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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).

The effect of local administration of thrombin via a newly devised four-way balloon indwelling catheter was investigated on 89 patients who underwent transurethral resection of the prostate (TURP). The catheter was introduced into the bladder immediately after TURP, the balloon was inflated with sterile water and mild moist sponge traction was applied to seal the bladder neck for 15 minutes. At the same time, the thrombin solution, 5, 000 U in 5 ml of saline, was then injected into the prostatic fossa via the newly added infusion channel to promote early hemostasis. The results were compared with those of 36 randomized control patients, who were treated with the conventional three-way balloon catheter of the same size. The results obtained with this new device were favorable, showing significantly less postoperative hemorrhage in the thrombin infusion group than in the control group. In 7 of 89 thrombin infused patients, serum FDP revealed mild elevation for 2 hours after TURP. In 2 of these 7 patients FDP was closely correlated with thrombin infusion. However, no adverse reactions were observed in any patient in the thrombin infusion group. In conclusion, our new device to administer locally the thrombin solution is effective and safe for management of bleeding after TURP.

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)

排尿後尿洩れを訴える16例につき, ビデオ録画システムを用いた排尿時尿道膀胱造影を施行し, 経時的な尿道膀胱の動態を観察した.排尿後洩れの原因は, 排尿終了後に生ずる球部尿道内残尿が座位や体の前屈などで圧迫され, 外尿道口から洩れるためである.治療は排尿終了後, 患者自身が会陰部を手指で圧迫し, 球部尿道内残尿を排出することである, Sixteen patients presenting with a symptom of postmicturition dribble were studied. All the patients were examined by the technique of voiding cysto-urethrography recording on video-tape. The findings of the videocysto -urethrography confirmed that postmicturition dribble resulted from a residue of urine in the bulbar urethra. No urodynamic abnormality was seen in the six patients who had no other symptom or disease. The patient is instructed to compress the bulbar urethra manually in the perineum after micturition and evacuate the bulbar residual urine. Symptomatic relief is usually obtained.

The uroflowmetry of a total of 533 males over 50 years old, who had undergone a mass examination of the prostate in Tanno Town, Hokkaido Prefecture in 1982, and 1985, was studied. These subjects were divided into 4 groups, i.e., those 50 to 69 years old and those over 70 years old and those with and without prostatic hypertrophy by rectal palpation, the relationship between voided volume and flow rate was examined. Subjects without prostatic hypertrophy by rectal palpation in the older group showed markedly lower flow rate rate than the younger group and subjects with prostatic hypertrophy in the younger group had a lower flow rate than the older group. Thus, urinary disturbance in elderly men was supposed to occur due to aging changes such as benign prostatic hypertrophy and bladder neck contracture.

Objectives and methods of the study: Although superficial bladder carcinoma can be surgically eliminated by TUR, recurrence is common. Various attempts have been made to prevent recurrence, but to date an excellent prophylactic method with few adverse reactions has not been established. We conducted a clinical trial study for prophylaxis of bladder carcinoma recurrence, using intravesical instillation of bleomycin, a drug which cause little local irritation, in combination with bestatin, a recently developed immunomodulator. Bleomycin was selected on the bases of experimental results. That is, in beagle dogs, the 1-hour intravesical instillation of bleomycin gained a drug concentration in the bladder wall of 2.08 micrograms/g, which is approximately 4 times higher than that in the intravenous administration of the same dose. The above bleomycin concentration was thought enough to obtain a good clinical effect. A total of 124 patients were randomly divided into the two treatment groups: An only bleomycin intravesical instillation group (60 mg on each treatment day) (58 patients) and a bleomycin with bestatin (60 mg per every day) group (66 patients). In the 2-year follow-up period the recurrence of bladder carcinoma in the two treatment groups was studied. Analysis of non-recurrence rate by life-table method and Kaplan-Meier method: The non-recurrence rate of the bladder carcinoma every three months was calculated by the life-table and Kaplan-Meier methods. The non-recurrence rate in the bleomycin group was approximately the same as the rates in adriamycin or mitomycin reported in the literature. In the bleomycin + bestatin group, the recurrence rates at 9 months and 12 months were significantly (at P = 0.09 and P = 0.08, respectively) lower, and in addition, even the 2-year overall non-recurrence rate curves showed a nearly significant difference (P = 0.179). Especially in the case of papillary pedunculated tumors, the difference in the non-recurrence rate curves was almost statistically significant (P = 0.104). The stratified analysis on the basis of various tumor factors, were as follows. Pathological grade: Although no differences were found in Grades 1 and 2, the bleomycin + bestatin group had a lower recurrence rate in Grade 3 cases (P = 0.1).(ABSTRACT TRUNCATED AT 400 WORDS)

前立腺症(前立腺肥大症および膀胱頸部硬化症)に対するantiandrogen剤oxendoloneとα遮断剤bunazosin hydrochlorideの併用効果を検討するために, それぞれ単独および両剤併用の3群について比較検討した.自覚症状に対する効果, 他覚所見に対する効果およびこれらを総合した総合所見に対する評価ともに併用使用群が最も良好であった, Antiandrogen and alpha-adrenergic blockers have recently been tried in the medical treatment for benign prostatic hypertrophy and bladder neck contracture. We herein report our results of a randomized comparative study on the clinical efficacy of oxendolone, bunazosin hydrochloride (bunazosin) and their combination for the treatment of benign prostatic hypertrophy and bladder neck contracture. The attending doctors evaluated at twelve weeks the improvement rate for three treatment regimens, 400 mg/day oxendolone, 3 mg/day bunazosin and a combination of both. Oxendolone + bunazosin showed the highest improvement rate in the evaluation of each subjective symptom and objective finding and of both. Oxendolone + bunazosin tended to show a better clinical efficacy than the other of these regimens, when the improvement was defined as that with more than one degree in the severity of retarded voiding, prolonged voiding, urinary stream condition, abdominal pressure on voiding and residual urine sensation. The improvement of such subjective symptoms seemed to occur earlier with oxendolone + bunazosin or bunazosin than with oxendolone. A significant difference was shown among the three treatment regimens in the general improvement rate on four subjective symptoms, with oxendolone + bunazosin being the highest followed by bunazosin and oxendolone in this order. The improvement rates of maximum and mean flow rate which are most important parameters to evaluate the voiding condition, at twelve weeks were significantly higher with oxendolone + bunazosin. No serious side effects were observed in this study, although treatment regimens containing bunazosin caused some minor side effects. These side effects could be prevented by the use of initial low doses of bunazosin with a subsequent gradual increment up to 3 mg/day. Taking the differences in the mechanism of oxendolone and bunazosin and the results of our study into consideration, we believe that the combination of oxendolone and bunazosin would be more useful in a clinical situation.

男子尿道狭窄80例に対して直視下内尿道切開術を施行した.1)3ヵ月から5年間経過観察し, 非再発率は43.2%であった.2)再発の時期は50%が3ヵ月以内に, 80%が1年以内であった.3)数回の手術により再発率が著しく低下した.4)外傷性尿道狭窄が炎症性尿道狭窄に比して有意に再発しやすかった.5)カテーテル留置期間に関しては4日留置例の再発が少なかった.6)狭窄の部位, 長さ, 径, 数に関する再発率には有意差がなかった, Internal urethrotomies under direct vision for urethral strictures were carried out in 80 male patients during the past 5 years. None of the patients died and morbidity was minimal. The immediate postoperative success rate was 96.3%. A retrospective review of results showed an overall cure rate of 43.2%. In the patients in whom the stricture recurred after the first operation, the recurrence was recognized in 50% during the first three months and in 80% during the first year. Repeated operations resulted in a significantly higher cure rate than the initial operation. The results were unrelated to the site, length, width, or the multiplicity of the stricture. However, the recurrence rate was significantly higher for traumatic strictures than inflammatory ones. The recurrence rate was lowest when the catheter was indwelling for 4 days.

We conducted a second mass screening for prostatism on males 50 years of age and older in the Tanno town area, to determine the incidence of benign prostatic hypertrophy (BPH) and prostatic carcinoma. We also studied how often elderly males had symptoms related to prostatism according to their age. The incidence of BPH was 10.0% in these males who were received the first and/or second mass screening as well as those treated previously, when BPH was defined as the prostate with a moderately or greater enlarged size upon digital palpation. The incidence of BPH was 8.9% in males fifty years of age and older who lived in Tanno town. The figures tended to elevate with the advance of age. Two new patients with prostatic carcinoma were discovered during this second mass screening, which resulted in a total of 8 patients discovered in this area. Of these 8 patients, 6 had been found in the first screening. The incidence of prostatic carcinoma was 1.4% in those males who received the first or second mass screening as well as those treated previously, and that in all the males who lived in the town was 1.0%. Further efforts will be necessary to establish a more convenient system that can provide less costly screening procedures and more effective diagnostic procedures to detect localized prostatic carcinoma. With advance in age the male tended to have a higher incidence of prostate with a moderately or markedly enlarged size, and symptoms related to prostatism. In addition, the urinary flow rate tended to decrease, irrespective of the prostate size. The results supported the significance of mass screening for prostatism.

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)

ヒト前立腺の組織条片はアルファ交感神経刺戟薬によって収縮した.ベータ-交感神経薬, 副交感神経薬, プロスタグランディン, PGEおよびPGF2α, アンジオテンシン2では収縮も弛緩反応も示さなかった.このノルアドレナリン誘発性収縮は, アルファ交感神経遮断薬によって抑制された.通電法による電気刺戟は, この前立腺組織条片を収縮させた.この電気刺戟により誘発された収縮は, フェノキシベンザミンで抑制拮抗されたが, ヨヒンビンでは抑制拮抗されなかった.ヒト前立腺組織では, アルファ-1受容体の存在が優位である, Strips of human prostate showed a contractile response to alpha-adrenergic agonists There was no response to beta-adrenergic and cholinergic agents, prostaglandins, PGE 1 and PGF 2 α or angiotensin II. The noradrenaline-induced contraction was inhibited by an alpha-adrenolytic agent. Electrial field stimulation elicited contraction of the prostatic specimens. This stimulation-induced contraction was antagonized by phenoxybenzamine, but not by yohimbine. These results indicate that alpha-I-adrenergic receptors are Preferentially present in the human prostatic tissue.

睾丸腫瘍の発生における母親の要因を明らかにするために, 37人の睾丸腫瘍患者に対してmatched pair方式の患者対照研究を行った.単変量解析の結果, 統計学的には有意ではなかったが睾丸腫瘍患者群は対照群に比べて以下の特徴がみられた.本人を妊娠する前の母親の肥満度が低かった.本人を出産した時の母親の年齢が高かった.本人に対する母親授乳期間が長かった.本人の出生順位が下位であった.母親の出産回数が少なかった.そして, 以上の6つの要因をすべて含めた多変量解析を行ったところ, 睾丸腫瘍患者の母親は対照群の母親に比べて出産回数が有意に少ないという結果を得た(p=0.02).その他の5つの要因には有意差がみられなかった.母親の内因性ホルモン環境が睾丸腫瘍の発生に関与してい可能性が示唆される, A study on the possible association of maternal factors with testicular cancer was undertaken. Information was obtained from the mothers of testicular cancer cases (N = 37) and the mothers of men without the disease (N = 37). Comparisons were made between the two groups. The cases were collected from the records of nine hospitals, and the controls were selected from five Public Health Centers by individually matching the sex and the year of birth with the testicular cancer cases. The mothers of the cases had significantly fewer live births than the mothers of the controls (the adjusted odds ratio per live birth = 0.4, p = 0.02), when the five following variables had been simultaneously adjusted by the logistic regression analysis. Those five variables included the Quetelet's Index of mothers before pregnancy, the age at an index birth, the duration of breastfeeding for an index child, the birth order of an index child, and the number of induced abortions. The endogenous hormonal milieu of a mother may be associated with the occurrence of testicular cancer in her child.; PIP: A study on the possible association of maternal factors with testicular cancer was undertaken. Comparisons were made among 2 group of women: those mothers of testicular cancer cases (n=37) and those mothers of men without the disease (n=37). Cases were collected from the records of 9 hospitals, and controls were selected from 5 public health centers by individually matching the sex and year of birth with the testicular cancer cases. Mothers of the cases had significantly fewer livebirths than those mothers of the control group (the adjusted odds ratio per livebirths=0.4, p=0.02) when the 5 following variables were simultaneously adjusted by the logistic regression analysis: Quetelet's Index of mothers before pregnancy, age at index birth, duration of breastfeeding for an index child, birth order of an index child, and number of induced abortions. The endogenous hormonal milieu of a mother may also be associated with the occurrence of testicular cancer in her child. (author's modified)

α1遮断剤の1つである塩酸モキシシリト(90 mg/日, 4週間)を前立腺肥大症患者22例に投与した.1)自覚症状では, 残尿感(53%)遷延性排尿(74%), ぜん延性排尿(63%), 尿線の状態(67%), 腹圧排尿(58%)に改善を認めた.2)副作用は4例に認められ, そのうち, めまいを呈した1症例で投与を中止した.血圧低下はほとんど認められなかった.3)全般改善度に概括安全度を加味した本剤の有用度は, 有用以上41%, やや有用以上77%であった, The clinical effectiveness of moxisylyte hydrochloride (Moxyl, Fuji Rebio), a selective alpha 1-adrenoceptor blocking agent, was investigated in patients with symptomatic benign prostatic hyperplasia. Moxisylyte hydrochloride was administered at the dose of 90 mg per day orally for four weeks. Residual urine sensation was improved in 9 out of 17 cases (53%), retarded urination in 14 out of 19 (74%), prolonged urination in 12 out of 19 (63%), weak stream in 14 out of 21 (67%) and strained voiding in 11 out of 19 cases (58%). Residual urine volume and residual urine ratio were decreased in 14 out of 21 cases (67%), maximum urine flow rate was increased in 14 out of 21 (67%) and mean flow rate was increased in 15 out of 21 cases (71%). There was, however, no statistical significance between pre- and post drug administration in objective parameters. Our open trial showed that the subjective efficacy of moxisylyte hydrochloride was 82% (18/22 cases), the objective one was 59% (13/22 cases) and overall efficacy was 77%. Side effects were observed in four of all subjects (18.2%), and drug administration had to be ceased in only one of these patients due to mild dizziness. Other side effects were mild nausea, headache and chest discomfort. Decrease in blood pressure was not seen in all but one case.

慢性前立腺炎74例に対しnorfloxacin (NFLX) 600 mg/日を原則として4週間投与し検討した.総合臨床効果を前立腺分泌液(EPS)中細菌, 白血球, 自覚症状の3つの要因で判定してみると, グラム陰性桿菌(GNR)群の総合有効率は2週目71.4%, 4週目100%, グラム陽性球菌(GPC)群のそれはそれぞれ79.3%, 88.0%と良好であった.治療前のEPS分離細菌数103CFU/ml未満であった症例の総合臨床効果をEPS中白血球, 自覚症状の2つの要因で判定してみると, その総合有効率は2週目89, The clinical efficacy of norfloxacin (NFLX) was evaluated in 74 patients having chronic prostatitis with the subjective symptoms suggesting the inflammations of prostate and more than five white bloodcells (WBCs)/hpf in their prostatic secretions (EPS). Of these, gram negative rods with greater than or equal to 10(3)CFU/ml (GNR group) were isolated from the EPS in 10 patients (13.6%) and gram positive cocci with greater than or equal to 10(3) CFU/ml (GPC group) were obtained in 46 patients (62.2%). E. coli (70.0%) was the most frequent strain isolated among GNR group and S. epidermidis (40.4%), S. aureus (19.1%), E. faecalis (17.0%) and S. haemolyticus (14.9%) were frequently isolated among the GPC group. The overall clinical efficacy of NFLX was determined at the second and fourth week by the three factors, (1) the effect on bacteria, (2) WBCs in the EPS and (3) the subjective symptoms in the patients with bacteria of greater than or equal to 10(3) CFU/ml being isolated. The overall clinical effectiveness rate was 71.4% and 100%, respectively, in the GNR group. In the GPC group, its rate was 79.3% and 88.0%, respectively. The patients with no bacteria or less than 10(3) CFU/ml isolated from the EPS had an overall clinical effectiveness rate of 89.8% at the second week and 90.0% at the fourth, when it was evaluated by the effect on WBCs and subjective symptoms. In the effect of NFLX on bacteria in the EPS, it eliminated them in 75.0% and 83.9% at the second and fourth week, respectively, of all patients with GNR or GPC of greater than or equal to 10(3) CFU/ml isolated from the EPS. The minimum inhibitory concentrations (MIC) of NFLX against E. coli isolated from the EPS was distributed from 0.025 microgram/ml to 3.13 micrograms/ml with most below 0.1 microgram/ml. Those against all other GNR were below 0.78 microgram/ml. NFLX showed good antimicrobial activities against GPC with most of MIC being distributed from 0.78 microgram/ml to 1.56 micrograms/ml. NFLX produced the highest eradication rate in bacteriological response not only against GNR such as 100% at the first, the second and fourth week but GPC as 89.2%, 93.8% and 96.0%, respectively. In the effect of NFLX on WBCs in EPS, 40-50% of patients got free from the inflammation of prostate by NFLX treatment. This became prominent in the GNR group as the treatment was continued although not in the GPC group. The subjective symptoms were improved by NFLX treatment in most of the patients.