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Patients administered anti-cholinergic agents, as first-line therapy for an overactive bladder (OAB) are often unable to continue medical treatment because of dry mouth. We assessed oral health in patients with OAB using the General Oral Health Assessment Index (GOHAI), an oral health-related quality of life questionnaire. We investigated 75 patients with OAB who were receiving continuous administration of anti-cholinergic agents. The OAB symptom score, as well as GOHAI and our original dry mouse score were determined by self-administered questionnaires. The mean age of the subjects was 70.9±10.2 years, the median period of anti-cholinergic agent use was 20 (1-116) months and the mean OAB symptom score was 6.3±3.1. The GOHAI score for all patients was 51.9±8.4 and not significantly different from the national normal value (p＝0.22). On the other hand, the score in patients with a severely dry mouth was 49.2±8.6, which was worse than the national normal value (p＝0.04). The psychosocial functioning score in patients with a severely dry mouth was significantly lower than in those with a slightly dry mouth (p＝0.02). Our results indicate that dry mouth in patients with OAB is significantly associated with worsening of oral health. GOHAI is useful as a screening test to assess the quality of life in patients with OAB.

A 67-year-old man presented with macroscopic hematuria. Transrectal prostatic needle biopsy was performed because of elevated prostate specific antigen (PSA) (3.85 ng/ml) and palpation of hard nodules at the prostate. Pathological diagnosis was leiomysarcoma. Computed tomography revealed several pulmonary metastases. Radical cysto-prostatectomy and construction of ileal conduct were performed. Adjuvant radiotherapy (50 Gy) was also performed. During follow-up, the size of the pulmonary metastases increased, and we decided to start systemic chemotherapy 7 months after surgery. The chemotherapy consisted of gemcitabine (900 mg/m2 on day1 and day 8), and docetaxel (100 mg/m2 on day 8). After eight courses, there was 20% reduction in the size of some pulmonary metastases. He remained alive 21 months after diagnosis.

We have performed transurethral enucleation with bipolar system (TUEB) on 60 patients since April 2008. The patients were 61 to 81 years old (average 71.7 years old), and estimated prostate volumes were 25 cm3 to 80.43 cm3 (average 51.1 cm3). The weight of prostate removed was 8 g to 56 g (average 27.4 g) during the operations which lasted between 40 min to 200 min (average 117.5 min). The International Prostate Symptom Score (IPSS), quality of life index (QOL) maximum flow rate (Q max) and average flow rate (Qave) were recorded before operation, and at 1 and at 3 months after operation. The results indicated a high safety with TUEB compared to TUR-P even for beginners. In conclusion, TUEB may become the most common approach in the treatment of BPH.

A 74-year-old man visited our hospital, because of high prostate specific antigen (PSA). Retropubic radical prostatectomy was performed for prostatic cancer. Suddenly right inguinal lesion pain appeared at 25 days after operation with disturbance of gait. Pelvic magnetic resonance imaging (MRI) demonstrated inflammatory change in right pubic bone, pectineal muscle, adductor muscle, which suggested the diagnosis of osteomyelitis of the pubis. After long-term administration of antibiotic therapy, osteomyelitis of the symphysis pubis and gait possible. There was no recurrence of osteomyelitis of the symphysis pubis at one year after operation. In addition to our case, we review the 8 cases of osteomyelitis of the pubis after radical prostatectomy previously reported in Japanese publications.

We retrospectively analyzed the records of 21 patients with penile carcinoma treated between January 1993 and February 2007. According to TMN classification (UICC 2002), 9, 8, 2 and 2 patients belonged to stages I, II, III and IV, respectively. During the follow up period of 4 to 144 months (median 15 months), the overall 5-year survival rate was 75.8%. All three patients having N2 died within one year. Lymph node metastasis (p=0.001) and organ metastasis (p=0.007) were found to be unfavorable prognostic factors for patients with penile cancer.

2005年2月～2007年4月に前立腺肥大症で手術を施行した48例を, Gillingの手技で経尿道的前立腺核出術(HoLEP)を行った14例(年齢66～82歳)を第1群, 尿道括約筋損傷を避けるために尿道外括約筋に針電極を刺入して電気刺激を行い1群と同様の手技でHoLEPを施行した17例(51～81歳)を第2群, 精阜より尖部よりで尿道粘膜と筋層を9～3時にかけて切開し, 尖部腺腫を温存してMorcellatorを用いて膀胱内に遊離された前立腺腫を摘出する変法HoLEPを施行した17例(59～76歳)を第3群として比較検討した。3群間における平均推定前立腺体積に差はなく, I-PSSは各群ともに1ヵ月後, 3ヵ月後で有意に改善したが, 群間での有意差は認めなかった。QOLスコアもI-PSS同様に低下し, Qmaxも有意に改善したが術後1ヵ月時のQmaxでは第3群は第1群より有意に高かった。残尿量については第1群では術前と術後1ヵ月に有意な改善はなく, 他の群では有意に低下したが群間での有意差は認めなかった。術後入院期間は第3群が有意に短かった。尿禁制における退院時, 術後1, 3ヵ月の尿失禁率では, 退院時と術後1ヵ月時点で第3群で有意に低下した。前立腺切除率では第3群が有意に低かった。以上より, HoLEPを改良することで, 最大合併症である術後の一過性尿失禁が解決される可能性が示唆された。, From February 2005 to April 2007, 48 consecutive patients with BPH underwent holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation. The first 14 cases (group 1) underwent HoLEP according to Gilling's method. In the next consecutive 17 cases (group 2), in addition to HoLEP performed as in group 1, the urethral external sphincter was stimulated electrically with a needle electrode inserted in a transperineal manner to prevent sphincteric injury. In the latter 17 consecutive cases (group 3), we used a modified HoLEP procedure, which partially preserved the apical adenoma in the 10-to 2-o'clock position. International Prostate Symptom Score, quality of life index, urinary flow (Qmax) data, and postvoid residual urine were significantly improved postoperatively in each group, there being no differences among them with the exception that group 3 had better Qmax data than group 3 at one month after operation. On the other hand, postoperative transient urinary incontinence was significantly reduced in group 3 on the day of discharge and 1 month after the operation. These results demonstrate that our modified HoLEP procedure is a promising method to avoid postoperative transient urinary incontinence.

対象は2005年2月より内服加療でも排尿障害が改善しない症例や尿閉をきたした外科的治療を要する前立腺肥大症患者14例で、年齢は62歳～84歳(平均75歳)であった。全例で腰椎麻酔下に手術を実施し、治療結果は術前と術後3ヵ月との比較で国際前立腺症状スコア(IPSS)、QOL、最大尿流率(Qmax)、残尿量(RU)のいずれも統計学的に有意に改善を認めていた。切除重量と出血量の相関をみると、経尿道的前立腺切除術(TUR-P)群では切除重量が増えるに従って出血量も増える傾向にあったが、ホルミウムレーザー前立腺核出術(HoLEP)群では切除出血重量と出血量に相関はなかった。術後合併症は3例に内尿道切開術を必要とする尿道狭窄を認め、1例で原因は不明だが球部尿道に尿道周囲腫瘍を形成した。最終的に1例を除き術後3ヵ月で尿失禁は完全に消失したが、尿道周囲腫瘍を形成した1例は術後6ヵ月の時点で尿失禁が持続している。, We have performed holmium laser enucleation of prostate (HoLEP) in 14 cases since February 2005. The patient's age ranged from 62 to 84 years old (average: 75). The preoperative results of International Prostate Sympton Score (IPSS), quality of life index, maximum urinary flow rate and residual urine volume were compared with those 3 months after surgery. The mean operation time, the mean estimated prostate volume and the mean enucleated prostate volume were 143 min, 50 cm3 and 35 g, retrospectively. All cases showed improvement in each parameter, and all but one case recovered continence in 3 months after surgery. A periurethral abscess had developed in the patient, suffering from incontinence. We concluded that HoLEP is an effective treatment. The relatively higher incidence of urinary incontinence in HoLEP remains to be resolved in the future.

70歳女性。左腎細胞癌術後4年目に頸部腫瘤, 右肺S8の腫瘤を指摘され, 著者らの施設へ紹介となった。精査の結果, 腎細胞癌の頸部リンパ節転移, 肺転移と診断され, IFN-α投与を開始されたが, 肺転移巣の増大がみられた。追加治療としてIL-2投与を併用したものの, 頸部リンパ節転移巣は著明に増大, そこで, 局所コントロールの目的で, 右肺に対しては52.8 GyE, 右鎖骨上窩および上縦隔リンパ節に対しては57.6GyEの炭素イオン線照射が行われた。更に粒子線治療後も継続して週2回のIFN-αおよびIL-2の投与が行われた。その結果, 現在, 約1年経過で照射部位は縮小しており, 明らかな新病巣もみられていない。, We report a case of lung and lymph node metastasis treated with carbon ion radiotherapy after radical nephrectomy five years earlier. The patient was a 70-year-old woman. She was diagnosed with lung and neck lymph node metastasis by chest computed tomography four years after surgery. The metastatic mass increased gradually despite interferon-alpha and interleukin-2 treatment. Carbon ion radiotherapy was applied to the metastatic mass, and it has not increased in size to date. Carbon ion radiotherapy is thus regarded as an effective treatment for metastatic renal cell carcinoma masses, and it can be an important option for treatment of renal cell carcinoma.

56歳男.約3年前に出現した右上腹部圧迫感を主訴に受診し, 腹部CTで右腎腫瘍を指摘された.画像検査で悪性腫瘍が否定できない充実性腫瘍と診断し, 用手補助腹腔鏡下右腎摘除術を施行した.腫瘍は充実性で明らかな出血壊死像は見られず, 胞巣状に増殖する腺管状に配列した好酸性腫瘍細胞を認め, 後天性嚢胞性腎疾患(ACDK)に合併した腎オンコサイトーマと診断された.術後は経過良好で, 右上腹部圧迫感が消失した.約6ヵ月後に献腎移植術を施行し, 移植術から約18ヵ月経過現在, 移植腎機能は良好で, 腎腫瘍の再発徴候は認めていない, A case of renal oncocytoma associated with acquired cystic disease of kidney (ACDK) in a 56-year-old man is reported. He had received hemodialysis for 15 years because of chronic renal failure. Computed tomography (CT) was performed because of distention in the upper abdomen, revealing a right renal tumor. He underwent laparoscopic right nephrectomy, and was diagnosed with renal oncocytoma. There have been reported 8 cases of renal oncocytoma in hemodialysis patients, and our case was the third one associated with ACDK in the literature.

68歳男.患者は直腸診にて前立腺の中等度肥大を認め, PSA値が高値であった.更に右下腹部に虫垂切除時の手術瘢痕および右鼠径部に鶏卵大, 表面平滑, 弾性軟, 可動性のある腫瘤を認めた.膀胱造影では, 膀胱に連続した右鼠径部に介在する膀胱ヘルニアが描出された.以上より, 前立腺癌に合併した膀胱ヘルニアと診断し, 根治的前立腺全摘除術と同時に膀胱ヘルニア修復術が施行された.その結果, 摘出前立腺の病理所見はGleason score 8点であり, 精嚢浸潤を認めた.所属リンパ節に転移を認めず, 病期はpT3bN0M0であった.術後にホルモン療法が施行され, 術後5ヵ月現在, 前立腺癌ならびに膀胱ヘルニアとも再発を認めていない, We report a case of bladder hernia. A 68-year-old man was admitted to our hospital for the management of prostate cancer. An egg-sized soft mass was palpated at his right inguinal region. Magnetic resonance imaging and cystography revealed that the mass was a bladder hernia. During radical prostatectomy, we had to resect the bladder hernia for safe regional lymphadenectomy. This hernia was the extraperitoneal type. The stage of prostate cancer was pT3b N0 M0. This is the third reported case of inguinal bladder hernia associated with prostate cancer in Japan.