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(BACKGROUND). To evaluate urinary symptoms, the International Prostate Symptom Score (I-PSS), which queries about frequency of symptoms, has been recently used in a clinical setting. However, there are men who are not satisfied with their voiding conditions in spite of a low symptom score. In such cases, their dissatisfaction may not be appropriately expressed by querying about frequency of the symptoms alone. We investigated whether the degree or the frequency of the obstructive symptoms correlated with the symptom-related problems. (METHODS). We analyzed obstructive symptoms in 739 males 40 years old and older who participated in a field survey for prostatic diseases. (RESULTS). Although not only frequency but degree of "hesitancy", "intermittency during urination", "strain or pushing" or "weak stream" correlated with the trouble, the correlations were higher in frequency than in degree. However, since some participants felt bothered when they expressed some degree of the symptoms alone but not frequency of the symptoms, evaluation of symptom degree may be helpful to identify such participants. Of the participants who answered "none" for frequency of the symptoms, some reported "having a mild symptom" in degree. This indicated that in recognition of symptoms degree may precede frequency. If the obstructive symptoms are very mild, men may express the symptoms as changes in degree, but not as changes in frequency. (CONCLUSIONS). These results suggested that evaluation of symptom degree is necessary for some participants.

We investigated changes in the voiding condition with aging in 1476 males 50 years and older, who participated in a field survey for prostatic diseases conducted from 1982 to 1991 in Hokkaido. Voiding conditions were evaluated subjectively with a symptom index (weak stream, intermittency, nocturia, urge incontinence), and objectively with maximum flow rate. Digital rectal examination (DRE) revealed 10.3% (572 participants) of total evaluable participants to have moderate or marked enlargement of the prostate. The incidence of enlargement of the prostate apparently increased with aging. Subjective urinary symptoms, both obstructive and irritative, increased in the incidence and degree with aging. The maximum flow rate and maximum flow rate-nomogram also became worse with aging the incidences participants having urinary symptoms or decreased maximum flow rate increased in parallel with the size of the prostate on DRE. For each size of the prostate on DRE, the incidence of participants having urinary symptoms increased with aging. The maximum flow rate showed a similar tendency, decreasing with aging, irrespective of the size of the prostate. These results indicate that aging as well as the size of the prostate may affect the voiding condition in males aged 50 years and older.

Fourty-eight patients with stage D2 prostate cancer, initially treated with endocrine therapy at the University of Tokyo between 1981 and 1990, were followed up and analysed. For the assessment of a subjective response, pain score, narcotic score, and performance stages (PS) were used. Of the fourty-eight patients, twenty-one suffered from cancer pain due to bone metastases. These patients showed significantly (p < 0.01) more lesions of bone metastases and higher PS, compared with patients without cancer pain. The progression free survival of these patients was significantly (p < 0.01) lower than that of patients without cancer pain, although the actuarial survival was not significant. In twenty-one patients with cancer pain, the objective and subjective response rates to endocrine therapy were 75% and 86%, respectively. The duration of pain relief was 1.25-54 (median 19) months. Those rates to anti-cancer chemotherapy in refractory patients (8 patients) previously treated with endocrine therapy were both 25% and those to additional administration of flutamide (FUL) or diethylstilbestrol (DES) in refractory patients (6 patients) were 33% and 100%, respectively. Although the duration of pain relief was 0.78-8 (median 2) months, the additional administration of DES or FLU led to pain relief and improved quality of life (QOL) in all 6 patients. Endocrine therapy such as LH-RH agonist and non-steroidal pure anti-androgen, which has no severe side effects, would be of great usefulness in stage D2 prostatic cancer patients with pain on the basis of efficacy and safety.(ABSTRACT TRUNCATED AT 250 WORDS)

Laparoscopic left adrenalectomy was performed on a 47 years old male patient with primary aldosteronism. Subcutaneous steel traction method was utilized in addition to intraperitoneal CO2 insufflation method. The combined use of steel traction method reduced CO2 insufflation pressure below 12 mmHg and might reduce possibility of CO2-related complications. A left adrenal gland was approached by a resection of phrenic colic ligament and a traction of a transverse and descending colon. Laparoscopic adrenalectomy has distinct advantages over open adrenalectomy in terms of avoidance of skin and muscle incision and rib resection, and early convalescence. This less invasive method might prevail in near future.

Laparoscopic nephrectomy was carried out on 6 sows in order to develop the procedures of clinical laparoscopic nephrectomy and the equipment necessary for this operation. Based on the animal experiments, it was shown that (1) retroperitoneal approach was difficult due to narrow space. (2) there must be at least 5 cm distance between each trocar and 4 or 5 trocar 1 cm in diameter were basically required. (3) The procedure consisted of incision and dissection of the peritoneum around the kidney, cutting and ligation of the ureter, dissection along the medial side of the ureter to approach the renal pedicle and clipping and cutting of the renal vessels. (4) The equipment required for this surgery must be functionally equivalent to those used in the open surgery. (5) In addition, the specifically designed equipment, such as a morcellator and an instrument to ligate renal vessels are necessary. The first clinical case of laparoscopic nephrectomy was a 34 years old man with a right non-functioning hydronephrosis due to ureteropelvic junction stricture. The surgery was successfully performed with a 110 ml blood loss. It took 7 and half hours because of abundant peri-renal fatty tissue and large extra-renal pelvis. The convalescence was uneventful. Laparoscopic nephrectomy can be applied on selected cases and the development of equipment will make the surgery more popular.

The effect of intravesical instillation of dimethylsulfoxide (DMSO) on bladder carcinogenesis was examined in mice. Experiment 1: Fifty-five female C3H/He mice were administered 0.05% N-butyl-N-(4-hydroxy-butyl) nitrosamine (BBN) in their drinking water for 8 weeks. In week 9 they were divided into two groups consisting of 25 mice each. Then, under nembutal anesthesia the first group was given weekly intravesical inatillations of 0.1 ml DMSO (minimum 99.0%) for 10 weeks. The second group received no treatment except anesthesia. All mice were killed 30 weeks after the begining of the experiment and their urinary bladder resected for histological examination. The incidence of bladder carcinoma was 93.7% (15.16) and 27.7% (6/22) in groups 1 and 2, respectively. These incidences differed significantly between the two groups. Experiment 2: One hundred and twenty female C3H/He mice were divided into two groups. The first group was given 0.05% BBN in their drinking water for 5 weeks and then tap water. The second group was not given BBN. In week 6, the first group was divided again into three groups (1, 2 and 3) consisting of 28, 26, and 27 mice, respectively. The second group was divided into groups 4 and 5 consisting of 21 and 18 mice, respectively. Under nembutar anaesthesia groups 1 and 4 received weekly intravesical instillation of 0.05 ml DMSO (minimum 99.0%) from weeks 6 to 13, Group 2 received weekly intravesical instillation of 0.05 ml distilled water from weeks 6 to 13. Groups 3 and 5 received no treatment except anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Fifty-five female C3H/He mice were given 0.05% N-bytyl-N-(4-hydroxybutyl) nitrosamine in their drinking water for 18 weeks. In week 19, eleven mice (group 3) were sacrificed to confirm that they all had bladder carcinoma. The remaining mice were divided into two groups. Group 1 received 20 Gy of proton irradiation over the whole pelvis, while group 2 received no treatment as a control. After 3 weeks all the animals were sacrificed and their bladders were resected to weigh and to examine histologically. The average weight of the bladder, as an index of the tumor volume, was 67.7 mg in group 1, 120.6 mg in group 2 and 106.5 mg in group 3. There was a significant differences (p less than 0.05) between group 1 and group 2. The incidences of superficial (pT1) and deeply invasive (pT2-3) bladder carcinomas were [10/18 (56%) and 8/18 (39%)] in group 1, [3/17 (18%) and 14/17 (82%)] in group 2 and [2/11 (18%) and 9/11 (82%)] in group 3, respectively. These rates of incidence were significantly different (p less than 0.05) between group 1 and group 2. However, there was no significant difference (p = 0.068) between group 1 and group 3. These results indicate that proton irradiation is effective for treatment of invasive bladder carcinoma in mice.

From May 1987 to April 1988, 7 male patients, 43-69 years old in age, underwent enterocystoplasty after total cystectomy. In 5 of them, a selected intestinal segment, consisted of the terminal portion of the ileum, the cecum and the proximal part of the ascending colon, was freed and detubularized for construction of "bladder" substitution. In the remaining two patients with a previous history of cholecystectomy, having severe intestinal adhesions, the ileum or the sigmoid-colon were used. At 3 months after operation, 6 patients had a vesical capacity of 300 ml or more and the maximum volume of urine excreted at one voiding was 200 ml or more. Daytime continence had been achieved in 6 patients at 3 months after operation, whereas nighttime continence had been achieved in 5 patients at 6 months after operation. Serum electrolytes, pH value of arterial blood and renal function, were all normal during the follow-up period (5-13 months). Potency was preserved in 2 patients. All the patients, except one whose "bladder" was constructed with ileum and who was performing daily intermittent selfcatheterization, were able to enjoy almost the same activity of daily life as before operation. The final shape of the "bladder" and its position in the pelvic space seemed to be an important factor for the "bladder" function after operation. By our hand, however, postoperative cystogram revealed a sigmoid shape in all cases, though the reservoirs had an oval shape at the time when they had been constructed.(ABSTRACT TRUNCATED AT 250 WORDS)

A 63 year old man, having right renal cell carcinoma which was found after initial symptoms of left supraclavicular tumor and gross hematuria, is presented. The points to note with this case are; (1) An unusual production of alpha-fetoprotein (AFP), (2) Being discovered at a very advanced stage and that the disease progressed rapidly (at initial presentation the patient had lymph nodes metastases from the paraaorta, mediastinum to the left supraclavicular region. Later the patient had a recurrent tumor in the left supraclavicular area and multiple cutaneous metastases), (3) Various modalities of treatment were given (right nephrectomy, abdominal lymph nodes dissection, resection of the supraclavicular and mediastinal lymph nodes metastases, hyperthermia combined with irradiation for the recurrent tumor in the supraclavicular region and systemically adoptive immunotherapy with tumor infiltrating lymphocytes). During this treatment course, the drift of serum AFP showed a good correlation. The possibility of AFP as a tumor marker of renal cell carcinoma in selected cases was presented and the suitability of the treatments performed to this patient was discussed.