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比較的若年の再燃性前立腺癌26例(年齢中央値67歳)に対して, cyclophosphamide(CPM), uracil+tegafur合剤(UFT), estramustine phosphate(EMP)併用療法を行った.PSAが50%以上下降したのは16例で, EMPを前治療とした7例では5例が下降した.骨シンチグラムで改善を示したのは16例中1例で, リンパ節転移3例では2例に部分緩解を認めた.骨痛の17例中5例は消失或いは改善した.骨転移, 貧血合併の37例(年齢中央値74歳)にはdexamethasone(DEX)単独投与を行い, PSA50%以上下降は23例, 骨シンチ改善は21例中4例で, リンパ節転移5例中1例がPRとなった.骨痛18例中11例は消失又は改善し, 血中Hb値は32例中10例で上昇した.他の再燃性前立腺癌44例(年齢中央値69歳)にはDEX, CPM, UFT併用を行い, 前治療はEMP投与19例, DEX単独3例であった.PSA50%以上下降は28例, 骨シンチ改善は30例中1例で, リンパ節転移7例中1例がPRとなった.骨痛は16例中9例が改善した, To our knowledge, no standard chemotherapy for patients with hormone-refractory prostate cancer (HRPC) has been established. Since most patients with HRPC are elderly and have bone metastasis, cytotoxic chemotherapy causes them to be at high risk for myelosuppression. Therefore, chemotherapeutic agents with low toxicity and good compliance should be elected. We conducted three regimens for HRPC on an outpatient basis. Eligibility criteria were defined as serial rising PSA values on 3 or more occasions at least 2 weeks apart or radiological new or extensive lesions under hormonal therapy. The first regimen is comprised of cyclophosphamide (CPM), 100 mg/day, UFT, 400 mg/day, and estramustine phosphate (EMP), 560 mg/day in two daily fractions. The second regimen is comprised of an oral administration of dexamethasone (DEX) (0.5-2 mg/day). The third regimen is comprised of DEX, 1 mg/day, cyclophosphamide, 100 mg/day and UFT, 400 mg/day in two daily fractions. Post-therapy prostate-specific antigen (PSA) level in serum, objective response on bone scan or measurable disease, and symptomatic response on bone pain were assessed. All regimens showed clinical efficacy with mild toxicity. Indications and limitations of these regimens are discussed. Further, the combination trials of taxane and EMP in patients with HRPC are reviewed.

53歳女.膀胱炎の診断で加療していたが尿閉となった.尿閉の原因が不明で, 抗生剤や臭化ジオスチグミンを投与しても改善しなかった.MRI, 経腟的超音波検査により尿道腫瘍が疑われ精査加療目的で入院した.腫瘍の針生検を施行し, 病理組織学的に腺癌と診断した.内視鏡検査等により尿道原発の腺癌と診断し, 内腸骨リンパ節, 閉鎖リンパ節郭清及び腟前壁切除を伴う膀胱尿道全摘除術及び回腸導管造設術を施行した.病理組織学的診断は高度から中等度に分化したcolumnar typeの腺癌であった.術後経過は良好であったが, 術前からの不安精神病が悪化した為, 化学療法や放射線療法は行わずに退院した.その後, 肺転移を認めテガフールウラシル投与で経過観察を行った.転移巣は徐々に増悪を示しているが現在は生存中ある, A 53-year-old female visited our hospital with a complaint of acute urinary retention. Transvaginal ultrasonography, computed tomography and magnetic resonance imaging showed extreme thickening of the urethral wall. Histopathological examination of the transvaginal needle biopsy suggested well-differentiated adenocarcinoma. She underwent total cysto-urethrectomy with partial vaginal wall resection and ileal conduit urinary diversion. Pathological diagnosis of the tumor was columnar adenocarcinoma invading into the vaginal wall and periurethral connective tissue. Fifty-eight cases of primary adenocarcinoma of the female urethra in the Japanease literature are briefly reviewed.

超音波検査の最大の利点は非侵襲性にあり, 超音波ウロダイナミクスは, 非侵襲的に多くの情報を提供し, その結果, 診断効率のさらなる向上に寄与するものである.超音波ウロダイナミクスの代表的な検査について解説した, Recent developments of ultrasound imaging have contributed much to the understanding of urodynamics in patients with lower urinary tract symptoms (LUTS). These include ultrasound estimated bladder weight (UEBW), transrectal power Doppler imaging of the prostate and transrectal ultrasonography during voiding (voiding TRUS). UEBW, which is obtained by measuring the thickness of the anterior bladder wall using a 7.5 MHz probe, represents well the degree of bladder hypertrophy caused by obstruction. This parameter is, accordingly, of clinical use in the evaluation of obstruction. The UEBW predicted the presence of obstruction as determined by pressure-flow study with a diagnostic accuracy of 73%. Transrectal power Doppler imaging of the prostate has made it easy to detect prostatic vessels and furthermore to obtain their resistive index (RI). Accumulating data suggest strongly that RI reflects the intraprostatic pressure. More interestingly, RI decreases significantly during voiding in normal subjects but not in patients with benign prostatic hyperplasia. Thus, this method is of particular use in monitoring noninvasively the dynamic change in intraprostatic pressure during voiding. Voiding TRUS makes it possible to monitor the movement of not only the posterior urethra but also the prostate during voiding. Based on our recent study, the anterior fibromuscular stroma (AFMS) seems to contract to open the urethra. Although the physiological function of the AFMS in the prostate remains unknown, AFMS may play a significant role in normal micturition. Due to its noninvasiveness and ease of application, ultrasound imaging would play a vital role in the diagnostic process for patients with LUTS in future.

ラジオ波焼灼術による小さな腎癌に対する焼灼術の術式と手術成績を報告した.対象は7例で, 根治的治療が困難であった理由は, 重複癌4例, 腎不全2例, 呼吸機能障害1例, 血液疾患1例であった.病理組織学的には全例, 腎細胞癌であった.施行回数は1回あたり1～2サイクルの焼灼を行い, 4例は1回で終了し, 3例は術後のCT, MRIで造影効果を認める部分が残存し, 2回の焼灼術を施行した.最近の評価では, 6例がCR, 1例がPRであった.術後合併症として, 1例に血尿を認めたが, 尿漏, 尿管狭窄は認めなかった.術前後の腎機能の変化では, クレアチニンは0.2以下の変動で, レノグラムも変化を認めなかった.鎮痛剤は特に使用せず, 経摂取も6時間内内に可能であった.観察期間は3～24ヵ月で, PRであった1例に局所再発と肺転移を認めた, We report the efficacy of radio-frequency ablation (RFA) for T1a renal cell carcinoma (RCC). RFA was performed under epidural or local anesthesia by ultrasound or computed tomography (CT) guidance in seven patients with Tla RCC, who were at significant operative or anesthetic risk for invasive surgery. At a median follow-up of 17.5 months, 6 (86%) of the seven patients showed no tumor enhancement in follow-up CT scans or magnetic resonance images. Temporary macroscopic hematuria was observed in one case. RFA is an effective and safe minimally invasive therapeutic option for selected patients with RCC who have reason to avoid invasive surgery under general anesthesia.

Endoscopic adrenalectomy by a retroperitoneal approach through the skin incision less than 5 cm has been performed in 6 patients (3 males and 3 females; 4 right and 2 left side) with primary aldosteronism from December 1992 to June 1993. The treatment was successful in all the cases. As for complications, pneumothorax occurred in one case. The required operation time was from 120 to 330 min (mean: 196 min) and the blood loss was from 20 to 279 ml (mean: 94 ml), which were similar to those in open adrenalectomy. The retroperitoneal approach was thought to be more advantageous than widely adopted laparoscopic adrenalectomy in the following points: (1) No complications such as pulmonary embolism or pneumomediastinum. (2) No injuries to the intraabdominal organs. (3) Two operators using one video system is sufficient.

67歳男.1995年より前立腺癌を放射線外照射にて加療し, 2000年に突然肉眼的血尿が出現し下腹部痛とテネスムスが強く筋性防御を認め, 膀胱破裂が疑われた.膀胱造影では破裂部位は明らかでなく, 骨盤部CTにおいて膀胱前腔に空気と造影剤の漏出が観察され, 膀胱の腹腔外破裂と診断した.下腹部CTで後腹膜腔に沿って上方に連続する気腫を認めた.胸部レントゲン検査, 胸部CTで縦隔気腫を認めた.開腹し膀胱前壁の裂孔を縫合し, 術後血尿や腹膜刺激症状は速やかに消失した.発症より1年6ヵ月の現在経過観察中である.男性の前立腺癌に対する放射線治療後の膀胱自然破裂は本症例が1例目であった, A 67-year-old male admitted to our hospital with a complaint of gross hematuria and lower abdominal pain. He was being followed up at our hospital for prostate cancer with multiple bone metastases. He was diagnosed with spontaneous rupture of the urinary bladder by abdominal computed tomography. Chest X-ray and chest computed tomography also showed pneumomediastinum. An urgent operation revealed a rupture of the urinary bladder 3 cm in length. We briefly reviewed 122 cases of spontaneous rupture of the urinary bladder reported in the Japanese literature.

1985～1989年の間のRPP(恥骨後前立腺摘除術)163例とTURP(経尿道的前立腺摘除術)30例で検討した.術後の尿失禁発生率はRPPで17.2%, TURPで33.3%であった.術後の失禁は1週間以内に半数で消失したが, RPPの4.9%及びTURPの3.3%では1ヵ月以上持続した.術前の膀胱内圧測定結果の解析上, 最大尿意容量は切迫性尿失禁の症例では失禁がない症例に比し有意に小さかった.最大尿意容量に対する初発尿意容量の比率(尿意切迫度と呼称)は, 切迫性尿失禁の症例では尿失禁のない症例に比し有意に高かった.尿意切迫度が70%上り高値であれば, 有意に術後の尿失禁発生率が高いことが明らかとなった, Postprostatectomy incontinence was evaluated in 193 patients, who underwent retropubic prostatectomy (RPP) or transurethral resection of the prostate (TURP) during the past 5 years from 1985 to 1989 at the Kyoto Prefectural University of Medicine. The occurrence rate of postprostatectomy incontinence was 17.2% in the patients who had undergone RPP and 33.3% of those who had undergone TURP. Although postprostatectomy incontinence disappeared within one week in half of the patients, postprostatectomy incontinence remained for more than one month in 4.9% of the patients who had undergone RPP and 3.3% of those who had undergone TURP. The incidence of postprostatectomy incontinence tended to be high in the patients of advanced ages. Postprostatectomy incontinence recognized in this series was classified into stress incontinence and urgency incontinence groups. An analysis of the results of cystometry performed before the operation showed that the volume of maximum desire of voiding in the urgency incontinence group was smaller than that in the group without postprostatectomy incontinence. Furthermore, supposing the urgency degree as a new parameter, which is defined as a ratio of first desire of voiding to maximum desire of voiding, the urgency degree of the urgency incontinence group was higher than that of the group without postprostatectomy incontinence. Patients with an urgency degree higher than 70% were found to have a high probability of urgency incontinence. These findings suggested that advanced age was the risk factor of postprostatectomy incontinence and that a small bladder capacity and high urgency degree were the high risk factors of postprostatectomy urgency incontinence.

A 28-year-old female complained of minimal fever elevation. Computed tomography (CT) revealed a left renal tumor of 10 cm in diameter. Ultrasonogram and CT, magnetic resonance imaging and angiography suggested a renal angiomyolipoma (AML) with marked extrarenal development. Partial nephrectomy was performed using a microwave tissue coagulater without clamping of the renal artery. The tumor weight was 800 g and the pathological diagnosis was AML. The management of large AML is reviewed in the literature. Nephron sparing surgery should be performed even in patients who have a larger tumor with extrarenal development.