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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.

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.

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.

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.

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.

2005～2006年に受診し尿道膿汁分泌を認めた淋菌性尿道炎51例(15～55歳)を対象に, 患者の性行動様式や淋菌薬剤耐性状況を調査した。10歳代5人, 20代25人, 30代10人, 40代3人, 50代2人であった。尿道炎発症前性交を行った人数は1人23例, 2人12例, 3・4人各2例, 5・6・7・8人各1例であった。30歳未満群では感染源は恋人, ナンパなど金銭の授受のない素人の頻度が高い傾向がみられた。腟性交のみ8例, 腟性交と口腔性交24例, 口腔性交のみ16例, 両方行わず1例で8割以上で口腔性交が行われコンドーム使用率は口腔性交0%, 腟性交21.9%であった。コンドーム未装着の口腔性交がSTDの原因となることを知っている症例は50%であった。ニューキノロン系薬剤の感受性株は10%以下, セフェム系の感受性は保たれたがCPDX-PRの耐性株を5.9%に認めた。再診症例は23例, 45%であった。, 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., 腎盂尿管腫瘍に対する体腔鏡下および開放腎尿管全摘除術につき手術成績、術後経過を比較検討する。全身的侵襲性の指標としてsystemic inflammatory response syndrome(SIRS)の発症頻度に関しても比較検討を行う。腎盂尿管腫瘍に対して腎尿管全摘除術を施行した体腔鏡下手術36例(2002年4月～2004年12月)開放手術(ONU)23例(1999年1月～2001年12月)を対象とした。体腔鏡下手術は後腹膜鏡下ハンドアシスト法(RHANU)を用いた。手術時間(中央値)はRHANU群140分、ONU群60分とONU群で有意に短かった。出血量は両群とも平均約150mlであった。RHANU群において歩行開始日が有意に短縮していた。SIRSの頻度はRHANU群17%、ONU群26%と有意差を認めなかった。膀胱再発率は52, 45%(以下RHANU群vsONU群)、遠隔転移11, 13%、局所再発は両群とも認めず2年での生存率は94, 91%であった。体腔鏡下手術では、歩行開始日が有意に短く早期の回復が示唆された。SIRSの頻度、再発・転移・生存率に有意な差を認めなかった。体腔鏡下手術のリスク、術式の患者への利点を充分考慮した手術方法の選択が重要と思われた。(著者抄録)

男性性感染症(STD)患者248例のアンケート調査結果について検討した.感染源は約70%の症例が友人やPick up(いわゆるナンパ)など, 金銭の授受を伴わない相手であった.症状出現までに性交渉をもった相手の数は2.8人で, 症状出現前のピンポン感染により一般のの人々にSTDが拡大している可能性が考えられた.STDに罹患したことをパートナーに伝えると回答した比率は, 59.4%で高い比率では無かった.過去1年間の性交相手は平均5.8人で, 若年層ほど高い傾向にあった.コンドーム装着率は12.4%(92/234)ときわめて低かった.Oral sexの頻度は82.0%(192/234)と高率であった.以上から, 若年層において, 広いsexual networkを形成し, 無防備な性交が行われていることが考えられた, 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.

54歳男。患者は著明な食欲低下(2ヵ月で7kgの体重減少), 倦怠感, 低血圧を主訴とした。内科的精査では診断がつかず, 低血圧に対して昇圧剤を処方されたが改善しなかった。心療内科を受診し, 鬱病の診断で抗鬱剤を投与されたが症状は改善しなかった。そこで, 男性更年期外来を受診したところ, Late-onset hypogonadism様症候群検査のため測定したtestosterone値および症状から副腎不全が疑われ, adrenocorticotrophic hormone(ACTH), cortisolを測定した結果, ともに感度以下の低値であった。一方, 一般血液生化学検査ではNa低値や低蛋白, 貧血傾向を認めるも, 他の下垂体前葉ホルモン, MRIでは異常を認めず, これらのことから本症例はACHT単独欠損症と診断された。治療としてHydrocortisoneの補充を開始し, 著明な改善が認められた。目下は6ヵ月経過でhydrocortisone 10mg/日の補充を継続しているが, 治療前に認められた症状は改善し, 副作用は認められていない。, 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.

78歳女.水腎症の精査依頼を主訴とした.入院時, 血液検査, 尿検査, 尿培養に異常はみられず, DIPおよび腹部CTにて右水腎症と右尿管口付近の隆起性病変を認めた.膀胱鏡では, 三角部右側に小指頭大の黄白色の腫瘍を認め, 膀胱内のその他の部位にも黄白色の扁平な腫瘍が5～6個散在していた.三角部右側の腫瘍に対して経尿道的切除術を施行し, double J catheterを留置した.膀胱および尿管より採取された検体の病理組織では, 組織球様細胞の増生がみられ, 一部の細胞質内にMichaelis-Gutmann bodyを認め, 膀胱, 尿管のマラコプラキアと診断した.ST合剤, アスコルビン酸, 塩化ベタネコールの投与を開始したが, 薬剤性肝機能障害のためST合剤は中止した.その後, 膀胱鏡, 右尿管鏡で腫瘍の消失を認め, 尿管および尿管口の狭窄に伴う水腎症や膀胱尿管逆流現象は現在まで認めていない, 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.

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.

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.

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.

18歳女。左側腹部痛があり、CTで上腎杯に近接し造影効果のある腫瘍を認めた。MRIでは同部にT1・T2画像とも肝臓とiso signal intensityの腫瘍を認めた。悪性腫瘍を疑い腹腔鏡下左腎摘除術を行った。腫瘍は黄白色で、組織学的に膠原線維を介在して不規則に走行する紡錘形細胞の増殖像からなり、多数の厚壁血管、鹿角様に分岐する小血管を含んでいた。免疫染色ではCD34、bcl-2、vimentin、S-100蛋白陽性、EMA、HHF35、desmin、HMB45、pankeratin陰性であった。以上より、孤立性線維性腫瘍と診断された。, We report a case of solitary fibrous tumor (SFT) arising from a kidney. The patient was an 18-year-old female who visited our hospital with the complaint of left abdominal pain. Computed tomography revealed a slightly enhanced tumor of approximately 3 cm in diameter near the upper calyx of the left kidney. Renal cell carcinoma was suspected, and left nephrectomy was performed under laparoscopy. Histopathological examination revealed proliferation of CD34-positive spindle-shaped cells, and a diagnosis of SFT was made. There has been no local recurrence or distant metastasis for 15 months after the operation.

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.

We report a case of solitary fibrous tumor (SFT) arising from a kidney. The patient was an 18-year-old female who visited our hospital with the complaint of left abdominal pain. Computed tomography revealed a slightly enhanced tumor of approximately 3 cm in diameter near the upper calyx of the left kidney. Renal cell carcinoma was suspected, and left nephrectomy was performed under laparoscopy. Histopathological examination revealed proliferation of CD34-positive spindle-shaped cells, and a diagnosis of SFT was made. There has been no local recurrence or distant metastasis for 15 months after the operation.

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.

68歳男.膀胱移行上皮癌の治療後の経過中に頻尿が出現した.膀胱鏡で後三角部, 左右側壁, 頂部に一部乳頭状変化を伴った広基性腫瘍を認め, 経尿道的膀胱腫瘍切除術を施行した.病理組織では尿細管類似の立方上皮の増生を認め, 腎性腺腫を伴った膀胱炎と診断された.悪性所見はなかった.保存的に経過観察の予定であったが, 多剤耐性緑濃菌による膀胱炎や萎縮膀胱により強い頻尿が持続するため, 膀胱全摘術, 両側尿管皮膚瘻術を施行した.全摘標本には膀胱全体に高度のリンパ球や形質細胞の浸潤, リンパ濾胞形成, 線維化などを認めたが, 腎性腺腫や悪性所見は認められなかった, 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.

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.

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.