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Objective: The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real-world clinical practice at a single institution in Japan., Materials and Methods: We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post-void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively., Results: On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre-interventional catheter-dependent patients, 91% achieved catheter independence., Conclusion: Our single-center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia., (© 2024 The Japanese Urological Association.)

An 81-year-old man with castration-resistant prostate cancer experienced general fatigue while receiving enzalutamide treatment. In some patients we encountered the enzalutamide treatment had to be interrupted or the dose decreased because of this adverse effect. We evaluated the patient's general fatigue using the Cancer Fatigue Scale (CFS) score and clarified the quantitative information about his general fatigue. In order to maintain the optimal dose, we advised the patient to take enzalutamide at night. This alleviated the adverse effect, and he could maintain the optimal dose of this medicine. We compared the CFS score before and after switching to nighttime treatment and found improvement. This is the first report of a CFS-based evaluation of the improvement in general fatigue caused by enzalutamide by switching to nighttime treatment.

Objectives: To evaluate urine loss ratio after catheter removal as a predictive factor of urinary continence after radical prostatectomy., Methods: A total of 190 patients who had undergone retropubic radical prostatectomy were evaluated. Urine loss ratio was measured using the 24-h pad test during 7 consecutive days after removal of urethral catheters. Continence rates at 1, 3, 6 and 12 months after operation were evaluated with the urinary function domain of the University of California, Los Angeles Prostate Cancer Index. The desirable urine loss ratio for continent condition at 12 months after the operation was calculated. As desirable target urine loss ratio continence at 12 months was determined by using logistic analysis., Results: Continence rates of all patients at 1, 3, 6 and 12 months after surgery were 13%, 37.8%, 58.9%, and 85.8%, respectively. Continence rates of patients who achieved ≤1% of urine loss ratio within 7 days or ≤5% urine loss ratio within 3 days after catheter removal was 100% at 12 months. Logistic regression analysis proved these urine loss ratio values were significant predictors of continence at 12 months., Conclusions: Urine loss ratio after catheter removal within 7 days is a significant determinant of urinary continence after radical prostatectomy. This parameter could have clinical usefulness to estimate future recovery of urinary continence., (© 2014 The Japanese Urological Association.)

Erectile dysfunction following radical prostatectomy (RP) is still a significant burden as a post-operative morbidity, despite advances in nerve-sparing techniques and penile (erectile function) rehabilitation (PR) programs. We assessed the effects of stimulation with the masturbation device "EGG" on enhancement of erectile response along with administration of phospho diesterase type 5 inhibitor. We also studied the change of self-esteem and motivation for continuation of PR after stimulation with EGG. Eight nonresponders for PDE5-I who underwent retropubic RP were enrolled. Patients' median age was 71.5 years old. No patients received adjuvant therapy for prostate cancer. The patients' erectile response in the penile rehabilitation session (masturbation) with PDE5-I＋manual stimulation and PDE5-I＋stimulation with EGG were evaluated by erection hardness score (EHS). Changes of self-esteem and motivation for penile rehabilitation were assessed by the self-esteem subscale of the Self-Esteem and Relationship (SEAR) questionnaire and one original question, respectively. PDE5-I ＋ stimulation with EGG significantly enhanced EHS compared to PDE5-I＋manual stimulation in the eight patients (p＝0.027). Transformed score of self-esteem subscale score of SEAR questionnaire was significantly increased in the PR session with EGG compared to the PR session with manual stimulation (p＝0.043). Six patients who showed a better erectile response with EGG retained motivation for continuation of PR. PDE5-I＋stimulation with EGG improved the erectile response in post-RP patients. EGG as a masturbation device may have a potential for contribution to successful PR.

Objective: To analyze expectations for sexual life after radical prostatectomy in patients and their partners, and its influence on sexual motivation and bothers in the postoperative period., Methods: A total of 162 patients who underwent retropubic radical prostatectomy and their partners were evaluated. The patients' sexual function, sexual bother and expectations for postoperative sexual life were assessed prospectively at baseline, and at 1, 3, 6 and 12 months after radical prostatectomy. The partner was asked questions about postoperative sexual life before the operation. Sexual function and sexual bother were evaluated by the University of California Los Angeles Prostate Cancer Index. Expectations for postoperative sexual life were studied using three ad hoc questions., Results: The rate of having sexual intercourse and adequate penile rigidity for vaginal penetration at baseline was 29.0% and 21.6%, respectively. A significantly higher rate of patients considered "sexual life is important" (patient 35.2%, partner 13.0%), hoped for "preservation of erectile function" (patient 66.0%, partner 33.3%) and accepted "use of phosphodiesterase type 5 inhibitor" (patient 65.4%, partner 43.2%) compared with their partners (P < 0.001). Patients who had partners with a negative sexual attitude lost sexual motivation 1 year after operation. However, patients with cooperative partners maintained sexual motivation, although they felt greater sexual bother 1 year after radical prostatectomy., Conclusions: There was a significant dissociation in perspectives of postoperative sexual life between patients undergoing radical prostatectomy and their partners. Partners' low expectations are associated with patients' low sexual bother and motivation. Partners' cooperative attitude might contribute to maintaining patients' sexual desire and motivation., (© 2013 The Japanese Urological Association.)

The lipid cell variant of urothelial carcinoma is a rare variant of urinary bladder cancer, comprised of lipoblast-like cells. In this report, we describe a case of the lipid cell variant of aggressive urothelial carcinoma. A 78-year-old man was admitted to the hospital because of gross hematuria. On cystoscopy, an ulcerative lesion, non-papillary architecture, was observed in the lateral wall of the bladder. Transurethral resection was performed. Histopathological findings of the bladder tumor indicated neoplastic cells forming irregular solid nests and sheets. Lipoblast-like neoplastic cells that had eccentric nuclei and cytoplasmic vacuoles were observed, not only in the resected specimen, but also in urine samples. On mucin histochemistry, the tumor cell cytoplasm contained no neutral or acidic mucus. The lipoblast-like cells were positive for cytokeratins (AE1/AE3, CK7) and adipophilin, known as a protein associated with neutral lipid synthesis. In general, it is difficult to prove the existence of intracytoplasmic lipid in formalin-fixed paraffin-embedded materials. This is the first report in which the presence of lipid in vacuoles of the lipid cell variant has been verified by immunohistochemistry., (© 2013 The Authors. Pathology International © 2013 Japanese Society of Pathology and Wiley Publishing Asia Pty Ltd.)

To determine the follow-up schedule in patients with non-muscle-invasive bladder cancer who had remained recurrence-free for 5 or more years, we retrospectively reviewed 258 patients with Ta and T1 bladder cancer who had been free of recurrence for at least 5 years. Of these 258 patients, subsequent recurrences developed in 100 patients. In spite of our recommendation that cystoscopic follow-up be done at 12-month intervals for patients who remained recurrence-free for more than 5 years, 45 had been followed at intervals of more than 12 months (range, 13-77 months) when the recurrences were found. Of 100 recurrent tumors, 20 (20.0%) showed bladder muscle invasion. Muscle-invasive cancer was identified more often in the patients with cytoscopic intervals of more than 12 months than in those of less than 12 months (35.6% versus 7.3%). Therefore, we recommend that cystoscopy be performed at intervals of less than 12 months in patients with non-muscle invasive bladder cancer for recurrence detection before tumors become muscle invasive, even when patients remain free of recurrence for a long period.

Premature ejaculation is a common sexual problem, as is erectile dysfunction. We evaluated silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for premature ejaculation. α1-Adrenoceptor antagonists are widely used for lower urinary tract symptoms, and clinical studies on silodosin have shown excellent clinical efficacy for lower urinary tract symptoms. However, compared with other α1-adrenoceptor antagonists, silodosin appeared to suppress ejaculation in a relatively higher percent of trial participants. This suppression of ejaculation by silodosin suggested its potential for treating premature ejaculation. Consequently, we evaluated the feasibility of off-label silodosin as a new treatment option for premature ejaculation. Eight patients suffering premature ejaculation were treated with silodosin. Silodosin (4 mg) was given 2 h before sexual intercourse. Intravaginal ejaculatory latency time, premature ejaculation profile item, clinical global impression change in premature ejaculation and systemic adverse events were recorded. Intravaginal ejaculatory latency time was significantly prolonged (from 3.4 min to 10.1 min, P = 0.003). All patients answered better (much better) or slightly better for their own premature ejaculation problem compared with pretreatment condition in the clinical global impression change. Premature ejaculation profile also significantly improved. Two (25%), three (37.5%) and seven patients (87.5%) experienced anejaculation, reduced semen volume and discomfort during orgasm, respectively. However, these problems were not of major concern for the participants. No systemic adverse effects were reported. The current results support the possible use of silodosin as a new treatment option for premature ejaculation, and suggest that a placebo controlled study assessing its clinical usefulness would be worthwhile., (© 2011 The Japanese Urological Association.)

Leiomyosarcoma is a malignant soft-tissue cancer arising from tissues containing smooth muscle. It commonly occurs in the gastrointestinal system and retroperitoneum, but is rare in the genito-urinary system. We experienced a case of primary testicular leiomyosarcoma. A 71-year-old man presented with painless swelling of the right scrotal contents for 4 months. A high orchiectomy was performed. Histological examination revealed primary testicular leiomyosarcoma. The patient did not receive any adjuvant therapy. Seven months after the operation, there has been no recurrence. Cases of primary intratesticular leiomyosarcoma are rare. To the best of our knowledge, only sixteen cases have been reported in the literature.

We present a case of isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) in a late onset hypogonadism (LOH) clinic, not diagnosed by examinations in internal medicine. A 54-year-old man showed body weight loss with severe appetite loss, general malaise and hypotension. He visited our clinic for a checkup for LOH after general examinations in internal medicine. His hormonal examination showed undetectable ACTH and cortisol levels. However, the values of other pituitary hormones and testosterone were normal. A load test for anterior pituitary hormone (CRH + TRH + LHRH + GRH test) revealed that the ACTH-cortisol system showed no response although the other pituitary hormones responded. These findings confirmed the diagnosis of isolated ACTH deficiency. Administration of hydrocortisone dramatically improved his symptoms. Symptoms of IAD are similar to those of LOH syndrome and depression. Thus, we should consider IAD as one of the differential diagnoses in LOH clinics.

Objectives: To clarify the influences of shock wave lithotripsy (SWL) treatments for renal and ureteropelvic junction stones on new onsets of hypertension and diabetes mellitus (DM)., Methods: We compared the new onsets of hypertension and DM after SWL in renal and ureteral stone groups. The renal stone group consisted of 772 patients treated with SWL, who had a possibility of renal and pancreatic shock wave damage. The ureteral stone group consisted of 505 patients treated with SWL, who were unlikely to have suffered SWL damage in the kidney and pancreas areas. Both treatment groups received SWL between 1984 and 1994., Results: The rates of new onset of hypertension in the renal stone and ureteral stone groups were 22.8% and 20.0% in men and 23.1% and 20.5% in women, respectively. The rates of new onset of DM in the renal stone and ureteral stone groups were 7.4% and 11.0% in men and 8.7% and 8.7% in women, respectively. There was no significant difference in the new onsets of hypertension and DM between renal and ureteral stone groups depending on each age decade or sex. Treatment for renal stone was not a significant risk factor for new onsets of hypertension and DM by logistic regression analysis., Conclusions: Our findings suggest that SWL treatment for renal and UPJ stones might not be associated with new onset of hypertension or DM.

We reviewed the results of clinical examinations conducted on and antimicrobial susceptibilities to Neisseria gonorrhoeae isolated from 51 patients with gonococcal urethritis who visited our hospital during the period from February 2005 to April 2006. The type of sexual activity by which the bacteria was transmitted was oral sex in 81.6% (40/49) of the patients, and none of the patients used a condom during oral sex. Fifty percent (24/48) of the patients were aware of the risk of getting sexually transmitted diseases (STDs) from having oral sex without the use of a condom. The ratios of drug-resistant N. gonorrhoeae were 56.9% for Penicillin G, 0% for CVA/Amoxicillin, Azithromycin and Minocycline, 5.9% for Cefpodoxime, 2.0% for Ceftriaxone, 0% for Cefodizime, and 84.4% for Ciprofloxacin, Levofloxacin and Gatifloxacin. The bacteria in 7.8% of the cases were beta-lactamase-producing strains. The results of this study indicated that STD from oral sex is prevalent in Sapporo. Increasing resistance to Quinolone was noted, but levels of susceptibility to other drugs remained relatively high.

The goal of this study is to compare surgical and oncological outcomes of laparoscopic nephroureterectomy and the open surgery using the concept of systemic inflammatory response syndrome (SIRS) in addition to common variables. Thirty-six and 23 patients having upper urinary tract urothelial cancer who were operated on with retroperitoneoscopic hand-assisted nephroureterectomy (RHANU) or standard open nephroureterectomy (ONU) retrospectively, were analyzed. Median operation time was 140 (range 70-200) and 60 (range 45-85) minutes, respectively in the RHANU group and the ONU group. The median days to ambulation and hospital stay of the RHANU group were significantly shorter than those of the ONU group. There was no significant difference in the incidence of SIRS and other surgical results between the two groups. In oncological outcome, no significant difference was found in the bladder recurrence rate (RHANU vs. ONU; 52% vs. 45%), local recurrence (0% vs. 0%), distant metastasis (11% vs. 13%) or survival rate (94% vs. 91%) between the RHANU group and the ONU group at 2-year follow-up. There was no port site recurrence in the RHANU group. Although the RHANU may have an advantage in terms of earlier recovery, there were no significant differences in the incidence of SIRS and oncological outcomes between the RHANU group and the ONU group.

Aim: Patients with superficial bladder tumors sometimes have long recurrence-free intervals. We evaluated whether patients with long recurrence-free periods had subsequent recurrences. We also clarified how these patients should be followed., Materials and Methods: We enrolled 244 patients with superficial bladder cancer (62 pTa and 182 pT1) treated by transurethral resection of bladder tumor (TURBT) and adjuvant chemotherapy with pirarubicin. Median follow up was 75.5 months. Patients were stratified by the length of their recurrence-free interval., Results: Recurrences occurred in 124 patients (50.8%). Of 185 patients who did not have a recurrence for the first 3 years, subsequent recurrences occurred in 65 patients; in more than half the first recurrence developed after 5 years or more. Ta tumors had a low recurrence rate (14.5%) with the first recurrence often developing after a long recurrence-free period. Of 40 patients who remained recurrence-free for 3 years or more after at least one recurrence occurred, 16 patients (40%) had subsequent recurrences. Furthermore, most of these patients who remained free of recurrence for more than 5 years eventually had a recurrence. The overall progression rate was 15.6%, and this did not relate to the length of the recurrence-free interval., Conclusion: When patients did not have a recurrence for the first 3 years, tumors subsequently often recurred, even in pTa tumors. In patients with at least once recurrence, subsequent recurrences appear to occur irrespective of the length of the recurrence-free period. Thus, we recommend that all patients with superficial bladder tumors be followed for as long as possible.

Aim:  The objective of the present study was to measure serum free and total testosterone values using the radioimmunoassay (RIA) method in healthy Japanese male volunteers with no current diseases. Methods:  Two hundred and fifty-one healthy men who had no medical illness and received no current medical treatment were selected from 405 male volunteers. Free and total testosterone were measured in blood samples using the RIA method. Results:  Free but not total testosterone significantly decreased with age. Mean free testosterone values from morning blood samples for each age decade from the 20s to the 70s were 17.0, 14.6, 12.5, 10.6, 8.9 and 8.5 pg/mL, respectively. Mean total testosterone values from morning blood samples for each age decade from the 20s to the 70s were 4.7, 4.2, 4.4, 4.2, 4.2, 4.0 and 4.0 ng/mL, respectively. The rates of healthy volunteers that fell within the standard reference ranges for free and total testosterone were 97% and 97%, respectively. However, 19% of the total testosterone values were considered to indicate hypogonadism according to the International Society for the Study of the Aging Male (ISSAM) criteria (<3.17 ng/mL). Conclusions:  Our data corresponded to the standard reference ranges of Japanese men but not the ISSAM criteria. It may be more appropriate to establish a standard reference range for serum testosterone for individual countries. (Reprod Med Biol 2006; 5 : 37-41).

Purpose: A new approach for retroperitoneoscopic radical nephrectomy is introduced. The point of our surgical method is the application of a combination of hand assistance and pure laparoscopic procedures with appropriate surgical steps via the retroperitoneal approach. In our early series we had good surgical results and we completed radical nephrectomy in about 100 minutes using this procedure., Materials and Methods: A total of 20 consecutive patients with renal cell carcinoma (cT1-2) who were operated on with this surgical method were analyzed. Surgical procedures occurred in 5 steps. In step 1 the retroperitoneal space was created manually from a pararectal incision at the umbilicus level. In step 2 the lateroconal fascia was incised and the renal hilar area was exposed with hand assistance. In step 3 hilar dissection was performed by pure laparoscopic procedure with another surgical instrument inserted from the hand device. Step 4 involved the application of hand assistance again for the quick mobilization of the kidney and adrenal gland. In step 5 the intact surgical specimen was retrieved from the hand device., Results: Mean operative time and estimated blood loss were 103 +/- 21 minutes (range 70 to 145) and 49 +/- 85 ml (range 5 to 360), respectively. Mean days to oral intake and ambulation were 1.0 and 1.1, respectively. Operative times of the steps of hilar dissection and mobilization of the kidney and adrenal were shorter than in other series performed by standard retroperitoneoscopic radical nephrectomy. Major complications were not experienced. At this point, no metastasis has been experienced., Conclusions: Our surgical method may have the benefits of the retroperitoneal approach and hand assistance. The retroperitoneoscopic hand assisted method may be another important option in the 3 major approaches for laparoscopic radical nephrectomy, although longer-term followup is clearly required.

We report a case of malacoplakia in the ureter and bladder. A 78-year-old woman was admitted to our department for detailed examination of hydronephrosis. A small-fingertip-sized tumorous yellowish white lesion was detected by cytoscopy at a site that appeared to be the right side of the ureteral orifice. Transurethral resection was performed on the same site. Flat yellowish white protruding lesions were seen at two sites on the right ureter. Michaelis-Gutmann bodies were observed in biopsy specimens from both the bladder and ureter, and a diagnosis of malacoplakia was made. Ascorbic acid and bethanechol chloride were administered postoperatively. Endoscopy performed three months after the operation showed that the protruding lesions in the bladder and ureter had disappeared. Narrowing of the ureter or vesicoureteral reflux has not been seen to date.

Purpose: To elucidate the factors contributing to staghorn stone formation in patients., Materials and Methods: The records of 82 patients (44 men and 38 women) with complete staghorn calculi were reviewed retrospectively for clinical presentation, metabolic disturbances and anatomical abnormalities., Results: There were 79 unilateral and three bilateral cases. The patient performance of the activities of daily life was assessed with the modified Rankin scale (MRS) and it was found that 69 patients were functionally independent (84.1%, MRS 0-1) and 10 patients had a severe disability (12.2%, MRS 4-5). Seven patients had chronic indwelling catheters (8.5%). A positive urine culture was found in 24.4% of patients. Analysis of stone composition revealed magnesium ammonium phosphate and mixed calcium oxalate-phosphate were the most frequently identified types of stone (32.1% and 22.2%, respectively). Urinary pH was low in patients with uric acid stones (mean 5.4). Hyperuricemia, cystinuria and hypercalciuria were found in 14.6%, 2.4% and 37.8%, respectively. Hypercalciuria was found more frequently in calcium-stone cases. Eleven patients (13.4%) showed structural abnormalities of the kidney., Conclusions: Our data show that the patients with severe disability, urinary tract infection and hypercalciuria could be recognized more frequently in staghorn calculi compared with common urolithiasis. However, in Western countries, the frequency of both urinary tract infection and struvite stones is much higher than in our data. Other Japanese authors have also reported the low frequency of struvite stones in staghorn calculi, suggesting that various factors other than urinary tract infection possibly contribute to the formation of staghorn calculi in Japan.

Purpose: To analyze clinical manifestations and endocrinological aspects of the patients who visited our hospital to be examined for partial androgen deficiency in the aging male (PADAM)., Materials and Methods: Two hundred forty-three patients were evaluated. History taking and questionnaires were employed for analysis of their symptoms. Serum total testosterone (T), free-T and other hormones were measured for evaluation of the androgen deficiency., Results: The chief complains of the patients were categorized as psychological symptoms, somatovegatative symptoms, and sexual symptoms, accounting for 51%, 36%, and 13%, respectively. A depressed mood, hot flashes and sweating and erectile dysfunction were dominant in these symptom categories, respectively. The prevalence of the psychological symptoms and somatovegatative symptoms was relatively high in the 30-50-year-old and 60-70-year-old groups, respectively. The free-T, but not total-T, was significantly decreased with aging as measured by the RIA method. Twenty one percent of the patients showed a lower total-T level than the normal range (2.7-10.7 ng/ml). The percentage of those with a total-T level lower than 2.0 ng/dl, which is the criterion for T-replacement recommended by the American Association of Clinical Endocrinologists guidelines, was 9%. Eighty two percent and 30% of the patients had lower free-T levels than the normal range (15.2-43.5 pg/ml) and that of men in their twenties in the Canadian data (9.3-26.5 pg/ml). Depending on the criteria of androgen deficiency, not all patients had low total-T and free-T levels., Conclusion: Patients suspected of having PADAM present various clinical symptoms and endocrinological aspects.

A 68-year-old man was admitted to our hospital for treatment of a recurrent bladder tumor. Histological examination performed after transurethral resection of the bladder tumor (TUR-BT) revealed a nephrogenic adenoma without any evidence of malignancy. After TUR-BT, total cystectomy was performed to control severe irritative symptoms. Prolonged cystitis and intravesical pirarubicin therapy after TUR-BT may have played an etiological role. Our case is the 25th case of nephrogenic adenoma of the bladder reported in the Japanese literature.

Primary signet-ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72-year-old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.

In Japan, there has been a rapid increase in recent years in the incidence of sexually transmitted diseases (STD), particularly in teenagers and people in their twenties. To determine the factors causing this increase in STD, we carried out a questionnaire survey on the sexual behavior of Japanese males. The subjects were 248 male patients who were treated at our outpatient clinic. The results of the survey showed that 1) about 70% of the male patients were infected through sexual intercourse with partners who were not paid for such services; 2) the average number of partners in the past year was 5.8, and the average number of partners was highest for the teenage group and decreased with age; 3) only 29 (12.4%) of the 234 males used condoms; and 4) 192 (82.0%) of the 234 males received oral sex. The results of the survey suggest that a large "sexual network" has been formed among young Japanese people and that a large percentage of young Japanese people are engaged in unprotected sex.

A 58-year-old man presented with a stone within the dilated intravesical ureter, which was probably attributable to a previous ureteroscopy. Transurethral incision of the right intravesical ureter and lithotripsy were carried out without subsequent urinary tract impairment. Although some complications resulting from ureteroscopy, such as ureteral stricture, ureteral perforation and vesicoureteral reflux, have been reported, this complication is considered to be very rare.

We report a case of small cell carcinoma of the urinary bladder. A 60-year-old man with microscopic hematuria was referred to our hospital. Cystoscopy revealed a sessile tumor on the left lateral wall of the urinary bladder. The patient underwent transurethral resection of the bladder tumor (TUR-Bt). Because of muscle invasion (pT2), total cystectomy was recommended, but was not performed because the patient would not give consent for the operation. Six months after TUR-Bt, invasive bladder tumor recurred and total cystectomy was performed. Pathological examination of the operative specimen revealed small cell carcinoma. Adjuvant combined therapy of irradiation and chemotherapy (nedaplatin and etoposide) was ineffective. Metastases to retroperitoneal lymph nodes, lung and liver were detected soon after the adjuvant therapy. The patient died 15 months after his first visit to our hospital.

We evaluated the availability of NMP22 for the diagnosis of urothelial cancer. Of 154 patients with gross hematuria or microscopic hematuria, 14 patients with bladder cancer and 4 patients with upper urothelial cancer were detected. Of 73 patients continued to be followed for urothelial cancers, 11 patients with bladder cancer were detected. NMP22 was not available when a large number of RBC was present in urine. Also, NMP22 was significantly higher in patients with urothelial cancers. Interpretation of the ROC curve indicated an optimal cutoff value of 9.2 u/ml. Using 9.2 u/ml as a cutoff, the sensitivity and specificity were, respectively 87.0% and 64.0% in patients with hematuria, and 81.8% and 78.7% in patients with a history of TCC. This indicated that when NMP22 was used for the diagnosis of urothelial cancers, 12.0 u/ml, the value recommended as a cutoff in Japan, might be too high to differentiate patients with urothelial cancers.

Two patients, aged 53 and 55, discharged stones spontaneously. Infrared spectrophotometry of the stones demonstrated silicate. They had no history of taking magnesium silicate. Thirty cases of silicate calculi previously reported in the Japanese literature are reviewed.

We herein report the clinical statistics on new outpatients over five years from 1994 at our hospital. The average number of new outpatients per year was 8,534.4 (8,366-8,658) and there was only a slight variation in the number over the last five years. The male to female ratio was 1.61:1. Twenty-one percent of the outpatients were referred to us by other sources. The representative operations on outpatients were circumcision, vasectomy, resection of condylomas and resection of caruncles. A statistical study was made on new outpatients according to the international classification of disease. There were 197.0 (2.3%) malignant urogenital tumors per year. There was a tendency for sexually transmitted diseases to increase over the last five years. In males, the major diseases were upper urinary tract stones (23-27%), benign prostatic hypertrophy (19-26%) and prostatitis (15-24%). In females, they were cystitis (57-59%), upper urinary tract stones (17-18%) and neurogenic bladder (3-4%). We conclude that our hospital plays a major role as a private urological hospital.

A case of transitional cell carcinoma of the bladder in a 18-year-old female is presented. Cystoscopic examination revealed a papillary tumor on the left lateral wall. Histopathology of the excised tumor showed transitional cell carcinoma, G1 > 2, pT1a. Recurrence has not been observed for about 1 year, after intravesical pirarubicin therapy.

A 67-year-old man visited our hospital with the chief complaint of painless swelling of the left scrotal content. An elastic hard mass was palpable in the left scrotum. Resection of the tumor, including the left scrotal skin, was performed. The tumor originated from the scrotal wall and did not communicate with the testis, the epididymis or spermatic cord. Histologically, the tumor was diagnosed as a malignant mesenchymoma composed of liposarcoma, chondrosacoma and osteosarcoma. Malignant mesenchymoma is very rare, especially in the scrotum. Our case that originated from the scrotal wall is the first one reported in Japan.

Benign tumors of the renal pelvis are relatively rare, and only a few reports have been published so far. Recently we experienced a case of a 50-year-old woman with a fibroepithelial polyp in the left pelvis. Drip infusion pyelography and abdominal CT revealed a filling defect and tiny renal stones in the left pelvis under the study of her urinary blood occult. A transitional cell carcinoma of the renal pelvis was suspected, so a left total nephroureterectomy was done. The pathological diagnosis of this tumor was fibroepithelial polyp. As it is said that preoperative diagnosis of such a polyp is difficult, preoperative ureteroscopy or perioperative pathological diagnosis by frozen sections should be attempted. But it is difficult to avoid a nephroureterectomy because low incidence of the disease.

We evaluated the protective effects of manidipine, which is a long-lasting calcium-channel blocker, against damage to spermatogenesis arising from hypertensive vascular changes in stroke-prone spontaneously hypertensive rats (SHRSP). SHRSP showed severe hypertension at 11 weeks of age, followed by hypertensive changes in intratesticular arterioles from 15 weeks of age. Manidipine lowered the blood pressure and the hypertensive vascular changes of intratesticular arterioles in SHRSP. The percentages of atrophic seminiferous tubules and tubules with less-differentiated germ cells were increased in SHRSP at 23 weeks of age, although the administration of manidipine preserved spermatogenesis at a normal level. The transferrin concentration in testicular cytosol was comparable, whereas insulin-like growth factor-I (IGF-I) was reduced from 19 weeks of age in SHRSP. Manidipine preserved the normal IGF-I concentration. Therefore, manidipine prevented the development of hypertensive vascular changes in the testis and maintained normal Sertoli cell function. As a result, manidipine protected spermatogenesis in SHRSP. These findings also suggested that hypertensive vascular changes in the testes play the most important role in spermatogenic damage in SHRSP.

It is reported that some elderly males exhibit both hypospermatogenesis and intratesticular arterial changes. These arterial changes are thought to contribute to spermatogenic damage. In this study the process of the damage to spermatogenesis induced by such changes was evaluated using stroke-prone spontaneously hypertensive rats (SHRSP). SHRSP showed a rapid increase of blood pressure, followed by hypertensive vascular changes. At 23 weeks of age, 61.8% of seminiferous tubules were atrophic in SHRSP, simultaneously with the development of hypertensive vascular changes. In addition, the transferrin concentration in the cytosolic fraction of the testicular homogenate was decreased at 23 weeks of age exactly when the severe damage to the spermatogenesis was seen, suggesting that Sertoli cell function in SHRSP regressed at 23 weeks of age. Based on these findings, it was suggested that the decline in the Sertoli cell function caused by the hypertensive vascular changes is part of the mechanism whereby spermatogenic damage occurs in SHRSP.

1. The process of the spermatogenetic damage induced by hypertensive vascular changes was studied with stroke-prone spontaneously hypertensive rats (SHRSP). 2. In SHRSP, hypertensive changes in intratesticular arterioles developed from 19 weeks of age. 3. At 23 weeks of age, a severe reduction in the number of mature and immature spermatids was observed. 4. The transferrin concentration in testicular cytosol was decreased at 23 weeks of age, suggesting that Sertoli cell function in SHRSP had regressed. 5. In conclusion, it was suggested that the decline in Sertoli cell function as a result of hypertensive vascular changes is part of the mechanism whereby spermatogenic damage occurs in SHRSP.

1. We evaluated the protective effects of manidipine on spermatogenic damage induced by the hypertensive vascular changes in stroke-prone spontaneously hypertensive rats (SHRSP). 2. Blood pressure reached more than 250 mmHg in SHRSP at 15 weeks of age, and thereafter the hypertensive changes in testicular arterioles developed. Manidipine reduced both the blood pressure and the hypertensive vascular changes. 3. Although immature and mature spermatids greatly diminished in SHRSP at 23 weeks of age, manidipine could preserve almost normal spermatogenesis even at 23 weeks of age. Transferrin concentration in testicular cytosol, which was considered to be indicative of the Sertoli cell function, in SHRSP with manidipine administration was significantly higher than that in SHRSP with no treatment at 23 weeks of age. 4. In conclusion, manidipine could prevent the development of the hypertensive changes in intratesticular arterioles and maintain normal Sertoli cell function. As a result, manidipine protected spermatogenic damage in SHRSP.

We investigated the spermatogenic function of patients with testicular cancer, and the influences of anti-cancer chemotherapy on testicular function in these patients. Fifty-one patients with testicular cancer were selected for evaluation of their testicular function, including spermatogenesis and endocrinological function, before and after chemotherapy with anti-cancer agents. Before chemotherapy with anti-cancer agents, 22 of 49 patients (44.8%) had a sperm concentration of less than 20 x 10(6)/ml, and 8 patients (16.3%) showed azoospermia. The mean sperm concentration of the patients with testicular cancer was 29.0 x 10(6)/ml before therapeutic chemotherapy with anti-cancer agents, but within 3 months after chemotherapy, it decreased to 3.86 x 10(6)/ml (p < 0.01). Fifteen of 19 patients (73.7%) were revealed to have azoospermia. Damage to spermatogenesis became more severe with the number of chemotherapy treatment. No patients had a detectable sperm count at the completion of 3 or more courses of chemotherapy. But some patients who received 3 courses or more of chemotherapy showed recovered sperm counts after 2 or more years. Thus, a lack of sperm after chemotherapy for cancer did not necessarily indicate inability to recover spermatogenesis over 2 years after chemotherapy. Serum FSH levels of the patients were 5.62 +/- 3.43 mIU/ml before chemotherapy, and 19. 70 +/- 17.06 mIU/ml (p < 0.05) at the time of its completion. Serum FSH levels could reflect damage to spermatogenesis in these cases. Cases in which spermatogenesis did not recover may have higher serum FSH levels than those with recovery of spermatogenesis.

To investigate the relation between testicular transferrin and insulin-like growth factor-1 (IGF-1) secreted by Sertoli cells and the differentiation of germ cells in the rat, testosterone and/or purified FSH was administered to rats medically hypophysectomized by an LH-RH agonist. Spermatogenesis was quantitatively analyzed and concentrations of intratesticular transferrin and IGF-1 were measured by radioimmunoassays. The last step of spermatogenesis was quantitatively restored by combined administration of testosterone and purified FSH. Intratesticular IGF-1 concentrations were significantly increased by combined administration of testosterone and purified FSH. From these observations, it is surmised that IGF-1 may have a stimulatory effect on the last step of spermatogenesis.

We have already reported that the rate of increase in the estradiol/testosterone ratio (E2/T ratio) following human chorionic gonadotropin (hCG) injection has prognostic value in the treatment of oligozoospermia. It was found that the rate of increase in the E2/T ratio was statistically greater in the therapeutically ineffective cases compared to the therapeutically effective cases. The present study was planned in order to elucidate the relationship between the changes in the endocrinological milieu, especially the change in the E2/T ratio, and the therapeutic efficacy when clomiphene citrate was administered. Thirty-eight oligozoospermic patients were administered 25 mg of clomiphene citrate daily for 3 months. Sixteen of the 38 (42.1%) cases showed improvement of more than 10 x 10(6)/ml in sperm concentration. The rate of increase in the E2/T ratio of the effective cases (0.90 +/- 0.43) during the administration of clomiphene citrate was statistically (P = 0.02) lower than that of the ineffective cases (1.44 +/- 0.80). The rate of increase in the E2/T ratio during clomiphene citrate treatment showed a statistically positive correlation (r = 0.542) with the rate of increase following hCG injection performed before clomiphene citrate treatment. The rate of increase in follicle-stimulating hormone (FSH) in the ineffective cases (2.16 +/- 1.01) was statistically higher than in the effective cases (1.50 +/- 0.43).(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of infections by the use of antimicrobial agents should be made essentially in a dose close to the minimally required dose. Acute uncomplicated cystitis in female fits as the subject for a single-dose therapy since it is an infection reactive relatively easily to antimicrobial agents. Accordingly, an assessment has been made regarding the therapeutic results of the single-dose therapy in 76 female cases of acute uncomplicated cystitis by the use of LVFX 200 mg which is a new quinolone. The urinary concentration more than MIC90 to Escherichia coli is sustained for about 3 days by this single-dose therapy. As a result of judging the therapeutic results from the reactions of the three clinical findings of pain on micturition, pyuria and bacteriuria, excellent therapeutic results were obtained with effective rates being 100% (76/76) on the day 3, 93.9% (46/49) on the day 7 and 94.4% (34/36) on the day 14. The rate of cystitic symptoms which recurred posed no problem, being 12.5% (5/40) up to three months, as investigated by a questionnaire. As a result of performing close urological examinations such as cystoscopy on six cases with insufficient results or recurrence, we could detect mild underlying conditions which are considered to be intractable factors in the bladder in three cases. From the above results, the single-dose therapy of acute uncomplicated cystitis in the female by LVFX which is a new quinolone was considered to be an excellent therapeutic drug from its characteristics such as its therapeutic results being the same as the conventional therapy by daily administration, excellent drug compliance, low cost, hard selectiveness of resistant strains, less side effects and furthermore it gives the opportunity of detecting a latent and mild underlying condition.

We report on a 5-year-old boy with functioning adrenocortical carcinoma as a proband of a specific pedigree with several young family members who had cancer. Most of the members who died of cancer had early onset of osteosarcoma, hepatoblastoma or malignant lymphoma. The finding of cancer aggregation in the family corresponded to the criteria for the cancer family syndrome.

Some patients develop hypertension after adrenalectomy for primary aldosteronism. We treated 60 cases with primary aldosteronism, and the percentages of cases manifesting hypertensive blood pressures after operation were as follows: 40.0% at the first month, 24.2% at the second year, 30.4% at the 5th year after operation. What are the most important clinical factors relating to postoperative blood pressure? Knowledge of those factors would help in predicting the postoperative blood pressure in cases with primary aldosteronism. The relationships between the postoperative blood pressure and several clinical factors were evaluated for a certain postoperative period using multiple regression analyses. The results were as follows: 1. The duration of preoperative hypertension is the major determinant at the second month after operation. 2. The histological findings for the kidney are the major determinant at the 6th month and the first year after operation. 3. At the second year postoperation, the histological findings for the kidney and the familial history of hypertension are the major determinant respectively. 4. The familial history of hypertension is the most determinant at the 5th year after operation. It is concluded that the preoperative duration of hypertension and the histological findings for the kidney are helpful in predicting blood pressure during the first 2 years after operation, while the familial history of hypertension influences the postoperative blood pressure thereafter.

To verify the role of the dopaminergic mechanism in the control of gonadotropin secretion and aging of this mechanism in men, we studied serum gonadotropin response to LH-RH (100 micrograms i.v.) in basal condition and during dopamine infusion (DA 4 micrograms/kg/min). Seven young males (24-29yr.) and twenty aged males (50-80yr.) without endocrinological diseases were included in the present study. Aged male subjects were divided into hyperresponders, in whom maximal LH response to LH-RH without DA infusion exceeded 153.5mIU/ml (mean + 2SD of young male subjects), and non-hyperresponders, in whom maximal LH responses to LH-RH without DA infusion were less than 153.5mIU/ml. In hyperresponders, serum LH response at 30 minutes after LH-RH administration was significantly (p less than 0.05) suppressed by DA infusion. In non-hyperresponders and young male subjects, however, serum LH response to LH-RH was not affected by DA infusion. Basal levels of serum LH and FSH in hyperresponders tended to be higher than that of non-hyperresponders. Total serum testosterone, free testosterone and estradiol levels of hyper and non-hyperresponders failed to reveal any significant differences. These observations suggest that 1) DA directly suppresses gonadotroph responsiveness to LH-RH, 2) in aging men, inhibitory tone imposed on gonadotrophs by DA is decreased, and 3) this decline of DA system can cause hypergonadotropism in aging men, independent of serum sex steroids levels.

Recently, it has been concluded that measurement of the serum free testosterone level is crucial for evaluating male gonadal function. However, the extent of the decline of serum free testosterone levels with aging and the actual levels in male infertility have not yet been clearly defined. In this study, the clinical significance of serum free testosterone levels was evaluated in a total of 248 subjects, including 120 healthy adult males (54 males aged 20-39, 26 males aged 40-59 and 41 males aged more than 60), 94 infertile males, 28 male hemodialysis patients, and 6 patients with Klinefelter's syndrome. Since the serum free testosterone levels correlate significantly with serum LH and FSH levels among 120 normal adult males, it appears that free testosterone has a biological action on the organ. In the subjects aged over 60, serum free testosterone levels were significantly decreased compared with the decrease of serum total testosterone. Thus, biologically active androgen levels decreased with aging. Serum free testosterone levels tended to decrease significantly from 40 years onwards. In infertile males, serum total testosterone levels were equal to those in normal adult males, but their serum free testosterone levels were significantly lower. This decrease of serum free testosterone may be one of the causes of their hypospermatogenesis. In male hemodialysis patients, serum total and free testosterone levels were not lower than in normal adult males. It is considered that the decline of percentage of serum free testosterone levels in aged males and infertile males was caused by increased serum sex hormone binding globulin (SHBG) levels. Several workers have shown that the production of SHBG is regulated by sex steroid hormones. In this study, however, serum SHBG levels were not correlated with the E2/T ratio. We concluded that measurement of the serum free testosterone level is of value in the endocrinological evaluation of male gonadal function.

This study was designed to evaluate the functional changes of Sertoli cells following the administration of clomiphene citrate for male infertility. Sperm count and seminal transferrin level were measured before and after the treatment in 22 cases of oligozoospermia (sperm count: less than 20 X 10(6)/ml) and 14 cases of subnormal sperm count group (sperm count: 20-30 X 10(6)/ml). Clomiphene citrate was administered per os for more than 3 months consecutively in a dose of 25 mg/day. Seminal transferrin concentration increased more than 1.5 times compared with pre-treatment level in 6 cases (16.7%). Among these patients, sperm count markedly increased (20 X 10(6)/ml or more than the pre-treatment level) in 3 cases (50%) and slightly increased (10 X 10(6)/ml or more than pre-treatment) in 1 case (16.7%). In 30 cases, in which seminal transferrin level did not increase, sperm count markedly increased in 6 cases (20%) and slightly increased in 6 cases (20%). Thus, sperm count was improved more frequently in the cases in which seminal transferrin level remained elevated than the cases with no elevation of serum transferrin level. Serum FSH level of patients whose seminal transferrin level remained elevated after the treatment was significantly higher than that of patients with no elevation of serum transferrin level (mean +/- SD = 32.8 +/- 18.0 mIU/ml v.s. 14.4 +/- 11.7 mIU/ml, respectively). These data suggested that the activation of Sertoli cells may contribute to the increase of sperm count following the administration of clomiphene citrate and the elevated seminal transferrin secretion may be related to the increase of serum FSH level following this treatment.