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The presence of a varicocele has been associated with decrease in testicular volume both in adult and pediatric patients. However, a study on the effect of varicocelectomy on testicular volume in the adult varicocele patient has never been reported. We determined the testicular volume before and after varicocelectomy in 52 patients with varicocele. A significant increase in testicular volume with the right side showing a greater increase was observed (p < 0.05). No greater increase in testicular volume was noted among the patients who achieved a pregnancy with their spouses. In addition, the age of the patient did not correlate with the observed change in testicular volume. These results suggest that varicocele is clearly related to decreased testicular volume and that varicocelectomy can increase bilateral testis volume resulting in improved testicular function.

The present study was undertaken to determine whether or not antigrade, proluminal 3H-androgen movement in the caput epididymis occurs in the absence of native lumen content. A single tubule was perfused with artificial caput fluid containing no androgen-binding protein for 30 min and subsequently tubules were perifused with Minimum Essential Medium perifusion fluid containing 26.7 μCi/ml 3H-testosterone and 1.3 μCi/ml 14C-polyethyleneglycol for 1 h. Radioactivity of isotopes in perifusion and intraluminal fluids was determined at 1 h after sustaining perifusion, and the percentage of peritubular isotopes appearing in the intraluminal fluid was determined. Net entry of 3H-androgen into the epididymal tubules in the presence of native intraluminal content was approximately 323%. In contrast, intraluminal 3H-androgen concentrations in the epididymal fluid in the absence of native lumen content were significantly reduced, to 100% of those in the peritubular fluid. Antigrade, proluminal movement of 3H-androgen in the caput epididymis does not occur in the absence of native lumen content. Androgen-binding protein in the epididymal lumen may be required to maintain uphill proluminal movement of 3H-androgen into the tubules.

The effect of metabolic inhibitors on transepithelial movement of 3H-androgens was investigated by in vivo perifusion and subsequent micropuncture of caput and cauda epididymal tubules. Epididymal tissue (adenosine triphosphate (ATP) concentrations were determined at 1 h after exposure of perifusion fluid with metabolic inhibitor. To determine whether or not metabolic inhibitor alters intraluminal androgen-binding protein concentration or androgen binding to interstitial proteins in the caput epididymis, 3H-dihydrotestosterone (DHT) binding to interaluminal androgen-binding protein and bound vs free androgen ratio in the interstitial fluid after 1 h perifusion with fluid containing metabolic inhibitor around caput epididymal tubules were examined. Proluminal movement of 3H-androgens and tissue ATP concentrations in the caput and cauda epididymis were significantly decreased by addition of dinitrophenol (DNP) or potassium cyanide to the perifusion fluid. Relative intraluminal androgen-binding protein protein concentration and bound vs free 3H-androgen ratio in the interstitial fluid were not altered when DNP or potassium cyanide was added to the perifusion fluid. These results demonstrate for the first time that an energy-dependent mechanism may be involved in the epididymal androgen uptake.

Proluminal movement of 3H-testosterone from peritubular space to intratubular fluids of the adult rat testis and epididymis was studied by using in vivo microperifusion and subsequent micropuncture of seminiferous tubules and caput epididymal tubules. Tubules were perifused with Minimum Essential Medium containing 3H-testosterone. To determine if androgen transport is saturable, 40, 80, 160, and 320 μCi 3H-testosterone were included in the perifusion fluid. Radioactivity of 3H-androgens in the intraluminal fluids was determined at 1 hour after perifusion. Transepithelial 3H-androgen movement in the testis was linear (r=0.735, p

To determine the clinical characteristics of grade 3 tumors with lamina propria invasion (pT1), we reviewed the data of 217 patients with superficial bladder cancer who had initially been treated by transurethral resection (193 patients) and fulguration (4), supravesical resection (13) or partial cystectomy (7). We classified the patients into four groups according to histological grade and stage of disease: group 1) grade 0 or 1, pTa tumors (n=58); group 2) grade 2, pTa tumors (n=106); group 3) grade 2, pT1 tumors (n=30); and group 4a) grade 3, pT1 tumors (n=23). Grade 3, pT1 tumors were significantly related to nonpapillary growth (p=0.0002), multiple tumors (p=0.005) and irritative bladder symptoms (p=0.01). The 5-year progression rates were 0% for group 1, 5% for group 2, 8% for group 3, and 18% for group 4a. The respective 5-year survival rates were 97%, 91%, 83% and 79%. All five patients with grade 3, pT1 tumors who had originally undergone total cystectomy (group 4b) remained alive free of disease for a median follow-up 57 months, establishing a far better survival rate than that for group 4a. These findings show that patients with grade 3, pT1 tumors face a high probability of progression and poor chance of survival. Immediate radical treatment is indicated when tumors recur after initial transurethral resection.

Proluminal movement of 3H-androgen from peritubular to intratubular fluids of the adult rat testis and epididymis was investigated by using in vivo microperifusion and subsequent micropuncture of seminiferous tubules and caput, corpus, and cauda epididymal tubules. Tubules were perifused with Minimum Essential Medium containing 3H-testosterone. 14C-polyethyleneglycol was included in the perifusion fluid as a marker for contamination of intraluminal fluid by peritubular fluid. Radioactivity of isotopes in interstitial and intraluminal fluids was determined at 1 and 2 hours after perifusion and the percentage of peritubular isotopes appearing in the intraluminal fluid was determined. Proluminal movement of 3H-androgen across the seminiferous epithelium was significantly restricted. In contrast, intraluminal 3H-androgen concentrations in the caput epididymal fluid were 200-300% of those in the peritubular fluid at both 1 and 2 hours after perifusion. Similar results were found in the corpus epididymis. 3H-androgen concentrations in the cauda epididymal fluid were approximately 125% of the peritubular isotope concentrations. The exact mechanism underlying this uphill transepithelial movement of 3H-androgen in the rat epididymis continues to be elucidated.

We report on a case of iatrogenic obstruction of the vas deferens following herniorrhaphy, successfully treated by vasovasostomy after an obstructive interval of 31 years, with his wife achieving pregnancy.

A case of simultaneous bilateral renal pelvic tumors is reported. A 64-year-old man with the chief complaint of gross hematuria and left flank pain was admitted. Clinical investigations revealed a tumor in the right pelvis and ureter, and another tumor in the left renal pelvis. The right ureteral tumor had invaded the bladder. Right nephroureterectomy, total cystectomy, left partial pyelectomy and ureterocutaneostomy were performed. By pathological examination, right renal pelvic and ureteral tumors were non-papillary transitional cell carcinoma, grade 3, pT4, and the left renal pelvic tumor was papillary transitional cell carcinoma, grade 2, pT1. To our knowledge, this is the 16th case of simultaneous bilateral urothelial tumors of the upper urinary tract in Japan.

Three cases of renal angiomyolipoma are reported. The first case was a 53-year-old female with the complaint of left flank pain. In both cases selective angiography revealed a renal tumor, and computerized tomography disclosed a renal mass with low density corresponding to the fat tissue. From several examinations these two cases were preoperatively diagnosed as renal angiomyolipoma and nephrectomy was performed. Histopathological diagnosis was renal angiomyolipoma. The third case was a 64-year-old female with the complaints of left flank pain and macrohematuria. In this case computerized tomography revealed a renal mass which did not have a low density area. The possibility of renal cell carcinoma was considered and nephrectomy was performed. Histological diagnosis was renal angiomyolipoma which was primarily composed of smooth muscle cells. The first case had a calcified lesion in the brain. But there was no evidence of tuberous sclerosis in the following two cases. Some problems in diagnosis and treatment of renal angiomyolipoma are presented, and a statistical study is made on 194 reported cases of renal angiomyolipoma in Japan.

We report a case of rhabdomyosarcoma of the prostate. The patient was a 56-year-old man who complained of anal pain and dysuria. Tumor of the prostate was suspected after rectal examination. Multiple metastatic lesions were found in the lungs and liver. A needle biopsy of the prostate revealed rhabdomyosarcoma. He received chemotherapy, using Etoposide and responded slightly. Subsequently VAC-therapy was also performed. Although the patient improved temporarily, he died 4 months after admission.

Workers in the dye manufacturing industry have a high risk of urinary bladder cancer. There may also be a high relative risk of bladder cancer in occupational dye users. Nine occupational dye users were found to have bladder cancer. The period of engaging with dye work ranged from 5 to 40 years. Seven patients had bladder cancer and the other 2 patients had lesions both in the bladder and in the renal pelvis. Histopathology of all cases was transitional cell carcinoma. Three cases were classified into grade 1 and 6 cases into grade 2. One patient died of bladder cancer. The other 8 patients are alive. Four cases recurred after TUR therapy. It is necessary to establish systemic mass screening examination of occupational dye users for the early diagnosis of bladder cancer.