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Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH., 2006年11月～2007年10月の前立腺肥大症166例(年齢69.9±6.4歳)を対象にシロドシン服用後超早期での有効性を検討した。シロドシン8mg/日を2週間処方し、排尿症状日誌に国際前立腺症状スコア(IPSS)、QOLスコア、BPH impact indexを記入してもらい、効果判定を行った。その結果、IPSSは服用開始後1、2、3日目と低下し、いずれの観察日も開始時と有意差を認め、14日目は更に低下した。QOLスコアも同様に有意な低下を示し、IPSSとQOLスコアの相関関係を認めた。また、α1遮断薬から切り替えた患者とα1遮断薬を初めて服用した患者との比較では、両群とも服用後1日目からIPSSは有意に低下して14日目まで低下し続け、2群間に有意差は認めなかった。14日目の治療判定ではExcellent 25例、Well 99例、Poor 36例であり、Poor例はいずれの観察日もIPSSの低下を認めなかった。IPSSのサブスコアの排尿、蓄尿症状の変化量は服用後1日目より有意に改善し、蓄尿症状重症例においても同様に1日目より有意に改善効果を認めた。副作用は187例中23例(12.3%)に認め、下痢が11例5.9%と最も多く、重篤な副作用は認めず、高齢により高くなる傾向は認めなかった。以上よりシロドシンの早期からの効果が判明し、無効な症例では早い時点で適した薬剤・治療法の提供が可能になると考えた。

前立腺全摘除術132例中31例(23%, 平均年齢65.4歳)に認めた前立腺特異抗原(PSA)≦4のPSA低値癌とPSA>4の101例(平均年齢65.7歳)の病理組織を比較し, 癌発見までのPSA推移について検討した。全摘標本の病理結果ではpT2, 被膜外浸潤, 精嚢浸潤, リンパ節転移の割合はいずれも有意差を認めなかった。直腸内触診(DRE)陽性率はPSA低値癌症例が20%に対しPSA>4症例は44%であり, PSA低値癌で有意にT1c癌を多く認めたが, 精嚢浸潤を認めた3例はすべてDRE陽性であった。癌診断前に1年以上PSA値を複数回測定したPSA低値癌症例の19例のうち74%が, PSA変化率0.50ng/ml/yearかつPSA倍加時間4年未満であった。「PSA値がその個人において以前確認された値に戻らない」という相対的異常は生検適応基準の1つの目安と考えられる。, Out of 132 prostate cancer (Pca) patients who underwent radical prostatectomy 31 (mean age 65 +/- 5 years) had prostate specific antigen (PSA) levels of 4.0 ng/ml or less (low PSA group). The average PSA level was 3.3 +/- 0.5 ng/ml in the low PSA group and 8.5 +/- 5.5 ng/ml in patients with a higher PSA (high PSA group). The pT2 ratio of the radical prostatectomy specimens was 74% (23/31) in the low PSA group and 55% (55/101) in the high PSA group, pT3a was 16% (5/31) and 31% (31/101), pT3b was 10% (3/31) and 10% (10/101), pN1 was 0% and 5% (5/101), respectively. The digital rectal examination (DRE) gave a positive result significantly (p = 0.026) less frequently in the low PSA group (6/31 : 20%), than in the high PSA group (44/101 : 44%). However all three pT3b patients with a low PSA were positive in DRE. This suggests the importance of DRE to detect significant Pca with PSA < or = 4.0. PSA was measured at least three times for more than one year in 19 of the 31 patients with a low PSA level before diagnosis. In 14 of these 19 cases (74%), PSA velocity was more than 0.5 ng/ml/ year and PSA doubling time was less than 4 years. Some patients with significant Pca can not be detected with a PSA cutoff level at 4.0 ng/ml. We recommend that individuals have their own PSA levels, and that long-term changes of PSA are sometimes very important to detect cases of Pca with lower PSA.

62歳男。患者は無症候性肉眼的血尿を主訴とした。腹部エコーならびに腹部造影CT上より右腎に大きさ8cmの腫瘤が認められ, 右根治的腎摘術が施行された。病理所見では淡明細胞癌, G2>G1, pT1bN0M0の診断で, 術後は天然型Interferon-alpha(IFN-α)が10ヵ月投与された。しかし3年後, 腹部造影CTで左腎に腫瘤が確認され, 左腎部部分切除術が行われ, 術後は組換型IFN-α2bが1年間投与された。以後, 2年経過で胸部CT上で左S3b領域に腫瘤が認められ, 左肺上葉切除術が施行されたが, 9ヵ月後に左腎および副腎の再発を認めた。治療として左腎と副腎の部分切除術が行われたが, 3ヵ月後に再発し, リンパ節転移も認めた。IFN-α, MVP療法を施行したものの, 10ヵ月後にこれを中断, 20ヵ月生存し, 初診から9年後に患者は死亡となった。, A 62-year-old man visited our hospital complaining of asymptomatic gross hematuria. Right radical Computed tomography (CT) demonstrated an 8 cm mass in the right kidney. nephrectomy was done in March 1995, and the pathological examination revealed renal cell carcinoma (RCC), clear cell type, G2>G1. Interferon (IFN)-alpha was administered for 10 months. About 3 years later, in March 1998, CT showed 1 cm mass in the left kidney. Left partial nephrectomy was done and the pathological finding was RCC, G1. IFN-alpha2b was administered for a year. About 2 years later, CT showed 2.7 cm mass in the left lung. Left upper lobectomy was performed in August 2000, and it was a metastasis of RCC, G2. IFN-alpha and IFN-gamma were administered. Nine months later, in June 2001, the recurrence of the left kidney and the left adrenal gland was found and partial nephrectomy and adrenalectomy was performed. Pathological finding was RCC, G3. IFN-alpha and tegafur-uracil (UFT) were administered. Only 3 months later, recurrence of the left kidney and the left adrenal gland and the lymph node of renal hilus was found. We gave up for surgical resection and chemotherapy of MVP (Methotrexate, Vinblastine, Pepleomycin) was performed. Despite the therapy, disease progressed. 10 months after the last recurrence, in July 2002, patient became disoriented and hypercalcemia and the MVP therapy was stopped. After that, medroxyprogesterone acetate (MPA) and UFT were administered; the patient lived 20 months with relatively good performance status and died in February 2004. MPA might be considered as a drug for advanced renal cell carcinoma.

66歳男。人間ドックで血清前立腺特異抗原異常高値, 排尿困難を訴え, 経尿道的前立腺切除術を行った。1年後PSAが低下後, 徐々に上昇したため再生検を勧めたが患者の同意を得られずPSAが13.2ng/mlになった時点で同意した。根治的前立腺全摘術を施行し, 病理所見は中分化癌で被膜浸潤はなく, 切除断端陰性であった。術後PSAが2.5ng/mlまでしか低下せず, 遠隔転移, 局所腫瘍残存を考えた。CT, MRI, 骨シンチを施行したが明らかな遠隔転移, 局所再発は認めなかった。病理組織を再検したところ尖部右側に充実胞巣状増殖を主体として, 少量の腺癌部分を混在する導管癌を認め, MAB療法, DES-DP大量療法を施行した。, A 66-year-old man visited our hospital complaining of a high prostate-specific antigen (PSA) (6.9 ng/ml) and dysuria. Prostatic needle biopsies revealed no malignancy in January 1998 and February 1999 (PSA 8.0 ng/ml). Transurethral resection of prostate (TURP) was performed in March 1999. Although none of the TURP specimen showed any malignancy, the PSA level remained high (3.7 ng/ml 1 year after the TURP), and gradually increased. About 3 years later, re-biopsy was done (PSA 13.2 ng/ml) and pathological finding was moderately differentiated adenocarcinoma (Gleason score 3 + 3 = 6). After 9-month MAB, radical prostatectomy (RP) was performed in January 2003 (PSA 4.2 ng/ml). Though the RP specimen showed moderately differentiated adenocarcinoma with negative capsule penetration and negative surgical margins, PSA decreased to 2.5 ng/ml and gradually increased. Computed tomography (CT), magnetic resonance imaging (MRI), and bone scintigraphy showed neither distant metastasis nor local recurrence. Review of the RP specimen revealed ductal carcinoma with positive capsular penetration and suspicion of positive surgical margins. Although the patient was treated with maximum androgen blockade, diethylstilbestrol diphosphate, and tegafururacil, PSA gradually increased and was kept at a high level (5-6 ng/ml). In December 2005, the patient complained of anal pain and MRI showed a 4.8 x 2.3 cm tumor in the prostatic bed. Needle biopsy of the tumor revealed ductal carcinoma (PSA 6.39 ng/ml). In January 2006 (PSA 11.9 ng/ml), we initiated a treatment with 66 Gy of intensity modulated radiation therapy. In November 2006, PSA decreased to 0.279 ng/ml, and the tumor reduced (3.8 x 1.0 cm) on MRI.

症例1:75歳男性。左腎細胞癌で根治的左腎摘除術を行い, 術後約1ヵ月頃より天然型インターフェロン(IFN)-α製剤300万単位週1回の投与を開始した。投与開始約6ヵ月後頃より体重減少を認め, 甲状腺機能検査にて遊離トリヨードサイロニン(fT3), 遊離サイロキシン(fT4)が上昇, 甲状腺刺激ホルモン(TSH)が低下し, 甲状腺刺激抗体(TSAb), 抗サイログロブリン抗体, 抗甲状腺ペルオキシダーゼ抗体が陽性であった。IFN-α投与中止後, 自覚症状は改善し, 無治療にてfT3, fT4, TSHが正常化し, TSAbが陰転化した。症例2:44歳男性。左腎細胞癌で根治的左腎摘除術を行い, 術後約5ヵ月頃よりIFN-α製剤300万単位週2回の投与を開始した。投与開始約5ヵ月後に動悸, 体重減少, 全身倦怠感を認め, fT3, fT4が上昇, TSHが低下し, TSAbは陰性, 抗サイログロブリン抗体, 抗甲状腺ペルオキシダーゼ抗体が陽性であった。IFN-α投与中止後, 無治療にて自覚症状は改善し, fT3, fT4が正常化したが, 同時にTSHが異常高値となりその後も持続している。インターフェロン治療による副作用の可能性を念頭に置き, 早期発見に努める必要があると考えられた。, Autoimmune thyroid disease is the result of a common side-effect of interferon-alpha (IFN-alpha) used to treat viral hepatitis C; but there have been few reports on thyroid disorders induced by IFN-a that was used to treat renal cell carcinoma. IFN-alpha therapy was conducted on two male patients, 75 and 44 years old, after radical nephrectomy. Six and five months, respectively, after this therapy, they complained of weight loss. Laboratory evaluation revealed hyperthyroidism; the thyroid stimulating hormone (TSH) level fell below normal; and the serum free T3 and T4 levels increased above normal values. Two months after the termination of IFN-alpha therapy, their thyroid hormone levels returned to normal without the help of antithyroid agents. In observational studies, thyroid dysfunction has been reported in 0.6 to 30% of the patients who had been treated with IFN-alpha. Careful observation is necessary to watch for the possible development of thyroid disorder during IFN-alpha therapy for renal cell carcinoma.

56歳女。頻尿, 残尿感を主訴に受診するも異常所見を認めず, 6ヵ月後の経過観察中に排尿時痛, 夜間尿失禁が出現し, 1ヵ月後に尿閉, 両側水腎症を認め, 精査目的入院となった。異常所見はなく血清クレアチニンの軽度上昇と膿尿を認めるも尿培養は陰性で尿道カテーテル留置により水腎症は速やかに改善した。1週間後のカテーテル抜去の数時間後に水腎症は再発した。病理組織学的所見では悪性所見はなく全ての粘膜下に好酸球を主体とする炎症, 細胞の浸潤を認めたため好酸性膀胱炎と診断した.廃用性膀胱萎縮防止のため尿道カテーテルを抜去し自己導尿を指導した。プレドニゾロン, マレイン酸クロルフェニラミンを開始して自排尿量は増加し, 治療3ヵ月後には著明に改善した。水腎症, 膀胱壁肥厚の消失, 粘膜不整部の消失を認め11ヵ月経過して明らかな再発は認めていない。, A 56-year-old woman was referred to our hospital presenting with urinary retention. Ultrasonography revealed bilateral hydronephrosis and magnetic resonance imaging of the pelvis showed diffuse thickening of the bladder wall. The hydronephrosis was improved by urethral balloon catheter. A cystoscopic examination revealed papillary lesions, polypoid yellow lesions and gross mucosal edema in the whole bladder. Pathological examination of transurethral punch biopsy showed no malignancy but inflammatory infiltration in the submucosa of bladder wall with many eosinophils. She performed clean intermittent self-catheterization and was treated with corticosteroids and antihistaminics. Three months after diagnosis, conservative treatment resulted in an excellent relief of symptoms, decrement of residual urine and remission of the bladder lesions in cystoscopy. In women with urinary retention, eosinophilic cystitis (EC) must be considered in the differential diagnosis. To our knowledge, this is the first case of EC presenting with urinary retention reported in the Japanese literature.

症例1:42歳男.5年5ヵ月の不妊を主訴として受診し, 無精子症を指摘された.全身所見で異常はなく, 精液検査所見も無精子症であった.染色体検査では末梢リンパ球培養G band法で細胞20個において検査を行ったところ46, XXと女性の核型であった.また2番染色体短腕p11, 長腕q13を切断点とする腕間逆位が認められた.以上の所見よりXX male症例と診断した.さらにPCR法によるsex-determining region Y(SRY)は陽性, deleted in azoospermia(DAZ)は陰性であった.患者は挙児は希望せず, 現在も外来で経過観察中である.症例2:29歳男.1年3ヵ月の不妊を主訴として受診した.症例1と同様に無精子症を指摘され, 全身所見で異常はなく, 精液検査所見も無精子症であった.染色体検査でも症例1と同様に末梢リンパ球培養G band法で, 細胞20個において検査を行ったところ46, XXと女性の核型であり, 以上の所見より, XX male症例と診断した.また, PCR法による測定を行い, SRYは陽性, DAZは陰性であった.挙児を希望し, 非配偶者間人工授精により正常男児がえられた, We report two cases of XX male with chief complaints of infertility. Physical examination of both patients aged 42 and 29 demonstrated normal male habitus except for small testes. Semen analyses demonstrated no spermatozoa. Endocrinological examinations showed hypergonadotrophic hypogonadism. Vesiculograms demonstrated normal seminal tracts. Histological examination of their testes did not reveal germ cells; one case lacked seminiferous tubules and there was hyalinization in the seminiferous tubule in another case. Chromosomal analyses of peripheral blood demonstrated 46, XX. The sex-determining region Y gene was positive and DAZ (deleted in azoospermia) gene was negative in both cases.

表在性膀胱癌に対するTUR-Bt後の5'-DFUR再発予防効果についてprospective randomized trialにて検討を行った.5'-DFUR群(n=31)においてはTUR-Bt後2～3週目より600mg/dayを2年間投与し, 対照群(n=31)ではTUR-Bt後無治療とした.1)両群の累積非再発率は全体では有意差を認めなかったが, 5'-DFUR群の方が概して良好であった(P=0.256).又, 腫瘍要因別の検討では, 異型度別の分析でG2症例において5'-DFUR群にて再発率が低くなる傾向が認められた(P=0.070).2)5'-DFURによる副作用発現率は40.0%(12/30)であったが, いずれもその程度は軽微であった.3)以上の結果より5'-DFURは表在性膀胱癌に対する再発予防治療薬の一つの選択肢となりうる可能性を示唆するが, 今後更なる検討が必要である, 5'-Deoxy-5-fluorouridine (5'-DFUR), an oral fluorinated pyrimidine carbamate, is widely used in patients with gastrointestinal and breast cancers because of its effectiveness. However, in bladder cancer, response rates have only been reported in Phase II clinical trials. Therefore, we conducted a prospective randomized trial to investigate chemoprophylactic effect of 5'-DFUR against recurrence of superficial bladder cancer after transurethral bladder tumor resection (TUR-Bt). The subjects were grouped as follows: 1) 5'-DFUR group (n = 31), received 600 mg/day of 5'-DFUR starting 2-3 weeks after TUR-Bt for 2 years; and 2) control group (n = 31) received no 5'-DFUR. Although there was no significant difference between groups, the cumulative recurrence rates was more favorable in the 5'-DFUR group (p = 0.256) than in the controls. Results according to cancer factors showed that, in patients with G2 based on grading, those in the 5'-DFUR group tended to have a lower recurrence rate than the control group (p = 0.070). There was a 40% incidence of adverse drug reactions (12/30 patients), primarily slight gastrointestinal symptoms which disappeared or improved with drug discontinuation. The results of the present study suggest that 5'-DFUR might be the choice of treatment to prevent recurrence of superficial bladder cancer.

We describe a case of bilateral renal cell carcinoma associated with chronic renal failure. A 49-year-old man was admitted to our hospital to initiate hemodialysis. He was found to have multiple renal cystic changes and a left renal mass by ultrasound. Computed tomographic (CT) scan showed a tumor 4 cm in diameter in the left kidney and another one 2 cm in diameter in the right kidney. Left nephrectomy was first performed and histopathological examination revealed renal cell carcinoma of mixed type and granular subtype. Six months after the operation, CT scan showed the mild growth of the tumor in the right kidney. Right nephrectomy was performed and histopathological examination revealed renal cell carcinoma of papillary type and granular subtype. The patient remains well on hemodialysis, with no evidence of recurrence or metastasis for 13 months after nephrectomy.

1)安全性評価症例141例中, 12週以上投与された症例は101例, 半年(24週)以上の症例は81例, 1年(48週)投与された症例は57例であった.投与が中止された症例は84例であり, おもな理由は来院せず40例, 副作用14例, 症状改善11例などであった. 2)副作用は22例26件に認められ, おもな内訳は消化器系(口渇6件, 便秘4件, 嘔吐・嘔気2件, 下痢2件, 胃痛1件)が9.9%, 泌尿器系(排尿困難4件, 残尿1件)が3.5%であり, 副作用発現頻度は15.6%であった. 3)最終全般改善度は著明改善15例, 改善26例で, 改善率は82.0%(41/50例)であった. 4)1年以上投与例の自覚症状の推移は, 昼間排尿回数は投与前10.3±4.0回が投与1年後は7.1±2.9回に, 夜間排尿回数は投与前4.2±1.7回が投与1年後は2.1±1.1回に, 尿失禁回数については投与前2.9±2.1回が投与1年後は0.7±1.0回に有意に改善した.同様に症状改善度の推移も高い結果が得られた, The safety and efficacy of one-year administration of propiverine hydrochloride (BUP-4 tablets) were assessed in facilities affiliated with the Department of Urology of Yokohama City University School of Medicine. Changes in subjective symptoms showed significant improvement in mean frequency of urination in the daytime from 10.3 +/- 4.0 times before administration to 7.1 +/- 2.9 times 1 year after the start of administration, in mean frequency of voiding at night from 4.2 +/- 1.7 times to 2.1 +/- 1.1 times and in mean incidence of urinary incontinence from 2.9 +/- 2.1 times to 0.7 +/- 1.0 times. The final degree of overall improvement rate was 82.0% (41/50 cases). Adverse effects were observed 26 times in 22 patients, the incidence being 15.6% (22/141 cases). They consisted of digestive symptoms in 9.9% (6 events of dry mouth, 4 of constipation, 2 of abdominal discomfort, 2 of diarrhea and 1 of gastritis), urinary tract symptoms in 3.5% (4 of dysuria and 1 of residual urine), abnormal laboratory findings in 1.4% (increase in glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase or lactate dehydrogenase levels) and others (1.4%). These results provide further evidence of the safety and efficacy of propiverine hydrochloride (BUP-4 tablets) even when administered for a long-term in the treatment of patients with pollakiuria and urinary incontinence.

We report a case of renal cell carcinoma in a 76-year-old man with pulmonary metastasis and tumor thrombus in inferior vena cava. The patient responded to the combination therapy with a small amount of HLBI (human lymphoblastoid interferon-alpha) and UFT (1:4 mixture of tegafur and uracil). HLBI was administered intramuscularly at a dose of 3 x 10(6) IU two times a week. However, the administration of the same dose was discontinued, because of the severe side effects, such as depression, general fatigue, anorexia and high fever. Finally, the maximum dose was determined to be 2 x 10(6) IU/week. Nine weeks after the first treatment, UFT was simultaneously given orally at a dose of 100 mg/day for potentiating the antitumor effect. At 12 weeks, the patient registered complete response of pulmonary metastasis, and partial response (83% reduction) of renal tumor. About 60 x 10(6) IU HLBI was administered until the response was noted. After 34 weeks of administration of HLBI, nephrectomy was performed. Histological diagnosis was renal cell carcinoma of clear cell subtype, grade 2. Microscopically, many lymphocytes infiltrated into the cancer cells. This suggests the possibility of immunological response caused by HLBI.

横浜市立大学泌尿器科およびその関連施設を加えた13施設で, TFLXを使用して有効性と安全性について検討した.1)女子急性単純性膀胱炎164例の総合有効率は98.78%であった.2)男子急性単純性膀胱炎4例, 急性単純性腎盂腎炎3例, 非淋菌性尿道炎1例, 複雑性尿路感染症7例にも投与して100%の有効率がえられた.3)原因菌の中で, グラム陰性菌は100%の消失率で, グラム陽性菌は90.60%の消失率であった.4)副作用発現は5例にみられ, その発現率は2.42%であった, We clinically evaluated the usefulness of a new oral antimicrobial agent, TFLX, in the field of urology. The dose administered was 150 mg t.i.d and the duration of administration was 3 days. The clinical effect was evaluated according to the criteria of the Japanese UTI committee. The clinical response obtained on 164 female patients with acute simple cystitis was excellent in 118, moderate in 44 and poor in 2 patients. The efficacy rate was 98.78%. The clinical response obtained on 4 male patients with acute simple cystitis was excellent in 2 and moderate in 2 patients. The efficacy rate was 100%. The clinical response obtained on 3 female patients with simple pyelonephritis was excellent in 2 and moderate in 1 patient. The efficacy rate was 100%. The clinical response obtained on one patient with non-gonococcal urethritis was excellent by doctor's evaluation. The clinical response obtained on 7 patients with complicated UTI was excellent in 3 and moderate in 4 patients. The efficacy rate was 100%. Three patients complained of stomach distress or malaise and 2 patients developed rash. No abnormal laboratory data were observed. Thus, TFLX appears to be safe and suitable for use in the field of urology.

Renal leiomyomas large enough to be clinically diagnosed are extremely rare. We review 30 cases of clinically diagnosed renal leiomyoma from the literature in Japan, including our 2 new cases. Case 1: In a 52-year-old man with no symptoms a renal mass was found accidentally on an ultrasonogram. CT scan showed a mass with a cystic area at the upper pole of the right kidney. Angiogram showed a hypovascular mass. Case 2: CT scan revealed a cystic mass and angiogram showed an avascular mass at the upper pole of the left kidney in a 19-year-old man having gross hematuria and left flank pain. Transperitoneal nephrectomy was done in both cases. Histologically each tumor was composed of monotonous proliferation of spindle shaped cells without atypia, which showed intense immunoreactivity for alpha-smooth muscle actin. The diagnosis of benign leiomyoma was made in each case. In a review of 30 cases, we found that renal leiomyomas occur most often in female (77%), between decades 2 and 5 of life (median: 46 years). On the angiogram it appears most often as an avascular or hypovascular mass. CT scan shows cystic or mixed solid/cystic or solid lesion, occasionally with calcification. Preoperative diagnosis is extremely difficult to be made. Histologically, fibroma, angiomyolipoma, congenital mesoblastic nephroma and leiomyosarcoma should be differentiated.