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Eleven cases of squamous cell carcinoma of the prostate have been previously reported in the Japanese medical literature. Patients with this type of carcinoma have dismal prognoses. Herein, we report a case in a 61-year-old man who was admitted to our hospital and whose chief complaints were dysuria and high fever. Pyuria, bacteriuria, and the results of a digital rectal examination suggested acute prostatitis. Despite the administration of antibiotics, the dysuria did not improve. A transrectal needle biopsy was performed, and histology of the tissue showed squamous cell carcinoma. After chemotherapy using methotrexate, pirarubicin, and cisplatin, total pelvic excentration was performed. At 12 months after the operation, the patient is alive with no evidence of the disease.

A 63-year-old male was admitted to our hospital with the complaint of bilateral hydronephroses. Total cystectomy and ileal conduit construction were performed because of bladder tumor (TCC, G2, pT2N0M0) in 1985. The patient remained asymptomatic, but bilateral hydronephroses was observed by ultrasonography in 1997. DTPA renogram showed the delayed excretion. Conduitgraphy and antegrade pyelography revealed that the conduit was narrow like a pinhole at 2 cm distal region from the anastomotic site of the urinary duct. The stenotic region was inflated by a 24 Fr inflation-balloon-catheter. Chronic inflammation, which was thought to be caused by infection, was detected at the stenotic conduit by biopsy. Hydronephroses disappeared after the operation and the postoperative course was uneventful.

We report a case of high flow priapism secondary to arteriovenous fistula produced by perineal trauma in a 43-year-old patient. Diagnosis was based on the result of gasometry in cavernous blood and color doppler sonography. Superselective embolization of the deep artery of the penis was performed with good results. After 6 months of treatment, erection and sexual function were normal. Our case demonstrates that this procedure is a safe and effective therapy for high flow priapism.

A 61-year-old woman visited our hospital complaining of right flank pain and fever. The radiograph demonstrated multiple renal calculi. Radio renography showed no uptake in the right kidney. Therefore, we diagnosed her with pyonephrosis, and recommended open nephrectomy. However, she selected the conservative treatment with extra corporeal shockwave lithotripsy (ESWL). In spite of disappearance of multiple calculi, pyuria continued for 3 months after ESWL. Retrograde pyelography showed a fistula from the right pelvis into the duodenum. The patient was successfully treated by nephrectomy and duodeno-fistelectomy.

The clinical efficacy of fleroxacin (FLRX), a new fluoroquinolone, for acute uncomplicated cystitis (AUC) in women was assessed. Two regimens, 3-day and 7-day courses of FLRX, 200 mg once a day, were compared. Clinical and bacteriological efficacy were evaluated after the therapy, and recurrence rate was evaluated 1 week and 4 weeks after termination of the therapy. Of 136 registered subjects, 35 in the 3-day group and 47 in the 7-day group were evaluated. According to the criteria of Japanese UTI Committee (3rd edition), the rate of excellent results was significantly higher in the 7-day group (78.9%) than in the 3-day group (48.6%), but the overall clinical efficacy rate was similar being 100% and 97.9%, respectively. Although no recurrence was seen 1 week after the therapy in either group, recurrence was seen in 14.3% and 7.4% of the cases in the 3-day and 7-day groups, respectively, 4 weeks after the therapy. Adverse reactions were observed in 2 and 3 cases in the 3-day and 7-day groups, respectively. Both 3-day and 7-day regimens of FLRX treatment showed good efficacy. Although the 7-day treatment was superior to the 3-day treatment as to high rate of excellent results and low rate of recurrence, the 3-day treatment was concluded to be sufficient for AUC.

Of 815 patients with prostatic carcinoma registered in Tokai Urological Cancer Registry between 1989 and 1991, 683 patients followed up until April to July 1992 were analyzed. The patients were between 48 and 94 years old (mean 73.2). The clinical stage was A in 96 (14.1%), B in 118 (17.3%), C in 117 (17.1%) and D in 352 (51.5%) patients. The histological study well differentiated adenocarcinoma in 150 (22%) patients, moderately differentiated adenocarcinoma in 305 (44.6%), and poorly differentiated adenocarcinoma in 194 (28.4%) patients. There were 12 undifferentiated adenocarcinomas and 22 were not classified. The incidence of patients with poorly differentiated adenocarcinoma increased with the progression of clinical stage. Hormonal therapy was the main treatment (92.8%) and a variety of hormonal therapies with surgery or chemotherapy were attempted through out the clinical stages. Overall survival rate at 5 years was 48.6%. The 5-year survival rage for stage A, B, C and D carcinoma was 84.7, 93.1, 51.8 and 30.3%, respectively. Significant differences in the survival of patients were noted among stage A or B, stage C and stage D (Logrank test: p < 0.0001). The 5-year survival rate was 70.2% for well differentiated, 53.0% for moderately differentiated, and 32.6% for poorly differentiated adenocarcinoma (Logrank test: p < 0.0001). Disease-specific death was observed in 128 patients (66%), and cardio- or cerebrovascular death accounted for 16 (8%) deaths.

Polyamine concentrations of human cancerous and non-cancerous tissues from the kidney, ureter, bladder were measured by a new enzymatic method for isolation and determination of polyamines. In cancerous and non-cancerous tissue of the organs studied, the spermine level was highest followed by the spermidine and diamine levels. The concentrations of diamine, spermidine and spermine in cancerous tissues were significantly higher than those in non-cancerous tissues, but there was no significant difference in the spermidine/spermine ratio between the cancerous and non-cancerous tissues. These data suggest that polyamines are produced above the normal levels in pathological conditions such as renal cell carcinoma, ureteral cancer and bladder cancer.

The enzymatic method for isolation and determination of urinary polyamines was modified to measure the polyamines in tissue. High recovery rates of polyamines in tissue by the enzymatic method were obtained, namely, 104.5 +/- 7.4% for diamine, 104.7 +/- 23.3% for spermidine and 104.8 +/- 7.5% for spermine. The results obtained by this method correlated well with those obtained by high performance liquid chromatography, and a close correlation was demonstrated for all fractions: diamine r = 0.8991, y = 0.9916x + 0.0499; spermidine r = 0.8936, y = 1.2073x + 0.1005; spermine r = 0.8921, y = 1.2200x-0.2194, (n = 13).

1. Six patients with bladder cancer and three patients with vesico-vaginal fistula underwent operation with this technique. The 5 male and 4 female patients ranged in age at the time of surgery from 44 to 66 years. The patients were followed for 3 to 37 months. 2. There was no operative mortality. But 5 patients died subsequent (beyond 30 days) to this urinary diversion. Two of five patients died of cancer recurrence, I of cardiac infarction, and 2 of electrolyte imbalance that might be considered as a result of inappropriate postoperative care. 3. No significant changes in serum sodium and BUN occurred. Serum potassium level varied with the case and should be watched periodically following the diversion. All of the patients experienced hyperchloremic acidosis, so it seemed necessary to give oral bicarbonate therapy consecutively. 4. Three of 9 patients had experienced episodes of pyelonephritis during the first postoperative month. But no recurrent bout was encountered in the late postoperative period. 5. Of eleven renal units with normal preoperative pyelogram, 3 remained normal postoperatively. Of eight deteriorated renal units one improved. 6. Urinary frequency of the patients after operation was 5-15 times by day, and 2-5 times by night. Urine and stools were passed separately in 5 patients. 7. Although this urinary diversion have seemed to be not so satisfactory method in our series, we feel that long-term evaluation of this technique in a larger number of cases is necessary to definitively assess as the preferred method of diversion.

Therapeutic effect of Robaveron Tablet (KN-7) was studied on 128 patients suffering from neurogenic bladder. Robaveron Tablet was administered 6 tablets daily for 3 weeks. The effect was evaluated by the residual urine, subjective symptoms, cystometric findings, urethral pressure profile and uroflowmetry. Remarkable decrease of residual urine was observed regardless of position of injury. The pressure amplitude defined as the difference between the maximum voiding pressure and the maximum resting pressure increased on any group of neurogenic bladder. The effectiveness, rated as moderately improved or better was 76.9% for brain disorders, 58.3% for upper motor neuron lesion and 75.7% for lower motor neuron lesion of spinal injuries, 58.3% for peripheral nervous injuries and 100% for others. No remarkable abnormality was observed in the results of side effects or clinical laboratory tests.

A 50-year-old man with the symptom of anal pain was treated by pelvic exenteration, ileal conduit diversion and artificial anus. The pathologic diagnosis was leiomyosarcoma of the prostate. At 5 months post-operatively, the patient had no evidence of metastasis or recurrence.

Two cases with angiomyolipoma were reported. The one was a 52-year-old housewife whose chief complaint was pain in the right abdomen. Her past history included adenoma cebaceum on the face, fits of epilepsy in her infancy, ichthysislike exanthems in lower thighs and kidney tumor on both sides on IVP. On the diagnosis of Bourneville-Pringle phacomatosis, she underwent an operation for the removal of the right kidney and partial resection of the uppermost part of the left kidney. Histopathologically, she was diagnosed as angiomyolipoma. The other case was a 36-year-old housewife whose chief complaint was pain in the right abdomen with cholelithiasis. In the course of the operation to remove the gallbladder, a right kidney tumor was detected accidentally, resulting in the concurrent removal of the right kidney. Histopathologically, a diagnosis of angiomyolipoma was made. The latter case was free from the Bourneville-Pringle phacomatosis. To the best of our collection, a total of 80 cases, including these cases, has been reported in Japan. A clinical statistic observation was made with priority given to these cases.

The enzymatic method for isolation and determination of urinary polyamines was modified to measure the polyamines in the blood. High recovery rates of polyamine in blood by enzymatic hydrolyzation were obtained, namely, 101.9 +/- 4.4% for diamine, 96.0 +/- 5.4% for spermidine and 104.1 +/- 3.3% for spermine. Furthermore excellent linearity was demonstrated. Within-run precision of polyamine in blood was excellent, namely, in C.V., 1.15% for Reaction 1, 2.11% for Reaction 2 and 2.79% for Reaction 3. This method was compared with high pressure liquid chromatography (HPLC), and a close correlation was demonstrated for all the fractions: diamine r = 0.8824, y = 1.367x+0.0417 (n = 15); spermidine r = 0.9878, y = 0.806x+5.218 (n = 15); spermine r = 0.9764, y = 1.068x-0.9195 (n = 15).

A 47-year-old woman presented with the chief complaint of gait disturbance and pain of bilateral lower limbs. She was diagnosed as having necrotizing myelitis because myelography was normal and incidentally bilateral adrenal tumor was recognized by ultrasonography and computed tomography. Left adrenalectomy was performed under the diagnosis of bilateral non-functioning adrenal tumor or metastasis to the adrenal glands with unknown origin. The tumor was 10 x 6 x 3 cm in size and 175 g in weight. The pathological diagnosis was non-Hodgkin lymphoma (diffuse large cell type). After combination chemotherapy of vincristine, cyclophosphamide, prednisolone and adriamycin, residual right adrenal mass showed a remarkable reduction, but unfortunately she died 5 months later postoperatively because of complications of lung edema and pneumonitis.

1974年1月より1981年6月までに岐阜大学泌尿器科において施行した恥骨上式前立腺被膜下切除術123例について, 統計的観察をおこなった.1)最年少48歳, 最年長89歳で平均年齢は70.1歳であった.2)平均術中出血量は590 mlであったか, 硬膜外麻酔が全身麻酔に比し有意に出血量が少なく, 麻酔方法が出血量の最大の因子であった.摘出重量と出血量にも相関を認めた.3)摘出重量は平均33.4 gで, 年齢が増加するにつれ重量も増加していたが, 術中に膀胱頸部硬化症の合併が重量20 g以下で27%と高率に認められた.術前残尿量と摘出重量とには相関を認めなかった.4)潜在性前立腺癌は4.1%に認められた.5)術後の副睾丸炎発症の予防としての精管切断術は意義が少ない.6)術後の尿路感染症は術前の細菌尿の有無とよく相関を示し, 術前の細菌尿に対するコントロールが重要である, Results of operation were analyzed statistically in 123 patients who underwent suprapubic prostatectomy for benign prostatic hypertrophy from 1974 through 1981. Age of the patients ranged from 48 to 89 years and the mean age was 70.1 years. The average amount of blood loss during operation was 590 ml. Amount of blood loss in patients operated under epidural anesthesia was less than that in the patients operated under general anesthesia. Furthermore, significant correlation was observed between amount of blood loss and the weights of enucleated prostate glands. The average weight of enucleated prostate glands was 33.4 g and the weight increased as the patient's age increased. Histological examination of the enucleated specimens revealed occult carcinoma in 4.1% of the patients. Association of bladder neck sclerosis was observed in 27% of the patients whose prostate weighed less than 20 g. Significance of prophylactic vasectomy for the prevention of postoperative epididymitis was considered to be low. Incidence of postoperative bacteriuria was higher in patients who had bacteriuria preoperatively than those without preoperative bacteriuria. Therefore, eradication of preoperative bacteriuria seemed important in the prevention of postoperative bacteriuria. No significant correlation was observed between postoperative residual urine volume and the weight of the enucleated prostate glands.

During our past 13 years of experience, we have seen 3 cases of bilateral testicular tumors, which account for .5.6% of all the testicular tumors seen during this period. Pathologically the 6 tumors were confirmed to be seminomas, but each tumor was supposed to have developed independently of the other tumor. All of the patients were treated with inguinal orchiectomy, irradiation and chemotherapy, and they are alive free of tumors. The contralateral lesion appeared 3 months, 8 months and 9 years after the first tumor had appeared. A total of 161 cases of bilateral testicular tumors reported in Japan are summarized and studied concerning incidence, age, histology, interval, prognosis and mechanism of the tumorigenesis.

A nineteen-year-old man with a painless tumor in the right scrotal area was seen at our Department. The scrotal mass had been noticed from his childhood. The tumor was 8.2 X 5.2 X 5.0 cm weighed 47.3 g. Histological examination revealed hemo-lymphangioma.

健康人18例のCICの平均は2.7%で, SDは±3.0%であり, この成績より2SDに近い10%以下を正常値とした.泌尿器科的良性疾患患者9例のそれは2.9±2.7%であり, いずれの症例ほ正常値であった.腎細胞癌患者9例での陽性率は33%, 前立腺癌患者16例のそれは19%と比較的高値を示したが, 膀胱腫瘍患者21例の陽性率は5%と低く, さらに腎盂尿管腫瘍患者3例においては1例も陽性を認めなかった.なお, 腎細胞癌患者9例についての検討で, 摘出標本の大きさとCIC値との間に相関は得られずむしろ逆相関の傾向を認めた, Circulating immune complexes (CIC) were detected and quantitated in 49 patients with urological malignant diseases (9 cases of renal cell cancer, 3 cases of renal pelvic and ureter cancer, 21 cases of bladder cancer and 16 cases of prostatic cancer), 9 patients with urological benign diseases and in normal subjects by the polyethylene-glycol precipitation complement consumption test (PEG-CC test). The average CIC level was 2.7 +/- 3.0% in 18 normal subjects and the normal range was less than 10% of the CIC level. CIC level of patients with renal cell cancer was 14.3 +/- 20.1%, being elevated in 3 of the 9 patients, that of patients with renal pelvic and ureter cancer was 4.7 +/- 4.6%, being within the normal range in 3 cases, that of patients with bladder cancer was 4.7 +/- 4.4%, being elevated in 1 of 21 patients, and that of patients with prostatic cancer was 8.9 +/- 15.4%, being elevated in 3 of 16 patients. In urological malignant diseases such as renal cell cancer and prostatic cancer the CIC values were relatively high.

進行性前立腺癌患者に対しPeplomycinの投与をおこなった.1)前立腺癌患者8名に対しPeplomycinを筋肉内投与したが, その臨床効果はKarnofsky分類1群は1例のみであった.投与量別には, 少なくとも100 mg投与しなければ効果はまったく認めなかった.副作用として, 肺腺維症2例, 皮膚色素沈着1例, 発熱3例を認めた.2)ホルモン抵抗性前立腺再燃癌で下部尿路通過障害をともなう患者2名に対し, Peplomycinの前立腺癌組織内局注をおこなった.臨床効果は, 1例がKarnofsky分類1-A, 1例が1-Bであり, 排尿障害の改善を目的とする場合, かなり効果が期待できると思われた.副作用は, 発熱および肛門部不快感は必発であるが, ほかにはとくに認めなかった.3)組織内局注用の注射液として, われわれは水溶性剤を用いたが, 組織停滞時間はあまり長くないものの臨床効果の発現には十分と思われた.血中濃度は, Peplomycin 20 mg局注と10 mg静注の場合がほぼ同様の推移を示し, 注意深く副作用防止に努めれば1回20 mgは危険な量とは思われなかった, Peplomycin, a new derivative of Bleomycin, was evaluated clinically for treatment of prostate cancer patients. Peplomycin was injected intramuscularly, 5 or 10 mg every other day, to 8 patients with prostate cancer. Total dose ranged from 30 to 200 mg. According to Karnofsky's criteria, only one case was I-B, other cases were in group 0. Pulmonary fibrosis, one of the major side effects of this drug, was experienced in 2 cases. This anticancer agent was injected directly into the prostate, 20 mg once a week for 5 weeks, to 2 patients who were refractory to estrogen treatment and had lower urinary obstruction for relief of local symptoms. One case was I-A, and the other was I-B. No severe side effect was observed. Serum concentration of Peplomycin after administration was measured by a bioassay. Serum levels of Peplomycin after a local injection of 20 mg and after one intravenous shot of 10 mg were almost equal.

A 13-year-old boy visited our hospital with the chief complaint of right undescended testis and retardation of secondary sexual characteristics. Central hyposmia and sensorineural hearing loss were found. The plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were low and the reaction to LH-releasing hormone (RH) test was poor. After repeated LH-RH tests, a good response in plasma levels of LH and FSH was observed. The diagnosis of Kallmann's syndrome was made from the above findings. The testicular biopsy specimen from him showed immature testis without any developed Leydig or Sertoli cells. To induce secondary sexual characteristics, 2000 I.U. of human chorionic gonadotropin (hCG) was administered to him twice a week for 3 months. The administration of hCG resulted in elevation of plasma testosterone level, swelling of testes, increase of pubic hair and spurt of height.

Statistical observations of 1505 out-patients, 169 in-patients and 156 operations revealed the following results; 1) According to our classification of out-patients, infections were most frequent (505 cases or 33.6%), followed by urogenital tumors (256 cases or 17.0%), urolithiasis (180 cases or 12.0%) and others. 2) Among the diseases of in-patients, urogenital tumors (71 cases or 42.0%) and urolithiasis (36 cases or 21.3%) were predominant. 3) Of the 156 operations, the representative operations were TUR-Bt, cryoprostatectomy and orchidopexy.

1)健常人20例のDiamineの平均は16.6±5.8 μmoles/g.Cr., Spermidineのそれは4.7±2.0, Spermineのそれは0.99±0.51 μmoles/g.Cr.であった.M+3SDよりも高値に陽性を設置した場合, 上記3ポリアミンの陽性値はそれぞれ40, 15及び3 μmoles/g.Cr.であった.2)泌尿器科良性疾患25例では概していづれのポリアミンも陰性であったが, 前立腺肥大症ではDiamine, Spermidineが18例中1例に陽性を呈した.3)尿路性器癌の早期症例において30%の陽性率を超えたのは腎細胞癌におけるDiamineの43%と前立腺癌におけるSpermidineの40%であった.4) 3者のうちいずれか1つが陽性を示す場合の陽性率は腎細胞癌84%, 腎盂尿管腫瘍50%, 膀胱腫瘍50%, 前立腺癌41%であり, 早期症例に限っても腎細胞癌40%と比較的高い陽性率が得られ, 分別定量の有用性が示唆された, A new enzymatic method for isolation and determination of urinary polyamines was presented and basically studied in previous report 1 and 2 in comparison with existing techniques. Using the new method, urinary polyamines were isolated and determined in 56 patients with genitourinary cancer. Urinary polyamines were also determined in 63 controls consisting of 20 normal subjects, 25 patients with benign urological disease and 18 patients with BPH. The mean concentrations of Diamine, Spermidine, Spermine in 20 normal subjects were 16.6 +/- 5.8 mumoles/g Cr, 4.7 +/- 2.0 mumoles/g Cr and 0.99 +/- 0.51 mumoles/g Cr respectively. To emphasize the specificity to cancer, the level of positiveness was modified to a higher value than M+3SD. The positive values thus calculated were 40 mumoles/g Cr for Diamine, 15 mumoles/g Cr for Spermidine and 3 mumoles/g Cr for Spermine. The positive ratios of Diamine in patients with early cancer were 43% in renal cell cancer, 20% in pelvic and ureter cancer, 0% in bladder cancer and 20% in prostatic cancer. Those of Spermidine were 29% in renal cell cancer, 0% in pelvic and ureter cancer, 20% in bladder cancer and 40% in prostatic cancer. Those of Spermine were 29% in renal cell cancer, 20% in pelvic and ureter cancer, 20% in bladder cancer and 0% in prostatic cancer. In early diagnoses, Diamine indicated high positive ratios to renal cell cancer and Spermidine to prostatic cancer. Relatively high positive ratios were demonstrated, when any one of the isolated polyamines was found positive: namely, 57% in renal cell cancer, 20% in pelvic and ureter cancer, 30% in bladder cancer and 40% in prostatic cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Prostatic acid phosphatase (PAPase) activities were determined by double antibody radioimmunoassay developed by Eiken Co. in 18 patients with untreated prostate cancer, 19 patients with prostate cancer under treatment, 80 patients with benign prostatic hypertrophy, 15 patients with cancer of the other organs (3 patients with renal cell cancer, 5 patients with bladder cancer and 7 patients with hepatic cancer) and normal male and female subjects. Mean PAPase values were 2.45± 1.73ng/ml in 8 patients with untreated prostate cancer at stages T, and T 2, 25.41 ±22.49ng/ml in 10 patients with untreated prostate cancer at stages T3 and T4, 1.03±0.57 ng/m1 in 8 patients with prostate cancer at stages T1 and T2 under treatment, 8.26± 12.33ng/ml in 11 patients with prostate 'cancer at stages T3 and T4 under treatment, 1.67 ± 1.27ng/ml in 80 patients with benign prostatic hypertrophy, 1.38±0.48 ng/ml in 15 patients with cancer of the other organs and 1.44±0.60 ng/m1 in 16 normal male and female subjects. PAPase values were significantly higher in patients with prostate cancer at stages T3 and T4 than those in the other groups. Furthermore, PAPase values were significantly higher in patients with prostate cancer at stage T, and T2 than those in patients with benign prostatic hypertrophy, patients with cancer of the other organs and normal male and female subjects. When 3ng/ml was regarded as the upper limit of normal PAPase, 2 out of the 8 patients with prostate cancer at stages T1 and T2, and 7 out of the 10 patients with prostate cancer at stages T3 and T4 showed a positive reaction. False positive results were seen in none of the patients with cancer of the other organs and in none of the normal male and female subjects, but were seen in 7 out of the 80 patients with benign prostatic hypertrophy. In addition, PAPase values were determined by radioimmunoassay in 166 males over 50-years-old of whom serum specimens were obtained by the resident health examination in S village. From the results obtained, determination of PAPase by radioimmunoassay was considered useful in the diagnosis of prostate cancer, especially as a mass screening test for the early diagnosis of prostate cancer.