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A case of solitary metastasis of renal cell carcinoma to the thyroid gland is presented. The patient was a 82-year-old man found to have an abnormal mass in his neck. He had a past history of renal clear cell carcinoma of the left kidney (pT1aN0M0, G1>2, alveolar type, clear cell subtype), which had been resected 12 years previously. Ultrasonography revealed a tumor mass in the right hemithyroid gland. This time fine needle biopsy of the thyroid tumor suggested metastatic thyroid carcinoma. Right hemithyroidectomy was performed last year. The histopathological findings were suggestive of clear cell carcinoma, thus metastatic renal carcinoma was diagnosed. This is the 26th case of thyroid solitary metastasis of clear cell renal cell carcinoma reported in Japan to date.

A 50-year-old Japanese man with a two-year history of a painless right scrotal mass visited our hospital. Considering laboratory findings and computed tomography, the patient was diagnosed with an uncharacteristic testicular tumor. No metastases were present on radiographic study at the first visit. Emergent high radical orchiectomy was performed, and the tumor was identified as a squamous cell carcinoma (SCC) of a testicular epidermal cyst. He is alive without recurrence or metastasis six months after surgery. Testicular SCC is an extremely rare tumor. This is the third case of testicular SCC associated with an epidermal cyst in English literature.

A case of solitary metastasis of renal cell carcinoma to the thyroid gland is presented. The patient was a 82-year-old man found to have an abnormal mass in his neck. He had a past history of renal clear cell carcinoma of the left kidney (pT1aN0M0, G1>2, alveolar type, clear cell subtype), which had been resected 12 years previously. Ultrasonography revealed a tumor mass in the right hemithyroid gland. This time fine needle biopsy of the thyroid tumor suggested metastatic thyroid carcinoma. Right hemithyroidectomy was performed last year. The histopathological findings were suggestive of clear cell carcinoma, thus metastatic renal carcinoma was diagnosed. This is the 26th case of thyroid solitary metastasis of clear cell renal cell carcinoma reported in Japan to date.

A case of renal cell carcinoma presentingwith paraneoplastic syndrome is reported. A 69-year-old man with uncontrolled diabetes was incidentally found to have a left thoracic tumor and a right renal tumor. He had intermittent fever of 39℃ or more and laboratory data showed diabetes and high C-reactive protein level. A radical nephrectomy was performed, but the neoplastic syndrome did not improve. After a second surgery consisting of complete resection of solitary bone metastasis the symptoms resolved immediately. At 6 months postoperatively, he had no reccurence. Generally prognosis of patients with bone metastasis from renal cell carcinoma has been said to be poor, but surgical control of bone metastasis may be a key factor for the prognosis of patient with metastatic RCC in the era of targeted therapy.

A 64-year-old man presented with gross hematuria. Physical examination showed a mass under the phimotic foreskin. Circumcision revealed a 2cm polypoid tumor on the inner layer of prepuce. Tumor resection was performed and pathological diagnosis was carcinosarcoma which was composed of squamous cell carcinoma and spindle cell sarcoma. Biopsy of the scar lesions revealed residual squamous cell carcinoma and computed tomographic scan revealed swollen inguinal lymph nodes. Partial penectomy and lymph node biopsy were performed. Pathological examination revealed residual squamous cell carcinoma and no lymph node metastasis. There was no recurrence for one year. We report this very rare case of carcinosarcoma of the penis.

A 90-year-old female patient presented with dysuria. She was treated with partial excision of the mass protruding from the urethral meatus. Pathological examination revealed non-Hodgkin's malignant lymphoma of the B-cell type. The patient received a total of 42.4 Gy extrabeam irradiation. Our patient was disease-free for 14 months. We reviewed 25 cases of this rare entity reported previously.

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。

Skeletal muscle and small intestine are rare sites of metastasis in renal cell carcinoma. Therefore very few reports of interferon-alpha (IFN-alpha) therapy exist for these types of metastasis. Here, a case of metastatic renal cell carcinoma to muscle and jejunum is reported. After IFN-alpha therapy for 9 weeks, muscle metastasis completely disappeared and intestinal lesions were markedly reduced. However, subsequent patient compliance for this therapy was poor, resulting in death after relapse of the RCC., 腎癌では骨格筋転移や小腸転移は稀であり, これらの転移に対するインターフェロンαによる療法の報告は非常に少ない。われわれは腎癌骨格筋・空腸転移の1例を経験した。9週間のインターフェロンα療法により筋肉転移は完全に消失し, 空腸転移も著明に縮小した。しかしながら治療の自己中断により病変の再燃を認め, 癌死の転帰をとった。(著者抄録)

キング健康調査票(KHQ), international consultation on incontinence-questionnaire:short form(ICIQ-SF)を用いて, 塩酸プロピベリンの頻尿・尿失禁に対する治療効果とQOLスコアの改善度との相関性を検討した.1)評価可能であった68例で, 8週間の投与後, 頻尿・尿失禁が有意に改善されていた.投与後, 尿意切迫感の有症状患者数は有意に減少し, 切迫感の強さも84%が改善した.2)尿失禁の形態では, 腹圧性の症状よりも切迫性尿失禁と考えられる症状の改善傾向が明らかになった.3)有害事象は32%に認められたが, 重篤なものはなかった.4)治療8週後の昼間尿失禁回数の治療効果と, KHQスコアの「仕事・家事の制限」の改善度, および「心の問題」の向上との間, 治療4週後の昼間尿失禁回数の治療効果とICIQスコアの「生活への影響」の改善度との間に相関関係を認めた.5)治療8週後の昼間排尿回数の治療効果と, ICIQスコアの「尿失禁の量」「生活への影響」「合計スコア」の改善度との間にはそれぞれ相関関係が認められた, To investigate how urinary frequency and incontinence affect the patient's subjective quality of life (QOL) and whether an improvement in objective findings by medical treatment affects his/her subjective QOL, a voiding diary using the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was delivered to patients with urinary frequency and/or incontinence before and after treatment with propiverine hydrochloride for 8 weeks. Sixty-eight patients completed the diary and the questionnaires. Objective symptoms decreased significantly with respect to the mean frequency of urination and to the mean incidence of urinary incontinence. The KHQ and ICIQ-SF scores improved significantly with respect to all domains except personal relationships in the KHQ. In the KHQ, furthermore, a significant correlation was found between decreased incidence of urinary incontinence and improvement in role limitations and between decreased incidence of urinary incontinence and improvement in emotional problems. In the ICIQ-SF, a significant correlation was found between decreased incidence of urinary frequency and subjective improvement in quantity of leakage, between decreased incidence of urinary frequency and improvement in subjective QOL scores, between decreased incidence of urinary frequency and improvement in the total ICIQ-SF score, and between decreased incidence of urinary incontinence and improvement in subjective QOL scores. Thirty-two episodes of adverse reactions were observed. None of them were serious. These results suggest that an improvement in objective symptoms with propiverine hydrochloride favorably improves subjective QOL of the patient, and provide further evidence about the safety and efficacy of propiverine hydrochloride.

61歳男.患者は無症候性肉眼的血尿を自覚していたが放置していた.下腹部不快感が出現するに至り, 膀胱鏡検査により浸潤性膀胱腫瘍と診断された.MRI上, 膀胱頂部に筋層浸潤を強く疑う広基性腫瘤を認めた.術前補助療法としてM-VAC療法を1コース終了後, 膀胱全摘術, リンパ節郭清, 回腸導管造設術が施行された.膀胱小細胞癌と診断され, 膀胱周囲脂肪組織への明らかな浸潤を認め, pT3b, pN0, INF-βと診断された.以後, 術後1ヵ月目の造影CTで左肺末梢2ヶ所に小肺転移巣を疑わせる所見を認め, 転移巣は化学療法NGで経過したものの, 再発などは認めずCRと判断した.術後12ヵ月経過現在, 再発は認められていない, A 61-year-old man was referred to our hospital with a complaint of gross hematuria and lower abdominal discomfort. Ultrasonography, magnetic resonance imaging and cystoscopy revealed a nodular invasive tumor in urinary bladder. The histopathological findings of transurethral-biopsy specimen was the small cell carcinoma and transitional cell carcinoma of the bladder infiltrating into smooth muscle layer. Total cystectomy with ileal conduit was performed following 1 course of neoadjuvant chemotherapy (M-VAC). Computed tomography (CT) before adjuvant chemotherapy revealed tiny lung metastasis in left peripheral lung area. As postoperative adjuvant therapy, 4 courses of chemotherapy (etoposide and calboplatin) were performed with 50 Gy of extra beam radiotherapy to the lung metastasis. Follow up CT revealed disapperance of lung metastasis, and the patient has been free from disease for one year after chemotherapy.

25歳男性.患者は左膝疼痛, 左下肢痺れを主訴に受診となった.症状より血行障害を疑われ, ドプラーエコーを施行したところ, 脛骨動脈の流量低下を認められた.そこで, 造影CTおよび3D-CTを行なったところ, 造影効果の低い巨大な腹腔内の腫瘍および腫瘍への栄養血管を認めた.血液生化学所見ではLDHおよびALPの高値を認め, 腹部正中切開で腫瘍摘出術施行した結果, 径25×18×12cm, 重量3000gの表面平滑な腫瘍および黄色混濁の腹水を認め, 細胞診検査でclass Vであった.腫瘍は被膜に覆われた左精巣動静脈をfeeding artery, drainage veinとしており, その時点で初めて左陰嚢内に精巣がないことが認識された.病理組織診断で精上皮腫(seminoma), 一部被膜外への浸潤を認めた, A 26-year-old man was admitted to the department of surgery of our hospital with a complaint of intermittent left leg pain for the past two weeks. Ultrasonography revealed reduced blood flow to the tibial artery, which suggested a vascular disease like arteriosclerosis obliterans. Enhanced computed tomography (CT) revealed a huge abdominal tumor and a 3-dimensional CT scan showed a feeding artery from the left renal artery to the huge tumor. Findings of routine blood and urine examinations were elevated levels of lactate dehydrogenase, alkaline phosphatase, and C-reactive protein. Surgical exploration revealed a giant tumor with clouded ascites in the abdominal cavity containing class V cells revealed by cytological examination. The tumor was easily resected. Its vascular pedicle was thick and hypertrophied. Thus, it could be traced to the origin of left gonadal artery. At this time, the surgeon incidentally noticed the absence of left testis in the patient's scrotum. The resected specimen was 25 x 18 x 12 cm in size, and it weighed 3000 gm. The histological finding was pure seminoma invaded to peritoneum. His leg pain was relieved after the tumor resection.

14歳.学校の健診で膿尿を指摘され受診した.1日15～20回程度の頻尿および1日に2～3個のパッド使用を要する尿失禁を自覚していた.排尿性尿路造影で骨盤内に6cm程度の円筒形と考えられる異物を認めた.問診では1年前にスプレー缶を自分で腟に挿入し, 抜去しようとしたところキャップが腟内に残ったまま抜けてしまい, そのまま放置していたとのことであった.膀胱造影で膀胱後方への造影剤溢流を認め, 膀胱腟瘻が示唆された.用手的に異物の除去を試みたが不可能であったため, 全身麻酔下に腟内異物除去および経腟的膀胱腟瘻閉鎖術を施行した.腟内を膀胱鏡で観察すると腟口から約2cmのところに異物が認められ, 非観血的に摘出できた.膀胱腟瘻は閉鎖術後3ヵ月で再発したため経腹的閉鎖術を施行し, 以後再発はない, A 14-year-old girl was referred to our hospital with severe pyuria pointed out in a school health check up. An intravenous pyelography and a cystography revealed a foreign body in the pelvic region outside the bladder and pooling of contrast medium in the vagina. Conputed tomography confirmed the foreign body in the vagina. About 1 year earlier, she inserted a hair spray can into the vagina but could not remove its cap. Under the diagnosis of vesicovaginal fistula due to vaginal foreign body, the cap was removed manually and transvaginal repair of the vesicovaginal fistula was performed under general anesthtesia, but it recurred twice. Finally, she underwent successful abdominovaginal repair of fistula. Although a variety of self-introduced objects in the vagina illegally used as a means of sexual gratification have been described, a vesicovaginal complication is very rare.

16歳男子.主訴は腰痛, 肛門痛, 排便障害.腹骨盤部CTでは左水腎症, 軽度の肝脾腫を認め骨盤内に9×6cmの境界不明瞭な腫瘤を認めた.骨盤部MRIでは直腸の右腹側, 前立腺の頭側にT1で等信号, T2で低信号の腫瘤を認め精嚢は不明瞭であった.骨盤内腫瘤に対して経直腸的腫瘤生検術を施行した.諸検査より臨床病期II EAXの小骨盤内原発の悪性リンパ腫と診断し, 血液膠原病科に転科しCHOP療法を開始した.化学療法開始直後より症状は著明に改善, クレアチニン, LDHとも正常化し, 左水腎症も消失した.当初小骨盤内と判断した原発部位は治療中の縮小した腫瘍の位置より傍直腸腔と診断された, A 16-year-old man presented with lumbago, perianal pain and constipation. A large tumor was palpable by digital rectal examination. Then, transrectal needle biopsies of the tumor were performed. Histopathological diagnosis was non-Hodgkin's malignant lymphoma (diffuse large B-cell type according to the new WHO classification). The results of some examinations were compatible with the diagnosis of primary lymphoma of the pararectal space. The patient underwent 2 courses of combination chemotherapy CHOP (consisting of cyclophosphamide, doxorubichin, vincristine, and prednisolone), and high-dose chemotherapy (ranimustine, etoposide, ifosfamide) with peripheral blood stem cell transplantation. After high-dose chemotherapy, radiation therapy was performed since there was a possibility of residual tumor, and complete remission was achieved. Now, 12 months after completion of the radiation, he remains free of the disease. This is probably the first clinical case of malignant lymphoma of the pararectal space ever reported in the Japanese literature.

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.

症例1(29歳男性).高血圧, 右副腎腫瘤を主訴とした.症例2(46歳男性).既往として神経線維腫症1型(NF1)があり, 検診にて腹部腫瘤, 高血圧を指摘された.いずれも体幹を中心にカフェオレ斑と神経線維腫を認め, 症例1では腋窩に小型の褐色斑もみられた.内分泌学的検査では血中・尿中ともにアドレナリン, ノルアドレナリン, ドーパミンが異常高値を示し, 腹部造影では右副腎にそれぞれ7cm, 5cm大の嚢胞性腫瘤を認め, 131I-MIBGシンチグラフィーでは腫瘍に一致して集積が認められた.以上より, NF1に合併した右副腎褐色細胞腫と診断し, いずれも右副腎摘除術を施行した.術後, 血中カテコラミン値, 血圧は正常化し, 経過良好である, Pheochromocytomas may occur as either sporadic or familial tumors. Clinical features of pheochromocytomas in neurofibromatosis 1 (NF1) patients are similar to those in patients with sporadic pheochromocytomas, unlike pheochromocytomas associated with other hereditary syndromes. Here we report two cases of pheochromocytoma associated with NF1. Case 1: A 29-year-old man with previously undiagnosed NF1, was admitted to our hospital for hypertension and a right adrenal tumor. On physical examination, cafe-au-lait spots and neurofibromas were observed on his body. Serum and urine catecholamine levels were markedly elevated. Case 2: The patient was a 46-year-old man with NF1. The tumor was incidentally detected by ultrasonography. Serum and urine catecholamine levels were similarly elevated. 131I-MIBG scintigraphy showed an abnormal accumulation in the right adrenal gland. After this diagnosis of pheochromocytoma associated with NF1, open adrenalectomy was performed. No evidence of malignancy was seen in either case.

58歳男.コントロール不良な本態性高血圧症の既往があった.3ヵ月前, 急性腎盂腎炎を契機に左腎結石を発見された.自然排石を待機していたが, 疝痛発作, 軽度の腎盂腎炎を繰り返し入院となった.R2結石に対して体外衝撃波尿路結石粉砕術(ESWL)を施行し, 術後3時間後より左背部痛, 肉眼的血尿, 嘔気, 嘔吐が出現した.緊急造影CTにて腎周囲後方脂肪組織に血腫を認め, ESWLの合併症である腎被膜下血腫と診断した.臥床安静, 血圧コントロール, 血腫の感染予防で経過観察としたが, 背部痛は軽快せず, 造影CTにて血腫の増大傾向, 肝臓周囲の腹水出現, 血中ヘモグロビン濃度の連日低下を認めた.ESWL後5日目の腎動脈造影検査にて, ESWLを施行した腎下極付近に複数の仮性動脈瘤様の像を認め, 選択的腎動脈塞栓術(TAE)を施行した.臨床症状は改善し, 現在明らかな腎機能障害は認めていない, A 58-year-old man with a left renal stone and with poor controlled hypertension was attacked by sudden onset of left renal colic pain, gross hematuria and nausea at 3 hours after ESWL. Ultrasonography and enhanced computed tomography revealed severe subcapsular hematoma, which compressed the left kidney. Since serum hemoglobin level continued to decrease in spite of 7 days of conservative therapy, we performed transfusion of red blood cells and selective transarterial embolization (TAE). Renal angiography showed multiple pseudo-aneurysms of arteriole at the lower pole of the left kidney. Embolization of left renal artery was effective to relieve patient's symptom and to stabilize the serum hemoglobin level.

58歳女.主訴は発熱と上腹部痛であった.尿検査で高度な膿尿を認めた.腹部CTでは左腎に珊瑚状結石, 左腎上極から外側周囲に広がる不均質に造影される腫瘤影と脾実質に多発する嚢胞性病変を認めたため, 珊瑚状結石に伴う膿腎症, 腎周囲腫瘍および脾膿瘍と診断した.SBC/CPZによる単独治療で主訴症状が改善した.その後, 経過観察していたが脾膿瘍の消退を認めた.しかし, 8ヵ月後に左無機能腎となったため, 左腎摘除術を施行した.術後再発は認めない.珊瑚状結石を伴う膿腎症が関連疾患となった脾膿瘍症例は非常に稀である, We report a rare case of splenic abscesses that were derived from left pyonephrosis. A 58-year-old woman was referred to our hospital with complaints of fever and epigastralgia. Computed tomography revealed splenic abscesses and left pyonephrosis with staghorn calculi. After admission, her condition improved with conservative therapy. Eight months later, the splenic abscesses had disappeared. The patient was then readmitted and left nephrectomy was performed to prevent relapse of the splenic abscesses. We suspected that direct invasion of inflammation from the left pyonephrosis caused the splenic abscesses, as her left kidney had adhered to the spleen. Only one case of splenic abscesses derived from a urinary tract infection has been reported in Japan.

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.

A case of renal cell carcinoma presentingwith paraneoplastic syndrome is reported. A 69-year-old man with uncontrolled diabetes was incidentally found to have a left thoracic tumor and a right renal tumor. He had intermittent fever of 39℃ or more and laboratory data showed diabetes and high C-reactive protein level. A radical nephrectomy was performed, but the neoplastic syndrome did not improve. After a second surgery consisting of complete resection of solitary bone metastasis the symptoms resolved immediately. At 6 months postoperatively, he had no reccurence. Generally prognosis of patients with bone metastasis from renal cell carcinoma has been said to be poor, but surgical control of bone metastasis may be a key factor for the prognosis of patient with metastatic RCC in the era of targeted therapy.

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.

症例は14歳女児で, 臍周囲の発赤, 腫脹, 血性滲出を認め, 小児科よりの紹介で来診した.腹部超音波検査で膀胱後壁より突出する辺縁平滑な腫瘤像を認め, 膀胱鏡でも膀胱後壁の腫瘤を認めた.入院後の膀胱, 瘻孔造影では膀胱と尿膜管との交通は認めず膀胱の後部へと尿膜管腫瘍が続いていた.同時に左膀胱尿管の逆流を認め, MRIでは臍部より連続する尿膜管が膀胱後部へ連続しており, 内部の不均一な腫瘤影を認めた.これら所見から膀胱後部に腫瘤を形成した尿膜管腫瘍の診断で, 保存的治療を試みたが無効のため尿膜管切除および左膀胱尿管新吻合術を施行した.膀胱後部の腫瘤は結石を核とする炎症性に肥厚した膀胱子宮窩の組織と判明した.摘出標本は上皮の剥離した炎症細胞浸潤を認める肉芽組織で, 移行上皮成分は認めず, 腫瘍組織も認めなかった.術後経過は良好で, 約1年経過の現在, 腫瘍の再発, 膀胱尿管逆流は認めていない, A 14-year-old girl was admitted to our hospital because of umbilical erythema and discharge. She had had an appendectomy at the age of twelve. Abdominal ultrasonography and cystoscopy revealed a large tumor-like mass at the posterior wall of the bladder. Computed tomography and magnetic resonance imaging revealed urachal sinus. The diagnosis of urachal abscess had been confirmed and conservative treatment had been continued by drainage via umbilicus and the administration of antibiotics. Total excision of the urachus was performed about one month later because the bladder mass was not reduced. Pathological findings revealed an inflammatory thickened wall of the urachus and no evidence of malignancy. We report this rare case of urachal abscess with a large mass in the retrovesical space.

A thirteen-year-old boy noted a swelling in his right scrotum one year prior to admission. On August 7, right high orchiectomy was performed. The tumor mass measured 10 x 6 x 7 cm. Microscopic examination revealed alveolar type rhabdomyosarcoma. Lymphangiography and computed tomography revealed retroperitoneal lymph node metastasis. He was treated with VAC therapy (vincristine, actinomycin D, cyclophosphamide) and VAD therapy (vincristine, adriamycin). This drug combination was effective, and he has been followed for two years with no evidence of recurrence.

A 37-year old female was admitted with a complaint of gross hematuria. Intravenous pyelography and retrograde pyelography showed right non-functioning kidney with a radiolucent stone in the ureter. Computerized tomographic scan revealed right hydronephrosis and ureteral stone. Ureterolithotomy was performed. Infrared spectrometric analysis of the stone revealed a 2, 8-dihydroxyadenine calculus. The adenine phosphoribosyltransferase activity in red blood cells was partially deficient. After the operation the patient has been given 100 mg/day of allopurinol and is on a low purine diet. There have been no signs of recurrence.

A 64-year-old man presented with gross hematuria. Physical examination showed a mass under the phimotic foreskin. Circumcision revealed a 2cm polypoid tumor on the inner layer of prepuce. Tumor resection was performed and pathological diagnosis was carcinosarcoma which was composed of squamous cell carcinoma and spindle cell sarcoma. Biopsy of the scar lesions revealed residual squamous cell carcinoma and computed tomographic scan revealed swollen inguinal lymph nodes. Partial penectomy and lymph node biopsy were performed. Pathological examination revealed residual squamous cell carcinoma and no lymph node metastasis. There was no recurrence for one year. We report this very rare case of carcinosarcoma of the penis.

A 90-year-old female patient presented with dysuria. She was treated with partial excision of the mass protruding from the urethral meatus. Pathological examination revealed non-Hodgkin's malignant lymphoma of the B-cell type. The patient received a total of 42.4 Gy extrabeam irradiation. Our patient was disease-free for 14 months. We reviewed 25 cases of this rare entity reported previously.

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.

To investigate how urinary frequency and incontinence affect the patient's subjective quality of life (QOL) and whether an improvement in objective findings by medical treatment affects his/her subjective QOL, a voiding diary using the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was delivered to patients with urinary frequency and/or incontinence before and after treatment with propiverine hydrochloride for 8 weeks. Sixty-eight patients completed the diary and the questionnaires. Objective symptoms decreased significantly with respect to the mean frequency of urination and to the mean incidence of urinary incontinence. The KHQ and ICIQ-SF scores improved significantly with respect to all domains except personal relationships in the KHQ. In the KHQ, furthermore, a significant correlation was found between decreased incidence of urinary incontinence and improvement in role limitations and between decreased incidence of urinary incontinence and improvement in emotional problems. In the ICIQ-SF, a significant correlation was found between decreased incidence of urinary frequency and subjective improvement in quantity of leakage, between decreased incidence of urinary frequency and improvement in subjective QOL scores, between decreased incidence of urinary frequency and improvement in the total ICIQ-SF score, and between decreased incidence of urinary incontinence and improvement in subjective QOL scores. Thirty-two episodes of adverse reactions were observed. None of them were serious. These results suggest that an improvement in objective symptoms with propiverine hydrochloride favorably improves subjective QOL of the patient, and provide further evidence about the safety and efficacy of propiverine hydrochloride.

The presentation of pheochromocytoma is quite variable. We report a case of previously undiscovered pheochromocytoma which was manifested by traumatic retroperitoneal hemorrhage. A 79-year-old man fell from his bicycle and was admitted to the emergency room complaining of right flank pain. Enhanced computed tomography (CT) revealed hemorrhage around the right adrenal gland. Since the plasma catecholamine levels were elevated, we suspected the presence of pheochromocytoma. After absorption of the hematoma, the tumor appeared clearly. The diagnosis of pheochromocytoma was confirmed through urine catecholamine testing and 131I-MIBG scintigraphy. Six months after the injury, the tumor was surgically resected. Traumatic hemorrhage of pheochromocytoma is extremely rare; only 3 cases have been reported in the literature.

A 26-year-old man was admitted to the department of surgery of our hospital with a complaint of intermittent left leg pain for the past two weeks. Ultrasonography revealed reduced blood flow to the tibial artery, which suggested a vascular disease like arteriosclerosis obliterans. Enhanced computed tomography (CT) revealed a huge abdominal tumor and a 3-dimensional CT scan showed a feeding artery from the left renal artery to the huge tumor. Findings of routine blood and urine examinations were elevated levels of lactate dehydrogenase, alkaline phosphatase, and C-reactive protein. Surgical exploration revealed a giant tumor with clouded ascites in the abdominal cavity containing class V cells revealed by cytological examination. The tumor was easily resected. Its vascular pedicle was thick and hypertrophied. Thus, it could be traced to the origin of left gonadal artery. At this time, the surgeon incidentally noticed the absence of left testis in the patient's scrotum. The resected specimen was 25 x 18 x 12 cm in size, and it weighed 3000 gm. The histological finding was pure seminoma invaded to peritoneum. His leg pain was relieved after the tumor resection.

Pheochromocytomas may occur as either sporadic or familial tumors. Clinical features of pheochromocytomas in neurofibromatosis 1 (NF1) patients are similar to those in patients with sporadic pheochromocytomas, unlike pheochromocytomas associated with other hereditary syndromes. Here we report two cases of pheochromocytoma associated with NF1. Case 1: A 29-year-old man with previously undiagnosed NF1, was admitted to our hospital for hypertension and a right adrenal tumor. On physical examination, cafe-au-lait spots and neurofibromas were observed on his body. Serum and urine catecholamine levels were markedly elevated. Case 2: The patient was a 46-year-old man with NF1. The tumor was incidentally detected by ultrasonography. Serum and urine catecholamine levels were similarly elevated. 131I-MIBG scintigraphy showed an abnormal accumulation in the right adrenal gland. After this diagnosis of pheochromocytoma associated with NF1, open adrenalectomy was performed. No evidence of malignancy was seen in either case.

A 14-year-old girl was referred to our hospital with severe pyuria pointed out in a school health check up. An intravenous pyelography and a cystography revealed a foreign body in the pelvic region outside the bladder and pooling of contrast medium in the vagina. Conputed tomography confirmed the foreign body in the vagina. About 1 year earlier, she inserted a hair spray can into the vagina but could not remove its cap. Under the diagnosis of vesicovaginal fistula due to vaginal foreign body, the cap was removed manually and transvaginal repair of the vesicovaginal fistula was performed under general anesthtesia, but it recurred twice. Finally, she underwent successful abdominovaginal repair of fistula. Although a variety of self-introduced objects in the vagina illegally used as a means of sexual gratification have been described, a vesicovaginal complication is very rare.

A 58-year-old man with a left renal stone and with poor controlled hypertension was attacked by sudden onset of left renal colic pain, gross hematuria and nausea at 3 hours after ESWL. Ultrasonography and enhanced computed tomography revealed severe subcapsular hematoma, which compressed the left kidney. Since serum hemoglobin level continued to decrease in spite of 7 days of conservative therapy, we performed transfusion of red blood cells and selective transarterial embolization (TAE). Renal angiography showed multiple pseudo-aneurysms of arteriole at the lower pole of the left kidney. Embolization of left renal artery was effective to relieve patient's symptom and to stabilize the serum hemoglobin level.

A 61-year-old man was referred to our hospital with a complaint of gross hematuria and lower abdominal discomfort. Ultrasonography, magnetic resonance imaging and cystoscopy revealed a nodular invasive tumor in urinary bladder. The histopathological findings of transurethral-biopsy specimen was the small cell carcinoma and transitional cell carcinoma of the bladder infiltrating into smooth muscle layer. Total cystectomy with ileal conduit was performed following 1 course of neoadjuvant chemotherapy (M-VAC). Computed tomography (CT) before adjuvant chemotherapy revealed tiny lung metastasis in left peripheral lung area. As postoperative adjuvant therapy, 4 courses of chemotherapy (etoposide and calboplatin) were performed with 50 Gy of extra beam radiotherapy to the lung metastasis. Follow up CT revealed disapperance of lung metastasis, and the patient has been free from disease for one year after chemotherapy.