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Transurethral surgery is widely accepted as standard therapy for male urethral obstruction. The present study was undertaken to identify and select lesions to be managed by processing endoscopic images of the urethra for assisting less invasive therapy in patients with voiding dysfunction.Cystourethroscopic video files of 25 patients with lower urinary tract symptoms were recorded before and after administration of alpha-1 adrenoceptor antagonists. Each video frame was restored and tagged with information indicating the position in the panoramic image of the urethra. A three-dimensional virtual urethra was created to indicate critical lesions for voiding dysfunction, together with fluid dynamics simulation of urine flow.The urine stream was depicted in the virtual urethras in 19 patients. Before therapy, 17 patients showed vortex formation that was diminished after therapy in nine patients with a significant relationship in improvement of relative energy loss of flow (p=0.025). The narrowing points proximal to the vortex, candidate of lesions, were identified in the panoramic image and linked to the endoscopic image.Therapeutic designing for endoscopic management was possible in patients with voiding dysfunction based on computational fluid dynamics, and would be promising as "focal" therapy for aging males.

Our recent studies of the microRNA (miRNA) expression signature in prostate cancer (PCa) indicated that miRNA-218 (miR-218) was significantly downregulated in clinical specimens, suggesting that miR-218 might act as a tumor-suppressive miRNA in PCa. The aim of the present study was to investigate the functional significance of miR-218 in PCa and to identify novel miR-218-regulated cancer pathways and target genes involved in PCa oncogenesis and metastasis. Restoration of miR-218 in PCa cell lines (PC3 and DU145) revealed that this miRNA significantly inhibited cancer cell migration and invasion. Gene expression data and in silico analysis demonstrated that LIM and SH3 protein 1 (LASP1) is a potential target of miR-218 regulation. LASP1 is a cytoskeletal scaffold protein that plays critical roles in cytoskeletal organization and cell migration. Luciferase reporter assays showed that miR-218 directly regulated expression of LASP1. Moreover, downregulating the LASP1 gene significantly inhibited cell migration and invasion in cancer cells, and the expression of LASP1 was upregulated in cancer tissues. We conclude that loss of tumor-suppressive miR-218 enhanced cancer cell migration and invasion in PCa through direct regulation of LASP1. Our data on pathways regulated by tumor-suppressive miR-218 provide new insight into the potential mechanisms of PCa oncogenesis and metastasis.

Objective: To investigate the risk of bladder cancer with pioglitazone, the data of diabetic patients treated at Teikyo Chiba Medical Center were analyzed retrospectively. Methods: From February 2009 to October 2011, 720 patients were treated with pioglitazone, and 742 patients were not treated with pioglitazone at Teikyo University Chiba Medical Center. The numbers of newly diagnosed bladder cancers from February 2009 to December 2013 in these patients and the occurrence of bladder cancer among type 2 diabetes mellitus patients were identified. The duration of diabetes, sex, age, smoking, and medication for diabetes were obtained from the medical records. The occurrence of bladder cancer was defined as incident cases after the initiation of pioglitazone. Statistical significance was analyzed by Fisher’s exact test. Results: About 2% of diabetic patients had bladder cancer. The incidence of bladder cancer was not different between the pioglitazone group (15/720, 2.0%) and the no pioglitazone group (14/742, 1.9%). No oral diabetes medication was related to the risk of bladder cancer. However, use of insulin was significantly related to bladder cancer risk (hazard ratio [HR]: 2.83; 95% confidence interval [CI]: 1.15–6.84; p=0.0246), and sex was also significantly related to bladder cancer (HR: 6.001; 95% CI: 1.397–43.06; p=0.0137). The duration of diabetes and smoking were not associated with bladder cancer risk. Conclusion: In this study, use of pioglitazone was not related to bladder cancer risk, while use of insulin was related

Renal cell carcinoma (RCC) is capable of metastasizing to several organs. Synchronous isolated contralateral adrenal metastasis of the primary RCC is, however, very rare. Herein we report a case of RCC with a huge solitary metastasis to the contralateral adrenal gland that was surgically treated. We scheduled nephrectomy for the left primary RCC and adrenalectomy for the right adrenal tumor. However, at surgery we found a huge right adrenal tumor that had invaded the right kidney, right renal vein, and inferior vena cava. Therefore right nephrectomy was performed simultaneously with resection and reconstruction of the inferior vena cava. Pathological findings demonstrated that the left renal tumor and right adrenal tumor had the same histology. Although the patient required hemodialysis, he remains well at six months postoperatively. So far, there have been only two cases of a solitary contralateral metastatic adrenal tumor that was larger than the primary RCC, thus the present case is the third one.

Our recent study of microRNA (miRNA) expression signature of prostate cancer (PCa) has revealed that the microRNA-143/145 (miR-143/145) cluster is significantly downregulated in cancer tissues, suggesting that these cluster miRNAs are candidate tumor suppressors. The aim of this study was to investigate the functional significance of the miR-143/145 cluster in PCa cells and to identify novel targets regulated by these cluster miRNAs in PCa. Restoration of miR-143 or miR-145 in PCa cell lines (PC3 and DU145) revealed that these miRNAs significantly inhibited cancer cell migration and invasion. Gene expression data and in silico analysis demonstrated that Golgi membrane protein 1 (GOLM1) resembling a type II golgi transmembrane protein was a potential target of miR-143/145 cluster target gene. Gene expression studies and luciferase reporter assays showed that GOLM1 was directly regulated by the miR-143/145 cluster. Silencing of GOLM1 resulted in significant inhibition of cell migration and invasion in PCa cells. Furthermore, the expression of GOLM1 was upregulated in cancer tissues by immunohistochemistry. Loss of the tumor-suppressive miR-143/145 cluster enhanced cancer cell migration and invasion in PCa through directly regulating GOLM1. Our data on target genes regulated by the tumor-suppressive miR-143/145 cluster provide new insights into the potential mechanisms of PCa oncogenesis and metastasis.

To investigate the hypothesis that 5-alpha-reductase inhibitors exert early ameliorative effects on voiding and storage symptoms in men with lower urinary tract symptom-associated benign prostatic hyperplasia.This was a prospective study involving the participation of eight outpatient clinics in Chiba Prefecture, Japan. The patients received dutasteride (0.5 mg) once daily orally for 24 weeks as an add-on to their ongoing therapy with an alpha-1 blocker. The study patients recorded their urinary symptoms every day for 14 days after starting dutasteride. The International Prostate Symptom Score, prostate volume, uroflowmetry results, and residual urine volume were checked at 3 and 6 months after starting dutasteride.A total of eighty-eight patients participated in the present study; 74 were eligible for analysis of the early effects of dutasteride. The median age was 69.6 years (range 54-89), the median prostate volume was 50.3 mL (range 24.7-103.3) and the median International Prostate Symptom Score was 17.6 (range 8-35). The proportion of patients with International Prostate Symptom Score improvements (≥3 points, or ≥25%) or 3 points or more decreased International Prostate Symptom Score were defined effective, 37 (50.0%) and 47 (63.5%) experienced improvement at 1 month after administration, respectively.This is the first prospective clinical study to show the early beneficial effects of 5-alpha-reductase inhibitors for lower urinary tract symptom-associated benign prostatic hyperplasia. Patients with severe symptoms were found to be responsive to dutasteride. The influence of the placebo effect was not denied. Further study is necessary.

Background: Although the percentage of patients with renal cell carcinoma (RCC) extending into venous systems is unexpectedly high, the prognostic impact and independency of venous tumor thrombus-related factors on overall survival (OS) remain controversial. Furthermore, the prognostic impact of various clinicopathologic factors including tumor thrombus-related factors on OS may change with elapsed years after the intervention and also with follow-up duration of participants. The aim of the study is to explore independent and universal predictive preoperative and intraoperative clinicopathologic factors on OS in patients with RCC extending into venous systems using subgroup analysis in terms of restricted follow-up duration and yearly-based survivors.Methods: Between 1980 and 2009, 292 patients diagnosed with RCC with venous tumor thrombus were retrospectively registered for this study. The prognostic impacts of various clinicopathologic and surgical treatment factors including levels of venous thrombus, venous wall invasion status and likelihood of aggressive cytoreductive operation, were investigated using Kaplan-Meier method and following multivariate Cox proportional hazards model for all patients and those still alive at 1, 2, and 3 years of follow-up. To investigate the impact of follow-up duration on the statistical analyses, multivariate logistic regression analyses were used to explore prognostic factors using restricted data until 1, 2, and 3 years of follow-up.Results: The median follow-up duration was 40.4 months. The 5-year OS was 47.6%. Several independent predictive factors were identified in each subgroup analysis in terms of yearly-based survival and restricted follow-up duration. The presence of tumor thrombus invading to venous wall was independently related to OS in the full-range follow-up data and in survivors at 2 and 3 years of follow-up. Using restricted follow-up data until 1, 2, and 3 years of follow-up, many independent predictive factors changed with follow-up duration, but surgical category could be universal and independent predictive factors.Conclusion: The most universal factors affecting improvement both in short-term and long-term survivals could be cytoreductive surgery and absence of venous wall invasion. It may mean that feasible aggressive cytoreductive operation following more reliable preoperative imaging for predicting venous wall invasion status would improve OS for patients with RCC extending into venous systems., BMC Cancer, 13(1), 447; 2013

INTRODUCTION AND OBJECTIVES: The number of antihypertensive drug classes used does not accurately reflect total consumption of antihypertensive drugs to control blood pressure (BP), although it can become one of predictors for postoperative hypertension outcome in patients with primary aldosteronism (PA). The defined daily dose (DDD) was adopted to analyze consumption of many prescribed drugs. The aim of this study was to use the DDD to assess postoperative changes in antihypertensive drug consumption in PA patients. METHODS: This retrospective study included 110 Japanese PA patients who underwent unilateral laparoscopic adrenalectomy between 1995 and 2012. Hyperaldosteronism was cured in all patients after surgery. After we defined the ratio of prescribed daily dose (PDD) to DDD (PDD/DDD) to estimate individual consumption of antihypertensive drugs, we calculated the preand postoperative PDD/DDD to assess total consumption change in antihypertensive drugs (Supplement). Uniand multivariate analyses were performed to identify clinical predictors for 75% decrease in total PDD/DDD. RESULTS: Total PDD/DDD decreased in 95.4% of patients postoperatively. The mean decrease in total PDD/DDD was 65.0%. A decrease in total PDD/DDD was significantly correlated with age, body mass index (BMI), duration of hypertension, estimated glomerular filtration rate (eGFR), and plasma renin activity (PRA). Postoperative decreases in total PDD/DDD 75% were confirmed in 52.7% of patients. Multivariate analysis identified no medical history of cardiovascular disease (odds ratio [OR] 5.4, P 0.02), lesser BMI (OR 1.2, P 0.03), and shorter duration of hypertension (OR 1.1, P 0.01) as independent predictors of postoperative decrease in total PDD/DDD 75%. Based on univariate analyses, additional factors associated with postoperative decrease in total PDD/DDD 75% included female sex, lower preoperative systolic BP, lower preoperative total PDD/DDD, greater eGFR, and lesser PRA (P 0.05). CONCLUSIONS: Total PDD/DDD was shown to be a useful tool to assess total consumption change of antihypertensive drugs in PA patients. Clinicians can explain the predicted postoperative change of antihypertensive drug consumption to PA patients in detail using total PDD/DDD.

INTRODUCTION AND OBJECTIVES: miRNAs are aberrantly expressed in many human cancers and can function as tumor suppressors or oncogenes that target many cancer-related genes. Therefore, genome-wide comprehensive study is necessary for decoding tumor suppressive miRNA-mediated molecular pathways in cancer research field. In this study we identified tumor suppressive miRNAs in prostate cancer (PCa) based on the miRNA expression signature in clinical PCa specimens and seek out of the tumor suppressive miRNA-mediated molecular pathways. METHODS: The miRNA expression signature of PCa was applied to screen 778 miRNAs by the TaqMan LDA Human microRNA® using five PCa tissues and five non-cancerous tissues. Gain-offunction studies were performed to investigate cancer cell proliferation, migration and invasion by restoration of mature miRNAs/siRNA into PCa cell lines. To identify the biological processes or pathways potentially regulated by the miRNAs, we applied gene expression data and in silico analysis using TargetScan database [http://www.targetscan.org/] and GENECODIS software. The GENECODIS software assigned a number of the putative miRNA targets to known pathways in KEGG [http://www.genome.jp/kegg/pathway.html]. RESULTS: The miRNA expression signature in PCa showed that 56 miRNAs were significantly down-regulated in PCa compared to non-PCa tissues. Among them, the functional screening of downregulated miRNAs demonstrated that miR-222, miR-31, miR-133a and miR-1 inhibited cell proliferation, invasion, and migration in PCa cell lines (PC3 and DU145), suggesting that these miRNAs may act as tumor suppressors in PCa. Our in silico analysis showed that these tumor suppressive miRNAs appeared to be an important modulator of tumor cell processes through suppression of many targets, particularly those involved in focal adhesion, MAPK and ErbB signaling pathways. CONCLUSIONS: Aberrant expression of miRNAs has shed light on recent miRNA signatures and identification of tumor suppressive miRNA mediated novel molecular pathways in PCa. Tumor suppressive miRNA-mediated novel molecular pathways provide a new insight of PCa oncogenesis and metastasis. Furthermore, miRNAmediated pathways contribute to discovery of molecular target search of PCa treatments.

546 Background: Diabetes mellitus is one of the major risk factor for renal cell carcinoma (RCC) development. Although, in various cancers, the relationship between diabetes mellitus and worse prognosis is pointed out, the association between RCC prognosis and diabetes mellitus is under discussion. We sought to determine the association between diabetes mellitus with outcome of sunitinib treatment in metastatic RCC (mRCC) patients. Methods: A retrospective study of sunitinib-treated mRCC patients was performed. 69 patients who had been treated with sunitinib in Japanese two institutions (Teikyo University Chiba Medical Center and Chiba University) were entered. Kaplan-Meier and the log-rank test were performed to investigate the association between the pretreatment status of diabetes mellitus and the outcome of the patients who received the treatment with sunitinib. Results: Between 2008 and 2015, 69 mRCC patients were treated with sunitinib. 53 (76.8%) patients received sunitinib treatment as the first line molecular target drug. 15 (21.7%) patients were diagnosed as diabetes mellitus at the time of sunitinib treatment. Median time to treatment failure (TTF) was 7.1 months, cancer specific survival (CSS) was 33.9 months for all patients. With regard to TTF, there was no difference between diabetic and non-diabetic patients, 9 months for diabetic patients and 7.1 months for non-diabetic patients respectively (P = 0.3271). CCS was significantly shorter for diabetic patients, 11 months for diabetic patients and 39.4 months for non-diabetic patients respectively (P = 0.0469). When focusing on HbA1c, CSS was significant longer for the patients with HbA1c under 6.5% than the patients with HbA1c was 6.5 or more, median CSS was 44.5 months and 11.3 months, respectively (P = 0.0055). Conclusions: Diabetes mellitus did not influence the TTF of sunitinib treatment for mRCC patients. Diabetes mellitus may negatively affect the CSS of sunitinib-treated mRCC. Clinicians should consider controlling patient’s HbA1c status at the initiation of sunitinib treatment for mRCC.

Correct interpretation of renal function in patients with primary aldosteronism is difficult before adrenalectomy, because subtle kidney impairment is often masked by glomerular hyperfiltration peculiar to primary aldosteronism. The aim of this study was to investigate postoperative changes in renal function for patients with primary aldosteronism and to identify clinical predictors of chronic kidney disease manifested postoperatively in the patients without pre-existing chronic kidney disease.Records of 78 Japanese patients who underwent unilateral adrenalectomy for primary aldosteronism were retrospectively surveyed. Patients who had been followed up for6 months were excluded. Preoperative and postoperative estimated glomerular filtration rate were compared. Furthermore, uni- and multivariate analyses were carried out to identify clinical predictors for chronic kidney disease manifested postoperatively.Patients with preoperative estimated glomerular filtration rate ≥60 mL/min/1.73 m(2) showed a significant decrease after surgery. Of the 66 patients without pre-existing chronic kidney disease, 24 developed chronic kidney disease postoperatively. Multivariate logistic regression analysis identified a medical history of dyslipidemia as an independent predictor for chronic kidney disease manifested postoperatively. According to univariate analyses, additional factors associated with postoperative manifestation of chronic kidney disease included older age, lower diastolic blood pressure and lower estimated glomerular filtration rate.The interpretation of normal or abnormal renal functions by examining estimated glomerular filtration rate heightened by hyperfiltration alone can mislead clinicians before adrenalectomy. Clinicians should pay attention to patients at greater risk of a significant decline in postoperative renal function.

To examine the efficacy of an alpha-1 blocker and its correlation to structural alteration of the prostatic urethra and the loss of energy in the urine flow using a virtual urethra processed from an endoscopic video image.Video images of the prostatic urethra were recorded during cystourethroscopy in 11 patients with benign prostatic hyperplasia (BPH) before and after treatment with an alpha-1 blocker, naftopidil. The three-dimensional (3D) structure of the prostatic urethra was reproduced from video files. Fluid dynamic analysis and hydraulic energy calculations were performed using the "virtual" 3D urethral images.In 9 of 11 patients studied, an 11% improvement in the loss of energy (range, 1%-82%) was seen. Alpha-1 blocker treatment mediated the disappearance or decrease of the bulky vortex formation in seven patients, which led to an improved urinary stream. A positive correlation was found between improved energy loss and residual urine volume (P=0.0312).Alpha-1 blocker therapy led to a decreased energy loss in the urine flow in the prostatic urethra in relation to the improvement of clinical symptoms. The cystourethroscopy could be a tool to assess the urethral resistance in patients with BPH using image processing methodology.

INTRODUCTION AND OBJECTIVES: Inappropriately high aldosterone levels impair renal function in patients with primary aldosteronism (PA), because hyperaldosteronism is associated with glomerular hyperfiltration and reduced glomerular filtration rate. Aldosterone excess, such as in PA, thus probably contributes to the development of chronic kidney disease (CKD). While CKD develops postoperatively with estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m, subtle kidney impairment is often masked by hyperfiltration before surgery. Interpreting renal function in patients with PA can therefore be difficult using conventional preoperative eGFR. This study investigated postoperative changes in renal function for all PA patients, to identify predictors of postoperative CKD development in patients without preexisting CKD. METHODS: This retrospective study included 78 Japanese patients with PA who underwent unilateral adrenalectomy between 1990 and 2011. Patients followed for 1 year were excluded. As eGFR is known to be limited by differences in creatinine generation among ethnicities, values were obtained using a new 3-variable Japanese equation that was developed and validated in a Japanese population: eGFR (ml/min/1.73 m) 194 (serum creatinine) 1.094 (age) 0.287 0.739 (if female). Changes in eGFR were compared by 1-way ANOVA, with multiple comparisons using the Bonferroni method. Uniand multivariate analyses were performed to identify clinical predictors for CKD within 1 year after surgery. RESULTS: Patients with preoperative eGFR 60 ml/min/1.73 m showed a significant decrease in postoperative eGFR, while patients with preoperative eGFR 60 ml/min/1.73 m showed no significant postoperative decrease. Of the 66 patients without pre-existing CKD, 24 developed CKD within 1 year postoperatively. In all patients with new-onset CKD, preoperative eGFR was 60-89 ml/min/1.73 m. Multivariate analysis identified preoperative eGFR as an independent predictor of new-onset CKD. Based on univariate analysis, additional factors associated with new-onset CKD included older age and medical history of hyperlipidemia (P 0.05). CONCLUSIONS: Patients with preoperative eGFR of 60-89 ml/min/1.73 m showed a higher proportion of new-onset CKD after surgery. Clinicians should be attentive to patients at greater risk of significant declines in renal function after adrenalectomy. These data may offer indications for early intervention to prevent declines in renal function.

Objective. The aim of the present study was to evaluate initial learning curves of laparoscopic radical prostatectomy (LRP) with regard to complications, urinary continence, and oncologic outcome.Materials and Methods. We retrospectively reviewed 100 consecutive patients with clinically localized prostate cancer. All 100 patients underwent LRP performed by the same urologist at one institution.Results: Mean operating time (208.4±48.6 min), estimated blood loss (495.8±436.5 mL), allogeneic blood transfusion rate (0%), and intraoperative complications diminished with surgical experience. Positive margin rate varied greatly among pathological stage (positive margin rates: pT2 = 20.5%; pT3 = 63.0%). A trend towards reduction of positive surgical margins in pT2 cases was apparent with increasing experience. Intraoperative and early complications occurred in 2.0% of patients. In all patients, 85.9% used none or no more than one pad per 24 h at 6 months postoperatively. Prostate-specific antigen recurrence was seen in only 2 patients.Conclusions. In the present series of 100 patients, our retrospective evaluation confirms that LRP provides satisfactory results.

In laparoscopic surgery, surgeons often encounter paradoxical vision according to their position against the camera position. Such a paradoxical vision evokes confusion and surely deteriorates surgical performance. Previous researches indicated inverted mirror image is useful to compensate this problem though upside-down inversion makes depth sensation perplex. To solve the dilemma, we proposed modified method that displays inverted mirror image plus perspective projection that adds simulated depth cue. After preparing the image adjustment software, trainer box, touch panel device to measure the motion of the forceps, we tested its validity in 36 participants including 10 experienced surgeons. Each participants were requested to push buttons following computer's assignment for ten times of task at three conditions: 1. stands parallel to the camera, 2. stands at the opposite side of the camera, 3. stands at the opposite side of the camera watching inverted mirror image with perspective projection. Mean duration of time for completion of the task was 23.1+/-5.0 seconds for the subjects stand parallel to the camera. It was 98.0+/-96.5 seconds and 43.3+/-24.3 seconds for the subject stands at the opposite side of the camera without and with transformed image, respectively. Paradoxical vision significantly deteriorated performance (p

MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression, primarily at the post-transcriptional level. Growing evidence suggests that miRNAs function as oncogenes or tumor suppressors in human cancers. The down-regulation of miR-145 has been reported in many types of human cancer, including prostate cancer (PC), suggesting that miR-145 functions as a tumor suppressor. Using the PC cell lines, PC3 and DU145, gain-of-function assays revealed that miR-145 transfection inhibited cell proliferation, migration and invasion. Fascin homolog 1 (FSCN1), an actin-bundling protein, is a candidate target gene of miR-145 based on genome-wide gene expression analysis. A luciferase reporter assay showed a significantly decreased signal at two miR-145 target sites at the 3'UTR of FSCN1, suggesting that miR-145 directly regulates FSCN1. In FSCN1 loss-of-function assays, cell growth, migration and invasion were all inhibited, implying that FSCN1 is associated with the progression of PC. The identification of tumor suppressive miRNAs and their target genes could provide new insights into the potential mechanisms of prostate carcinogenesis.

The objective of the present study was to document the treatment efficacy and safety of sorafenib in Japanese patients with advanced renal cell carcinoma (RCC). A retrospective analysis of 50 consecutive patients with metastatic RCC between January 2005 and December 2009 was carried out. Patients received sorafenib after failed cytokine therapy or first-line sorafenib treatment. All received 400 mg of sorafenib orally twice daily. Five of 14 patients with bone metastases were also given bisphosphonates. Tumor response was evaluated every 1-2 months according to the Response Evaluation Criteria in Solid Tumors. Adverse events (AE) were evaluated at each visit during and after treatment, and were recorded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 3.0. Dose modification of sorafenib was permitted if grade 3 or 4 AE occurred. Treatment continued until disease progression or treatment intolerance occurred. Partial response, and stable disease as best objective responses were observed in 11 (22%) and 23 (46%) patients, respectively. Median progression-free survival was 7.3 months and median overall survival was 11.9 months. All patients experienced AE and one or more grade 3/4 AE occurred in 43 of 50 (86%) patients. Although it requires close monitoring, sorafenib treatment seemed to be effective in the present study population.

To investigate the benefit of alpha1-adrenoceptor antagonist naftopidil on the quality of life (QOL) of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS).A total of 99 men with BPH/LUTS were prospectively recruited. The Short Form-8 (SF-8) was used for generic QOL assessment and each parameter was compared with the norm in these patients. Longitudinal changes were evaluated using the SF-8 and the International Prostatic Symptoms Score (I-PSS) at baseline, 4 and 8 weeks after naftopidil administration. The relationship between SF-8 and I-PSS was analyzed.Five of eight components in the SF-8 were significantly lower than the Japanese national norm at baseline. SF-8 score was improved by naftopidil at 4 and 8 weeks in general health (GH) and physical component summary (PCS) in the patients in their 70s. Mental health (MH) and mental component summary (MCS) were improved at 8 weeks in patients in their 60s. When analyzing the whole cohort, SF-8 GH, role emotional (RE) and MH had improved at 8 weeks, which was similar to the norm, and bodily pain (BP) results were better. Compared with the baseline, total I-PSS, storage/voiding symptoms and QOL index scores improved significantly under naftopidil. Each component of I-PSS (except for hesitancy) correlated with SF-8 sub-scales (except for BP) to some extent.BPH/LUTS impairs generic QOL, which is improved by naftopidil treatment. SF-8 can be a useful instrument to assess the efficacy of BPH/LUTS treatment because its simplicity to complete and analyze, and its meaningful relationship to I-PSS.

We retrospectively evaluated the outcome of oral low-dose dexamethasone (DXM) therapy for androgen-independent prostate cancer (AIPC). Between January 1999 and April 2006, 99 consecutive patients with AIPC were enrolled in this study. The median patient age was 70 years (range 46–86), and the median pretreatment prostate-specific antigen (PSA) level was 243 ng/ml (range 8.2–29600). Median follow-up was 41.9 months (range 11.4–170.4). Upon biochemical failure, patients were treated with oral low-dose DXM. A total of 40 of the 99 cases (40.4%) showed a ≥50% decrease in serum PSA levels (PSA responders). Twenty-five cases (25.2%) showed a

Objectives: To examine the pre-emptive analgesic effect of the non-steroidal anti-inflammatory drug zaltoprofen against rigid cystoscopy-associated pain, and compare it with the effect of an anesthetic gel. Methods: Forty men periodically undergoing follow-up office cystoscopy were enrolled in this prospective study. The effects of lidocaine gel alone or in combination with zaltoprofen, were examined. The following parameters were assessed using an 11-point numerical rating scale: pain during injection of gel into the urethra, insertion of rigid cystoscope, and the endoscopic examination of the urinary bladder, pain at the first urination after cystoscopy, and at the first urination in the following morning at home. Results: Pain scores with pre-emptive zaltoprofen plus lidocaine gel were significantly lower than the ones with lidocaine gel alone at the time points of inserting rigid cystoscope into the urethra, viewing inside the urinary bladder and the first urination after cystoscopy. The efficacy of zaltoprofen was more significant in the patients with higher baseline pain score. There was no correlation between pain scores and bladder cancer grading, number of tumors, and time from surgery. Conclusions: Pre-emptive zaltoprofen is able to control cystoscopy-associated pain, which translates into better quality of life for patients. Thus, its use is recommended in the management of these patients.

Endourology and laparoscopic surgery are evolving in accordance with developments in instrumentation and progress in surgical technique. Recent advances in computer and image-processing technology have enabled novel images to be created from conventional endoscopic and laparoscopic video images. Such technology harbors the potential to advance endourology and laparoscopic surgery by adding new value and function to the endoscope. The panoramic and three-dimensional images created by computer processing are two outstanding features that can address the shortcomings of conventional endoscopy and laparoscopy, such as narrow field of view, lack of depth cue, and discontinuous information. The wide panoramic images show an anatomical 'map' of the abdominal cavity and hollow organs with high brightness and resolution, as the images are collected from video images taken in a close-up manner. To assist in laparoscopic surgery, especially in suturing, a three-dimensional movie can be obtained by enhancing movement parallax using a conventional monocular laparoscope. In tubular organs such as the prostatic urethra, reconstruction of three-dimensional structure can be achieved, implying the possibility of a liquid dynamic model for assessing local urethral resistance in urination. Computer-based processing of endoscopic images will establish new tools for endourology and laparoscopic surgery in the near future.

Renal cell carcinoma (RCC) is capable of metastasizing to several organs. Synchronous isolated contralateral adrenal metastasis of the primary RCC is, however, very rare. Herein we report a case of RCC with a huge solitary metastasis to the contralateral adrenal gland that was surgically treated. We scheduled nephrectomy for the left primary RCC and adrenalectomy for the right adrenal tumor. However, at surgery we found a huge right adrenal tumor that had invaded the right kidney, right renal vein, and inferior vena cava. Therefore right nephrectomy was performed simultaneously with resection and reconstruction of the inferior vena cava. Pathological findings demonstrated that the left renal tumor and right adrenal tumor had the same histology. Although the patient required hemodialysis, he remains well at six months postoperatively. So far, there have been only two cases of a solitary contralateral metastatic adrenal tumor that was larger than the primary RCC, thus the present case is the third one.

Neuroendocrine (NE) cells originally exist in the normal prostate acini and duct, regulating prostatic growth, differentiation and secretion. Clusters of malignant NE cells are found in most prostate cancer (PCa) cases. NE differentiation (NED) is the basic character of the prostate, either benign or malignant. NE cells hold certain peptide hormones or pro-hormones, which affect the target cells by endocrine, paracrine, autocrine and neuroendocrine transmission in an androgen-independent fashion due to the lack of androgen receptor. NED is accessed by immunohistochemical staining or measurement of serum levels of NE markers. The extent of NED is associated with progression and prognosis of PCa. Chromogranin A (CGA) is the most important NE marker. In metastatic PCa, pretreatment serum CGA levels can be a predictor for progression and survival after endocrine therapy. It is recommended to measure longitudinal change in serum CGA. The NE pathway can also be a therapeutic target.

Laparoscopic surgery is widely accepted for managing renal disease. Thus, the system used to educate and train novice surgeons in laparoscopic surgery becomes important to reduce the risks of surgery during their training. A prospective study was carried out to determine the usefulness of using panoramic views during laparoscopic surgery.Between April 2004 and March 2007, four novice surgeons started learning laparoscopic radical nephrectomy: two carried out surgery without panoramic views and two used panoramic views. Operating time and blood loss for the initial 10 cases of each surgeon were compared. Panoramic views were obtained by interlacing each video frame of the video images electronically; the images were then processed and displayed during each step of laparoscopic surgery.Panoramic, real-time views could be obtained, and they served as navigation maps. The learning curve of surgeons using the panoramic views was shorter than that of surgeons who did not use panoramic views. Time to ligation of renal artery from port placement and the operating time was shorter (69.0 +/- 21.5 min vs 106.8 +/- 44.9 min, P = 0.0016, 212 +/- 42 min vs 254 +/- 46 min, P = 0.0489, respectively) and the estimated blood loss was less for the surgeons who used panoramic views (87 +/- 109 mL vs 334 +/- 268 mL, P = 0.0005).Panoramic views during laparoscopic surgery shortened operating time and reduced blood loss, indicating their usefulness in assisting novice surgeons to carry out procedures safely and accurately.

The heterodimeric complex composed of rBAT (related to b(0,+) amino acid transporter), a single-membrane-spanning glycosylated heavy chain, and b(0,+)AT, a putative 12-membrane-spanning non-glycosylated light chain, is an amino acid transporter that mediates the activity of system b(0,+), a major apical transport system for cystine and dibasic amino acids in renal proximal tubule and small intestine. The C-terminus of b(0,+)AT has been proposed to play an important role in the functional expression of the heterodimeric transporters. In the present study, to reveal the roles of the C-terminus, we analysed b(0,+)AT mutants whose C-termini were sequentially deleted or replaced by site-directed mutagenesis in polarized MDCKII (Madin-Darby canine kidney II), non-polarized HEK-293 (human embryonic kidney-293) and HeLa cells. Although the deletion of C-terminus of b(0,+)AT did not affect the formation of a heterodimer with rBAT, it resulted in the loss of apparent transport function, owing to the failure of the plasma-membrane targeting of rBAT-b(0,+)AT heterodimeric complex associated with incomplete glycosylation of rBAT. A motif-like sequence Val(480)-Pro(481)-Pro(482) was identified in the C-terminus of b(0,+)AT to be responsible for the C-terminus action in promoting the trafficking of rBAT-b(0,+)AT heterodimeric complex from the ER (endoplasmic reticulum) to Golgi apparatus. This is, to our knowledge, the first demonstration of the active contribution of the C-terminus of a light-chain subunit to the intracellular trafficking of heterodimeric transporters. Because the motif-like sequence Val(480)-Pro(481)-Pro(482) is well conserved among the C-termini of light-chain subunits, common regulatory mechanisms could be proposed among heterodimeric amino acid transporters.

Prostate cancer is androgen-dependent, and hormone therapy, mainly achieved by androgen deprivation, has been one of the main treatment modalities in the clinical management of prostate cancer patients for more than six decades. In the 1980s, luteinizing hormone-releasing hormone agonists, which reduce testosterone to castration levels, were introduced Also, after the 1980s, nonsteroidal antiandrogens were developed in addition to steroidal antiandrogens. Since then, so-called maximum androgen blockade (MAB)/combined androgen blockade (CAB), which is a combination of surgical or medical castration and oral antiandrogens, has been developed. More recently, novel treatment modalities have been developed, such as intermittent androgen suppression, nonsteroidal antiandrogen monotherapy, and alternative antiandrogen therapy after relapse from initial MAB/CAB, The present article focuses on these treatment modalities to review current topics and perspectives with respect to hormone therapy for prostate cancer.

We developed new software that enables three-dimensional (3D) images of the ureter and urethra to be automatically processed from the video image of a conventional endoscope. The entire image of the ureter or urethra is displayed opened in a picture like a 3D map. The locations of lesions and the 3D structure of the prostatic urethra are depicted using this method, which enables quantitative evaluation of lesions and the obstructive potential of the prostatic urethra. Application of the technology in the urinary tract is discussed.

Chromogranin A (CgA) and neuro-specific enolase (NSE) are gaining acceptance as markers of several types of neuroendocrine tumors and the concentration of CgA and NSE have been reported to be elevated in relation to neuroendocrine differentiation of prostate cancer. The aim of the present study was to examine the correlation between the immunohistochemical (IHC) findings and serum value for CgA and NSE in untreated stage D(2) prostate cancer patients.Immunohistochemistry was carried out using antibodies against CgA and NSE in 58 patients and, pretreatment serum CgA and NSE levels were measured by monoclonal immunoradiometric assay in 18 patients with stage D(2) prostate cancer treated by androgen ablation. We examined the relationship of the pretreatment serum level to IHC findings for CgA and NSE in prostate cancer patients to clinicopathological parameters, and prognosis. Also, we evaluated the correlation of IHC findings to serum levels for CgA and NSE.There was a statistically significant correlation between CgA positivity and serum CgA level (P = 0.0421). However, there was no statistically significant correlation between NSE positivity and serum NSE level (P0.05). We divided stage D(2) patients into three groups according to IHC positivity of CgA and NSE. The cause-specific survival was significantly poorer in patients with strongly positive (++) patients for independent CgA and combined CgA with NSE (P = 0.0379). Multivariate analysis of cause-specific survivals in patients with stage D(2) prostate cancer demonstrated that strong IHC stain was considered as independent variable associated with greater risk of death (P = 0.0142).Neuroendocrine differentiation in stage D(2) prostate cancer has attracted considerable attention as a potentially findings prognosis. Thus, CgA had a stronger relationship between serum levels and IHC positivity in contrast to NSE, suggesting clinical usefulness as a tumor marker in predicting the extent of neuroendocrine differentiation in prostate cancer.

We evaluated the efficacy of low dose tamsulosin after extracorporeal shock wave lithotripsy (ESWL) in Japanese male patients with ureteral stone.One hundred and two Japanese male patients with ureteral stones who underwent ESWL were randomly divided into three groups. Group A (38 patients) was given tamsulosin (0.2 mg/day); group B (30 patients) was given c horeito, a herbal medicine (7.5 g/day); and group C (34 patients) received no medication. Stone clearance was assessed at 1, 7, 14, and 28 days after ESWL using plain abdominal radiography and abdominal ultrasonography. After 28 days, stone delivery was checked every 2 weeks.The stone-free rate was 84.21%, 90%, and 88.24% for groups A, B, and C, respectively (P = 0.3425). The mean expulsion time was 15.66 +/- 6.14 days in group A, 27.74 +/- 25.36 days in group B, and 35.47 +/- 53.70 days in group C. The expulsion time of group A was significantly shorter than that of groups B (P = 0.0116) and C (P = 0.0424).The addition of tamsulosin to conservative treatment appeared to be effective in shortening the stone expulsion time.

A 76-year-old man had transitional cell carcinoma of the bladder and underwent orthotopic ileal neobladder, and developed severe nocturnal enuresis. We performed videomanometry in the ileal neobladder and the rectum of the patient. Slow filling of the ileal neobladder showed overactivity (the amplitudes up to 50 cmH2O), which was similar to that normally seen in the rectum (the amplitudes up to 20 cmH2O). In contrast to the normal rectal sensation, neobladder sensation was markedly decreased. During urination, the patient voided with strain and overactivity, both of which were similar to that seen in the rectum. Urethral sphincter function was preserved in the patient. In conclusion, both decreased sensation and neobladder overactivity, an equivalent to spontaneous phasic contraction of the rectum, contributed to nocturnal enuresis in our patient. Bowel-targeted management may be necessary to minimize nocturnal enuresis in bladder-substituted patients.

The aim of this study was to establish functional computed tomography (CT) imaging as a method for assessing tumor-induced angiogenesis.Functional CT imaging was mathematically analyzed for 14 renal cell carcinomas by means of two-compartment modeling using a computer-discretization approach. The model incorporated diffusible kinetics of contrast medium including leakage from the capillary to the extravascular compartment and back-flux to the capillary compartment. The correlations between functional CT parameters [relative blood volume (rbv), permeability 1 (Pm1), and permeability 2 (Pm2)] and histopathological markers of angiogenesis [microvessel density (MVD) and vascular endothelial growth factor (VEGF)] were statistically analyzed.The modeling was successfully performed, showing similarity between the mathematically simulated curve and the measured time-density curve. There were significant linear correlations between MVD grade and Pm1 (r = 0.841, P = 0.001) and between VEGF grade and Pm2 (r = 0.804, P = 0.005) by Pearson's correlation coefficient.This method may be a useful tool for the assessment of tumor-induced angiogenesis.

Laparoscopic surgery for kidney treatment is a common procedure. However, the efficacy of this procedure in patients with several comorbidities has not been well investigated. We conducted a retrospective comparison of results of laparoscopic surgery between patients with several comorbidities and patients with no comorbidity to access the efficacy and safety of this procedure.The subjects were 20 patients with three or more comorbidities (group A) and 46 patients with less than three comorbidities (group B). These 66 patients were 48 men and 18 women with a mean age of 62.3 years (age range, 24-83 years). The data from these two groups were compared for American Society of Anesthesiology (ASA) physical status score, previous surgical history, duration of surgery, estimated blood loss, tumor size, complications during and after surgery, conversion rates, time to oral intake, and length of hospital stay.The initial ASA score and age were significantly higher for the patients with comorbidities (P0.0001, P = 0.0008, respectively). All other variables before, during, and after surgery were similar for both laparoscopic groups. However, the incidence of atelectasis of laparoscopy was higher than that of open surgery.Laparoscopic nephrectomy for patients with comorbidities is safe and minimally invasive. Further investigation to prevent atelectasis is necessary.

e16049 Background: The most clinically significant castration level during androgen deprivation therapy (ADT) remains controversial. Moreover, no past studies demonstrated the prognostic impact of ...

The clinical significance of the urinary white blood cell (U-WBC) count and serum C-reactive protein (CRP) level was evaluated in an effort to improve the efficiency of prostate biopsies.We enrolled 228 consecutive patients with serum prostate-specific antigen (PSA) ranging from 3.0 to 20.0 ng/mL, normal digital rectal examination findings, and who underwent prostate biopsies between January 2001 and August 2004. Of these, 157 patients had histologically confirmed benign prostatic disease and the remaining 71 patients had prostate cancer. Patients with a pretreatment U-WBC countor =3 or3/high power field were defined as non-pyuria and pyuria, respectively. The patients were also separated into two groups based on the serum CRP level prior to biopsy. Several clinical factors were compared among these subgroups.Inflammation was histologically detected at rates of 58.1% and 34.1% in the pyuria and non-pyuria groups, respectively (P = 0.0014). The rates of cancer detection were significantly lower in the pyuria, than in the non-pyuria group (P = 0.0384). The cancer detection rates did not significantly differ according to serum CRP levels prior to biopsy.The U-WBC count appears to be a reliable indicator of minute prostatic inflammation. The serum PSA level was elevated in patients with asymptomatic prostatitis. Counting U-WBC is a simple, convenient and non-invasive method that should be valuable part of routine urological examinations.

The aim of the present study was to evaluate the clinical value of the pretreatment serum testosterone (T) level as a potential predictor of prostate cancer risk in screening for prostate cancer.The subjects were 420 patients suspected of having prostate cancer who underwent prostate biopsy, and whose pretreatment T levels were recorded. We checked for association between the presence of prostate cancer and the following clinical factors: pretreatment serum T level, age, pretreatment prostate-specific antigen (PSA) level, digital rectal examination findings, ratio of free to total PSA, prostate volume, and PSA density (PSAD).Overall, there was no significant difference in mean pretreatment T level between patients diagnosed with cancer (3.9+/-2.4 ng/ml) and patients diagnosed with benign prostate disease (BPD; 3.7+/-1.7 ng/ml); diagnosis was based on prostate biopsy. However, among patients with PSA10 ng/ml, the pretreatment T level was significantly higher in patients diagnosed with prostate cancer (4.2+/-2.6 ng/ml) than in patients diagnosed with BPD (3.6+/-1.4 ng/ml) (p=0.007); a similar trend was observed among patients with PSAD0.15 ng/ml/cc. Multivariate analysis indicated that pretreatment T level was an independent significant predictor of positive prostate biopsy (p=0.020). Additionally, the serum T level was significantly lower in patients with a Gleason scoreor=7 (3.7+/-2.1 ng/ml) versus a score7 (4.2+/-1.7 ng/ml) (p=0.030). Also, serum T levels were significantly higher in well-differentiated prostate cancer (4.8+/-2.1 ng/ml) versus moderately differentiated (3.8+/-1.3 ng/ml) or poorly differentiated (3.7+/-1.4 ng/ml) (p0.01).Among relatively low-risk patients, serum T level was an independent significant predictor of positive prostate biopsy, suggesting that the efficiency of prostate cancer screening can be improved by including measurement of serum T level.

To evaluate in a retrospective study the improvements in prostate cancer detection rates for patients with a prostate gland larger than 30 cm3 using a systematic 14-core biopsy strategy compared with a systematic 8-core biopsy.We retrospectively assessed 273 patients with screened prostate-specific antigen (PSA) levels of 3.0 to 50.0 ng/mL. A total of 204 patients with a prostate volume of 30 cm3 or larger and with normal digital rectal examination findings were enrolled in this study. Of the 204 patients, 110 underwent 8-core biopsy and 94 underwent 14-core biopsy of the prostate. We compared the cancer detection rates of prostate biopsy between the 8 and 14-core groups using total PSA, free/total PSA ratio, PSA density, and PSA density adjusted by transition zone volume. We also analyzed the Gleason grade of the biopsy core and the radical prostatectomy specimens.Of the 204 patients, 40 (19.5%) were identified as having prostate adenocarcinoma. The cancer detection rate for the 8 and 14-core groups was 14.5% (16 of 110 patients) and 24.5% (23 of 94 patients), respectively. The 14-core biopsy had a statistically significant greater cancer detection rate than did the 8-core group in patients with a prostate volume of 30 to 40 cm3 (36.7% versus 11.8%, respectively, P0.05) and a PSA density adjusted by transition zone volume of 0.38 ng/mL/cm3 or greater (47.8% versus 20.0%, respectively, P0.05). The difference in tumor grade between the 8 and 14-core biopsy samples was not statistically significant.The 14-core prostate needle biopsy is a recommended method for detecting prostate cancer in a large-volume prostate gland without increasing the risk of complications.

Objectives: The maximum size of adrenal tumors that should be removed by laparoscopic adrenalectomy is controversial. We conducted a retrospective comparison of the results of laparoscopic adrenalectomy between patients with adrenal tumors ≥6 cm (‘large tumors’) and patients with adrenal tumors

The first objective of the present study was to examine the presence of Oxalobacter formigenes (an oxalate-degrading bacterium in the human intestine) according to sex in a large number of Japanese. The second objective was to study the presence of three related genes in Bifidobacterium breve, which is considered to be a new oxalate-degrading bacterim. Fecal samples were collected from 55 male and 37 female healthy volunteers. O. formigenes was detected by a polymerase chain reaction (PCR) and a culture-based method. DNA was amplified by the PCR method including the site of important base sequences of each gene in order to detect oxc, frc, and OxlT. O. formigenes was present in 80% of 54 male and 62% of 34 female subjects in the PCR-based assay, while it was present in 62% of 40 male and 50% of 24 female subjects in the culture-based assay. The partial base sequences of the three related genes in B. breve were determined. The RNA polymerase-binding site in promoters and the rho-independent termination sequence were preserved in oxc and frc. In conclusion, the rate of the presence of O. formigenes was the same as in previous reports. Female subjects showed a 15% lower rate than males. B. breve is considered to be an oxalate-degrading bacterium since it was found to have oxalic acid-degrading ability and three genes involved in oxalate degradation.

To evaluate the occurrence and prevalence of microdeletions in the gamma chromosome of patients with azoospermia.DNA from 29 men with idiopathic azoospermia was screened by polymerase chain reaction (PCR) analysis with a set of gamma chromosome specific sequence-tagged sites (STSs) to determine microdeletions in the gamma chromosome.Deletions in the DAZ (deleted in azoospermia) loci sgamma254 and sgamma255 were found in three patients with idiopathic azoospermia, resulting in an estimated frequency of deletions of 10.7% in idiopathic azoospermia men.We conclude that PCR analysis is useful for the diagnosis of microdeletions in the Y chromosome, which is important when deciding the suitability of a patient for assisted reproductive technology such as testicular sperm extracion-intracytoplasmic sperm injection (TESE-ICSI).

BACKGROUND: Prostate cancer (PCa) is the most frequently diagnosed cancer and the second leading cause of cancer death among men in developed countries. Disease progression and the development of hormone refractory disease remain major cause of cancer-related death.Understanding the molecular mechanisms of PCa progression and metastatic pathways using currently available genomic approaches would help to improve therapies for and prevention of the disease. Our recent study of microRNA (miRNA) expression signature of PCa has revealed that microRNA-218 (miR-218) was significantly downregulated in cancer tissues, suggesting that miR-218 may be a putative tumor-suppressive miRNA in PCa. The aim of this study was to investigate the functional significance of miR-218 in PCa and to identify novel miR-218-regulated cancer pathways and target genes involved in PCa oncogenesis and metastasis.METHODS: The expression levels of miR-218 were validated using real-time RT-PCR using PCa clinical specimens and cell lines (PC3 and DU145). Cell proliferation, migration and invasion assays were performed to investigate the functional significance of miR-218 and its target gene, LIM and SH3 protein 1 (LASP1) in PCa cell lines.Cells were transfected with mature miR-218 or si-LASP1 by reverse transfection methods. Genome-wide gene expression data and in silico analysis were used to identify the molecular pathways and putative targets regulated by miR-218.The luciferase reporter assay was applied to identify the actual binding site of miR-218 in target gene. The expression of LASP1 was investigated by immunohistochemistry.RESULTS: The expression levels of miR-218 were significantly downregulated in PCa tissues and PCa cell lines. Restoration of miR-218 in PCa cell lines revealed that miR-218 significantly inhibited cancer cell migration and invasion.Gene expression studies and luciferase reporter assays showed that LASP1 was directly regulated by miR-218. Silencing LASP1 resulted in significant inhibition of cell migration and invasion in PCa cells.The expression of LASP1 was upregulated in cancer tissues as demonstrated byimmunohistochemical staining.CONCLUSIONS: The miR-218 was frequently reduced in PCa clinical specimens and appeared to function as a tumor suppressor through regulation of oncogenic LASP1. The identification of novel molecularpathways and targets regulated by the tumor suppressive miRNAs may lead to a better understanding of PCa progression and metastasis, and the development of new therapeutic strategies to treat this disease. Citation Format: Rika Nishikawa, Yusuke Goto, Takashi Kinoshita, Shinichi Sakamoto, Takeshi Chiyomaru, Hideki Enokida, Satoko Kojima, Masayuki Nakagawa, Yukio Naya, Tomohiko Ichikawa, Naohiko Seki. Tumor suppressive microRNA-218 inhibits cancer cell migration and invasion via targeting LASP1 in prostate cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4371. doi:10.1158/1538-7445.AM2014-4371

Voiding dysfunction is a common disease among the elderly male population. However, few studies have elucidated the flow dynamics of the disease mechanism. We attempted to clarify the fluid dynamics of urine in the prostatic urethra (PU) in patients with bladder outlet obstruction (BOO), a common disease associated with voiding dysfunction. A model of normal PU and three phase models following the BOO progression were prepared using 3D CAD software tracing cystourethroscopic images. In fluid dynamics computation, the normal detrusor pressure was applied to the bladder side in each model. Results of fluid simulation were compared for flow trajectory line, fluid energy dynamics using Bernoulli's principle and pressure loss coefficient. In the BOO model, a large vortex was observed adjacent to the bladder outlet (BO) with increased hydraulic energy loss during the passage through the tract. In contrast, opening of the BO eliminated the vortex with reduction of hydraulic energy loss. These results corresponded with clinical data measured by catheterized pressure sensors inserted into the urethra, and those of urethral diameter measured by urethrography. Fluid dynamics simulation using CAD models can clarify the mechanism of voiding dysfunction in a less invasive and more acceptable way in patients with BOO.