glomerulations during hydrodistension and 75% of them experienced amelioration of their symptoms after hydrodistension. Symptom relief lasted for 1 year for two thirds of the patients. Mean observation period was 15 months (range 2 to 30 months). Of 52 patients, 19 (37%) were ulcer type, who were significantly older at diagnosis (60 yrs vs. 52 yrs), had smaller maximum bladder capacity of voiding log (140 ml vs. 230 ml) and bladder capacity at hydrodistension (500 ml vs. 620 ml). However, ulcer type IC patients responded significantly better to hydrodistension (95%vs. 64%). CONCLUSIONS: IC patients suffered from severe symptoms for a long time without correct diagnosis or proper treatments. Hydrodistension was effective for IC patients, especially for ulcer type, combined with TUC.

We retrospectively assessed the surgical outcomes of nephron-sparing surgery (NSS) for patients with renal tumors.From 1985 to March 2001, a total of 99 NSSs were performed on 94 patients with renal tumors. The patients were divided into three groups. Group I comprised of 22 patients who underwent imperative surgeries for renal cell carcinoma (RCC). The tumors were found in 18 patients bilaterally (including 8 patients with von Hippel-Lindau disease), in 3 with solitary kidney, and in 1 with chronic renal failure. The mean +/- standard deviation of patient age and tumor diameter was 46 +/- 23 years and 36 +/- 23 mm, respectively. Twenty-three in situ NSSs were performed on 18 patients in Group I, and the remaining 4 patients were treated with 3 simultaneous operations for bilateral renal tumors with or without 2 ex vivo surgeries. Group II consisted of 49 patients who had small RCCs with the normal contralateral kidney and underwent NSSs (elective indication). The mean age and tumor diameter was 54 +/- 10 years and 28 +/- 11 mm, respectively. Group III consisted of 23 patients with non-RCC tumor (10 angiomyolipomas, 8 cystic tumors, 2 adenomas, 2 metastatic tumors, and 1 degenerative lesion), all of whom were treated with NSS. The mean age and tumor diameter was 47 +/- 14 years and 41 +/- 29 mm, respectively.In Group I, 3 patients died of cancer including 2 patients who had had multiple lung metastases preoperatively. The five-year tumor specific survival rate was 87.3% with a postoperative follow-up of 49 +/- 36 months. In Group II, there were few peri-operative complications or no local recurrence at follow-up of 52 +/- 38 months. A patient developed lung metastasis, which was removed surgically with no evidence of recurrence at 159 months after NSS. Postoperative renal scintigraphy on 35 patients showed well-preserved renal function of the operated kidney. Improvement in surgical techniques resulted in less-invasive surgery in 22 operations during the last 4 years. The patients of Group III were also operated uneventfully, although 1 experienced postoperative bleeding. In 12 patients with solitary kidney (11 in Group I and 1 in Group III) serum creatinine level increased transiently, decreased to 1.3 times of preoperative values within 3 months, and almost recovered at 1-year follow-up.Excellent outcomes in cancer control and preservation of renal function support the validity of nephron-sparing surgery to treat renal tumors. The candidate patients may include those with bilateral kidney tumors, tumor occuring in the solitary kidney or small renal cell carcinomas with the normal contralateral kidney. Earlier detection of small lesions and less invasive surgical techniques will facilitate a wider indication of NSS.

The inhibitory effect of Lactobacillus casei (L. casei) in superficial bladder tumors was investigated in an experimental study using N-butyl-N (4-hydroxybutyl) nitrosamine (BBN)-induced rat bladder cancer as an experimental system. The study consisted of two experiments; in a short-term experiment, the inhibitory effect of 6-week treatment with L. casei was assessed in vitro in terms of the capacity for agglutination by concanavalin A (Con A) of bladder epithelial cells in their incipient stage of malignant transformation induced by 1-week exposure to BBN. As a result, the number of bladder epithelial cell aggregates caused by Con A was significantly smaller in the L. casei-treated group than in the non-L. casei-treated group (p < 0.001). In a long-term experiment, treatment with L. casei of varying duration was investigated for effectiveness against bladder tumors induced by 7-weeks exposure to BBN that arose 22 weeks. The results indicate that both bladder weight and tumor volume per organ were significantly lower in the L. casei-treated than non-L. casei-treated group (p < 0.05). The inhibitory effect on these parameters was more pronounced with treatment with L. casei of longer duration. While there was no significant difference among the treatment groups in the degree of extension of induced malignancy, tumors with a high degree of extension (T1b, T2) developed only in the non-L. casei-treated group. The degree of malignancy of induced tumors was significantly lower in those groups receiving L. casei while BBN was being administered as compared to the non-L. casei-treated group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Of 65 cases of renal pelvic and/or ureteral tumor treated at Department of Urology, The University of Tokyo, during the period from January 1975 through December 1991, 26 had bladder tumors as well. These cases were divided into three groups; 1) bladder tumor preceding upper urinary tract tumor, 2) bladder tumor found simultaneously with upper urinary tract tumor, and 3) bladder tumor following upper urinary tract tumor. In group 1 (nine cases), the last bladder tumor preceded renal pelvic and/or ureteral tumors by 3 to 42 months (mean 14.6 months), and in seven cases, bladder tumor recurred 3 to 29 months (mean 9.0 months) after nephroureterectomy. The interval between the diagnosis of preceding bladder tumor and upper urinary tract tumor was highly correlated with the latent period of postoperative recurrence of bladder tumor (r = 0.948). Highly malignant pathological grade of bladder tumor featured seven cases of group 2, with the survival rate being significantly (p < 0.01) lower than that of other groups. In the group 3 consisting of ten cases, bladder tumors subsequently developed 6 to 37 months (mean 15.0 months). The latent period of bladder tumor was significantly (p < 0.01) longer than that in group 1. These results indicated that the bladder tumors associated with renal pelvic and/or ureteral tumors have distinct characteristics depending on the sequence of association.

A number of new treatment modalities for benign prostatic hyperplasia (BPH) have been introduced in these days: for example, laser ablation, alpha-adrenergic blocker, antiandrogens, hyperthermia, stenting and balloon dilation. The author basically mentioned the personal experiences in some of these modalities, and gave a general review on their effectiveness and safety. Also pointed out were a variety of problems, important but sometimes ignored, in the evaluation of treatments for BPH, including severity grading of BPH, response criteria of effectiveness, method for proper selection of treatment.

The distribution of selective alpha 1-adrenoceptor agonist 1-(2',5'-dimethoxyphenyl)-2-glycinamidoethanol hydrochloride, midodrine, and its active metabolite 1-(2',5'-dimethoxyphenyl)-2-aminoethanol, DMAE, was evaluated on bladder and urethra of 8-weeks and 52-weeks old female rats. Prior to the intravenous injection of 14C-labeled midodrine and DMAE, bilateral ureters were ligated to prevent drug uptake from the urinary tract. In 8-weeks rats, 14C-midodrine activity was significantly (p less than 0.01) higher in the bladder than in the femoral muscle, which served as a control for drug distribution. Similarly, higher uptake of 14C-DMAE was observed in the bladder than in the femoral muscle (p less than 0.01) and the urethra (p less than 0.05). In 52-weeks rats, there was no significant difference of midodrine uptake among these tissues. However, significantly higher uptake of 14C-DMAE was observed in the urethra than in the femoral muscle (p less than 0.05). Compared with midodrine, the concentration of DMAE was significantly increased in the bladder of 8-weeks rat and in the urethra of 52-weeks rats (respectively, p less than 0.05). In autoradiogram, the grains corresponding to midodrine and DMAE were diffusely distributed on the smooth muscles of bladder (mainly bladder neck and trigone) and urethra. The grains were also recognized on the vessels and perivascular areas of these tissues. These findings support that midodrine and DMAE could be effective for stress incontinence, because these drugs are known to bind specifically to alpha 1-adrenoceptor.

It has been known that alpha 1-adrenoceptors play an important role in urethral contraction. The incompetence of the urethral contraction is a cause of stress incontinence. We studied the urodynamic effects of a selective alpha 1-adrenoceptor agonist (midodrine hydrochloride) on the bladder and urethra of female dogs. Under anesthesia with intravenous chloralose, four doses (0.03, 0.1, 0.3 and 1.0 mg/kg) of midodrine were administered intravenously and urodynamic studies including cystometry, urethral pressure profilometry and electromyography (EMG) of the external urethral sphincter were performed. The administration of midodrine induced a significant increase of the maximum closing pressure in the proximal portion of the urethra (p less than 0.05 at 0.03 mg/kg and p less than 0.01 at 0.1, 0.3, 1.0 mg/kg). There were no significant changes in the functional profile length, the closing pressure at the external sphincters, the maximum bladder pressure, bladder capacity and bladder compliance. The administration of 0.3 mg/kg or more of midodrine produced a significant increase in the mean arterial blood pressure. After midodrine administration, transient increases in the external sphincter EMG activities were recognized. The activities showed the synergistic pattern during the bladder contractions. In conclusion, lower dose administration of a selective alpha 1-adrenoceptor agonist (midodrine) specifically produced an increase of the closing pressure in the proximal portion of the urethra without affecting blood pressure. These results suggest that midodrine is useful for the treatment of stress incontinence in humans.

One hundred twenty-four cases of renal cell carcinoma treated at Department of Urology, The University of Tokyo were analyzed for their clinical characteristics and prognosis. To be noted were the recent increase of incidentally detected cases, kidney-sparing technique in curative surgery and adjuvant therapy using biological response modifiers. Prognosis was more favorable in cases with incidental detection, normal ESR or cystic pattern in pathological architecture, whereas that of cases with metastatic lesions or Grade 3 tumors was ominous. Tumor stage as TUMV or Robson stage was useful to predict the prognosis, although one stage contained cases of considerably different survival periods. These results suggested that the efforts to improve prognosis in the present practice should include early detection of renal cancer by promoting health check-up and development of preventive measure of postoperative recurrence. A more proper staging system might also be needed to analyze clinical studies.