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Fifty patients with localized prostate cancer, clinical stage T1-T2N0M0 were studied. The therapy started with androgen deprivation therapy for 3 months to reduce the volume of prostate about 35%. High-energy transurethral microwave thermotherapy (TUMT) was then performed. Transurethral resection of the prostate (TURP) was performed in radical fashion at least 3 months after TUMT to confirm the treatment effect. Thorough pathological study of all the TURP chips revealed no cancer cells in 39 of the 50 patients. Among 11 patients who revealed remnant of cancer cells, 4 patients were with viable cancer cells, and 7 were with devitalized cancer cells., 限局性前立腺癌(T1c-T2bN0M0)と判定した50例(年齢70.8±6歳)を対象にアンドロゲン抑制療法 (ADT)による前立腺体積縮小後に経尿道的前立腺高温度療法(TUMT)を施行し、3ヵ月後に経尿道的前立腺切除術(TURP)を行った。切除による線維被膜の全切片の病理組織検索を行い3種構成の治療成績を検討した。前立腺の縮小効果についてADT開始後12週間後の前立腺体積は平均23.4ml、 34.7%の縮小を認め、次いでTUMTとADTの継続により更に縮小し12週間後には平均19.0mlとなり、TURP切片の全重量は平均11.6gであった。血清PSA値はADT施行12週後に平均0.2ng/ml以下となり約98%の低下を認め、さらにTUMT施行12週後は全例が0.1ng/ml 以下となった。ADTの終了後平均33ヵ月(19-46ヵ月)を経てTURP施行後6ヵ月におけるPSA値は50例中48例が4.0ng/ml以下に留まった。TURPによる切片の病理組織学的検査結果は全症例が線維細胞による置換を主とする退行変化を顕著に認め、39例に前立腺癌組織の遺残は認めなかった。他の11例中7例は退行変化を示し自然消滅の可能性が大であると判定されたが、前立腺癌細胞を認めた4例も組織学的には悪性度は低下傾向で低分化型およびGleason score 8以上のものは無かった。全例に中断を要するADTによる合併症は認めなかった。前立腺癌細胞の低分化型は高分化型より高温度に対する耐久性は弱い可能性があると考えた。

手術後2年以上経過観察した初発原発性膀胱移行上皮癌110例(15～88歳)を対象に, 膀胱癌術後に発生した上部尿路上皮癌の発生起源, 危険因子について検討した.4例(3.6%)に上部尿路上皮癌が続発し, 先行した膀胱癌と続発した上部尿路上皮癌は病理組織学的にほぼ一致していた.続発性上部尿路上皮癌の危険因子としては, 高異型度, 多発性癌, 再発の繰り返し, 職業性膀胱癌, 上皮内癌(CIS)の存在, VURの存在, 膀胱壁内尿管への浸潤などが考えられた, A total of 110 patients were treated with primary transitional cell carcinoma (TCC) of the urinary bladder from 1990 to 2000. During the follow-up period, which was for at least two years, four patients (3.6 percent) had subsequent upper urothelial cancer at an average of 61.5 months after initial treatment of the bladder tumor. Two of the four patients received transurethral resection several times, and the remaining two patients underwent radical cystectomy for the initial bladder tumor. The histopathological findings of subsequent upper urothelial cancer were almost the same as those for the initial bladder tumor. One patient had accompanying carcinoma in situ (CIS) and the other had adenocarcinoma with TCC. Since 1) high grade, 2) multiple, 3) recurrent and 4) occupational bladder tumors, 5) concomitant CIS, 6) vesicoureteral reflux and 7) tumor invasion of the intravesical ureters have been reported to be risk factors for developing subsequent upper urothelial cancer, patients with bladder tumors who have these risk factors should be followed-up closely.

右側腹部痛を主訴とした53歳女で, 超音波検査は右腎下極に充実性腫瘤病変を示し, 数日後, 突然増大した腹部腫瘤に痛みを感じた.CTは不均質な密度の巨大な後腹膜腫瘤を描出した.腎腫瘍を自然破裂が疑われ, 緊急腎摘出が行われた.破裂腫瘍は蒼白, 弾性硬で, 十二指腸に直接浸潤していた.組織学的に大部分の領域で中等度の核異型を示し, 高頻度の核分裂像が認められ, 免疫染色で腎平滑筋肉腫と診断された.術後2ヵ月に腸穿孔により死亡した, A 53-year-old female visited our out-patient department complaining of right flank pain. Ultrasonography revealed a solid mass lesion in the lower pole of the right kidney and further evaluation was scheduled. A few days later, she suddenly felt pain at the abdominal enlarged mass. Computed tomographic (CT) scan revealed a huge retroperitoneal mass with heterogenous density. Spontaneous rupture of renal tumor was suspected and emergency nephrectomy was performed. The ruptured tumor was pale, elastic firm and invaded directly to the duodenum. Histopathological findings revealed fibrous cells with frequent nuclear mitosis. Smooth muscle actin was identified immunohistochemically. Therefore, the tumor was diagnosed as leiomyosarcoma. The patient died 2 months after operation due to perforation of the intestine.

37歳男.全周を石灰化で覆われた腎細胞癌の1例.腎辺縁に位置し石灰化で完全に覆われた腎細胞癌の場合, 一部の症例においては, より侵襲の少ない腫瘍核出術が適応になりうると考えられた, A 37-year-old man was found to have large calcification in the left kidney in a health check. This calcification has not changed in size during 3 years with computerized tomographic (CT) studies. However, a suspicious lesion for a malignant tumor with the calcification was suggested by a magnetic resonance image (MRI) study. Thus, the patient underwent tumor enucleation and the histology showed the mixed typed renal cell carcinoma. Although it remains controversial, partial nephrectomy or tumor enucleation would be considered in a case of renal cell carcinoma with calcification, which is usually considered to have a favorable prognosis compared to that of a tumor without a calcification.

ビカルタミド1日1回50mg群, 80mg及び100mgを12週間投与する3群比較の無作為化非盲検試験を実施した. 1)登録症例は124例で, 適格例は122例であった. 2)総合効果における奏効率は50mg群, 80mg群及び100mg群でそれぞれ50.5%, 61.0%及び53.7%であった. 3)PSAに対する奏効率は50mg群, 80mg群及び100mg群でそれぞれ84.2%, 92.7%及び97.6%であった. 4)副作用発現率は3群ほぼ6割で副作用による中止例は80mg群の1例のみで, 安全度において3群間に有意差はなかった.主な副作用は乳房腫脹, 乳房圧痛等であった, To investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

前立腺とりわけ射精管の拡張は決して稀ではなく, 血精液症, 前立腺肥大症, 前立腺癌の症例にしばしば合併し, 時に, 前立腺, 射精管などの嚢胞性変化が不妊症の原因となりうることがわかった。特に血精液症の原因の一つとして, 射精管の構造異常が深くかかわっている可能性が示唆された, Transrectal ultrasonography (TRUS) has been used extensively to evaluate the lower urinary tract in males, including the prostate gland, seminal vesicles and ejaculatory ducts. Of 475 males who underwent TRUS at Kitasato University Hospital, 43 (9.1%) were found to have cystic changes of these structures. Most of these cystic changes could be identified as being of prostate origin, Wolffian duct origin or Mullerian duct origin by their sonographic appearance and location. Although most patients were asymptomatic, 8 of the 30 men with a complaint of hematospermia had a sonographic finding of cystic changes in the prostate (3 patients) or ejaculatory ducts (5 patients). Inflammation and allergic reaction have been suggested to be related to hematospermia, however, their mechanism remains to unclear. These findings suggest that cystic changes in the ejaculatory duct contribute to hematospermia.

A case of renal oncocytoma found incidentally by routine medical checkups is reported. An asymptomatic 70-year-old male was found to have a right renal mass by abdominal ultrasonography. Selective renal arteriography supported the diagnosis of renal oncocytoma with a typical appearance of "spoke-wheel" pattern. Right radical nephrectomy was performed. However, in consideration of the possibility of renal cell carcinoma. The diagnosis of renal oncocytoma was finally confirmed pathologically. The present case represents the 58th renal oncocytomas reported in Japan as of December 1992.

We report here two cases of bladder cancer in patients with chronic renal failure who had been treated with hemodialysis. Case 1: A 58-year-old male on hemodialysis for 3 years visited with a complaint of gross hematuria. Transurethral resection of the bladder tumor (TUR-Bt) was performed and histopathological examination showed grade 1, stage pTa transitional cell carcinoma (TCC). The patient was followed for 4 years postoperatively without recurrence. Case 2: A 64-year-old male with hemodialysis for 1 week was referred to our department with a gross hematuria. TUR-Bt was conducted and histopathological findings showed grade 2, stage pT1b TCC. In April, 1992, he revisited our hospital with bladder tamponade due to massive hematuria, and TUR-Bt was performed. Histopathologically, the tumors were grade 2, stage pT2 TCC. He was followed for 1 year without recurrence.

1)表在性膀胱癌63症例に対してTUR-Bt後3日間のブレオマイシン持続膀胱内灌流, BCG膀胱内注入, UFT経口投与による再発予防の有用性を封筒法によるrandomized studyによって検討した。2)BCG投与群34例, BCG非投与群29例の3年非再発率は, おのおの80.1%, 72.1%と両群ともに高い再発防止効果がえられた。3)3年非再発率は, BCG投与群の方がBCG非投与群よりも勝っていたが, その差は推計学的に有意ではなかった。4)BCG投与による副作用は76.5%に認められたが, いずれも軽度から中等度のもので重篤のものではなかった。5)TUR-Bt後3日間のブレオマイシン持続膀胱内灌流, BCG膀胱内注入およびUFT経口投与による集学的再発予防法は, 単剤による再発予防法に比しより効果が期待できる方法と思われた, We evaluated 63 patients with superficial bladder cancer (pTa, pTl) who were treated with instillation of bleomycin +/- bacillus Calmette-Guerin (BCG) and administration of uraciltfutraful (UFT) for prophylaxis of tumor recurrence after transurethral resection (TUR). The patients were randomly assigned to groups A and B after transurethral resection by the closed envelope method. Group A (34 cases) was designed as continuous diluted intravesical instillation of bleomycin (120 mg/2, 000 ml saline solution/day repeated for 3 days), instillation BCG (40 mg/40 ml saline solution/weekly 6 times) and UFT (400 mg orally/day for 2 years maximum). Group B (29 cases) was designed as the aforementioned minus BCG instillation. Cumulative non-recurrence rates in group A and group B were 80.1% and 72.1% at the time of three years, which revealed no significant difference between the two groups (p = 0.265, generalized Wilcoxon test). The high recurrent incidence of superficial bladder cancer is primarily due to the multifocal nature of the cancer or implantation of tumor cells at the time of the subsequent transurethral resection. The procedure was performed safely with no severe side effects. Our method might be useful to reduce the recurrences of superficial bladder cancer after transurethral resection of bladder (TUR).

1)抗菌ゼオライトカテーテルを試作し基礎的・臨床的にその効果について検討した.2)組織移植試験, 急性毒性試験, 発熱性物質試験, 溶血性試験において毒性は認められなかった.3)抗菌性試験では, 緑膿菌, 黄色ブドウ球菌, 大腸菌の順に抗菌性が認められ, その効果は抗菌ゼオライト含有濃度およびカテーテル面積に比例していた.4)長期留置例9例に最低3ヵ月間2～4週毎に本カテーテルを交換, 留置し, 従来型シリコーン製尿道バルーンカテーテルと交換前後の尿沈渣, 尿培養, 血算, 血液生化学, 自覚症状などについて比較検討した.5) UTI学会効果判定基準で9例中2例, 主治医判定9例中5例に効果が認められた, We present here a production of anti-bacterial zeolite balloon catheter and investigated its potential for controlling urinary tract infection. This anti-bacterial balloon catheter showed a bactericidal effect against Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli in vitro studies. The antibacterial effects were correlated with the concentration of anti-bacterial zeolite and size of catheter. We tried this catheter for 11 various urological patients who needed a long-term indwelling of a balloon catheter for lower urinary tract obstruction and neurogenic bladder. All patients were already indwelled silicon balloon catheter for 3 to 6 months and suffered with complicated urinary tract infection. Nine patients who had this anti-bacterial zeolite balloon catheter indwelled for 3 to 7 months and exchanged every 2 to 4 weeks, and no patient was taking antibiotics during this trial. Two patients (22.2%) showed good results by the urinary tract infection (UTI) criteria and 5 patients (55.4%) showed good effects by doctor's judgment. This anti-bacterial zeolite balloon catheter might be useful for patients who need long-term balloon catheter indwelling.

1)初回治療をうけた170例の腎細胞癌中41例が無症状で発見され, そのうち30例がstage T2b以下の早期癌であった.2) 23例が超音波検査にて発見された.3)画像診断法で発見された37例中31例は, 尿沈渣で顕微鏡的血尿はみられなかった.4)超音波で発見された23例中3例は, IVPでは腫瘤の存在は診断できなかった, We reviewed the cases of incidental renal cell carcinoma that had been treated at the Kitasato University Hospital between July, 1971 and December, 1989. Forty one of the 170 (24.1%) cases were found without any direct signs of renal cell carcinoma. The patients were between 30 and 78 years old (mean 55.0 years) and consisted of 29 males and 12 females. Fifteen cases were detected at the general health check-up and the remaining 26 during the postoperative follow-up for other malignant tumors or other diseases. Twenty three cases were identified by ultrasonography followed by computed tomography (CT) and excretory pyelography in 4 cases each. Especially, the number of patients incidentally found by ultrasonography had increased in the recent 8 years. Urinalysis did not show any microhematuria in 31 of the 37 cases (83.7%), and no tumor mass could be detected by excretory pyelography in 3 cases. We believe that ultrasonography may be valuable as a screening modality for early detection of renal cell carcinoma and should be used as a screening method at the routine health check-up.

器質性インポテンス患者34名に対しAMSハイドロフレックスをインプラントして12週後, 1)満足度:非常に満足, 性交可能16例, 性交可能で満足13例, 性交可能でやや不満2例, 改善なし1例, 不明2例, 2)有用度:極めて有用20例, 有用11例, やや有用1例, 好ましくない1例, 判定不能1例, 3)副作用:海綿体膿瘍で抜去の1例, 平均19.2ヵ月中感染糜爛で抜去2例となった, The AMS Hydroflex penile prosthesis was implanted in 34 organic impotence patients between June 20, 1986 and Aug. 6, 1990. Patients ages ranged between 26 and 71 with an average of 50.5. The causes of impotences were; 17 cases of post-radical pelvic surgery, 7 cases of injury, 6 cases of diabetes and 4 of others. First evaluation was made after 12 weeks of implantation in terms of patient satisfaction with sexual intercourse and post operative complication. Sixteen patients (47.1%) were highly satisfied with intercourse, 13 (38.2%) satisfied with intercourse, 2 (5.9%) slightly dissatisfied even with successful intercourse, 1 (2.9%) with no improvement and 2 (5.9%) could not follow. Utility of the prosthesis, e.g. effectiveness and safety was; high utility in 20 (58.8%), good utility in 11 (32.4%), slight utility in 1 (2.9%), no favorable in 1 (2.9%) and no judgement in 1 (2.9%). The overall effectiveness and safety of the Hydroflex was demonstrated based on the above findings. Long term evaluation was made from the initial implantation of the device up to the termination of the trial with average of 19.2 months and was mentioned altogether.

TAP-144-SRの前立腺癌に対する比較対照試験をリン酸ジエチルスチルベストロールを対照薬として行った.有効性では, 前立腺癌の判定基準の適格例で, TAP群54.5%(36/66), 対照群47.1%(32/68)のPR例が得られ, 両群間に有意差はみられなかった.病巣別効果や自他覚症状に対する効果でも両群間に差はみられなかった.PAPなど腫瘍マーカーに対して対照群の方が有意に優れる効果を示した.内分泌効果では両群とも全例で血清testosteroneがcastration levelに低下した.安全性については, 副作用発現率はTAP群64.1%(41/64)に対し, 対照群は95.4%(62/65)と有意に高く, 対照群で4例が副作用のため試験が中止された.主治医判定による全般安全度では"問題あり"と判定された症例はTAP群6.3%(4/64), 対照群36.9%(24/65)であった.主治医判定による有用度では"有用"以上でみると, TAP群65.6%(42/64), 対照群52.3%(34/65)であった, A randomized controlled phase III clinical trial comparing TAP-144-SR (TAP) and diethylstilbestrol diphosphate was conducted for patients with prostatic cancer. Patients with Stage B, C, or D disease, who were previously untreated, were enrolled. TAP-144-SR 3.75 mg was administered subcutaneously at 4-week intervals for 12 weeks (a total of 3 injections) in the TAP-144-SR group, while 100 mg of diethylstilbestrol diphosphate was administered orally three times a day (before meals) for 12 weeks in the control group. A total of 141 patients were enrolled using a centralized telephone registration system. Four of these patients were ineligible, and there were 3 drop-outs who never received drugs because they withdrew their consents to participate in the trial. These 7 were excluded from the evaluation, and as a result, 134 patients (66 in the TAP group and 68 in the control group) were evaluable in safety and efficacy. Between the two groups, there were no significant differences in patient characteristics, except the age distribution. Clinical response rates (CR+PR) in evaluable patients according to the criteria of Japanese Prostatic Cancer Study Group were 54.5% in the TAP group and 47.1% in the control group. In addition, the rates according to the criteria for Evaluating the Direct Response to Chemotherapy in Solid Carcinomas and NPCP criteria were 7.6% in the TAP group and 8.8% in the control group and 18.2% in the TAP group and 20.6% in the control group, respectively. Using any of the three criteria, there were no significant differences in response rate between the two groups. The incidence of side effects was 64.1% in the TAP group and 95.4% in the control group; the incidence being significantly higher in the control group (p less than 0.001; chi 2-test). Therefore, the overall safety was significantly greater in the TAP group than in the control group (p less than 0.001; chi 2-test). On the basis of the efficacy and safety the clinical usefulness rate of TAP-144-SR was significantly higher than that of diethylstilbestrol diphosphate (p = 0.038; U-test). In conclusion, TAP-144-SR was confirmed to be more useful than diethylstilbestrol diphosphate as a standard drug for hormonal therapy of prostatic cancer.

Removal of renal cell carcinoma (RCC) extended into the inferior vena cava (IVC) can be a difficult operation. Between 1941 and 1989, 110 RCC patients were treated with radical operation and examined for tumor thrombus histopathologically. Twenty nine (26.3%) patients had invasion into the returning vein of tumor (Stage Vla), 12 (10.9%) in renal vein (stage Vlb) and the remaining 4 (3.6%) into IVC (stage V2). In one patient who had surgery under extracorporeal circulation, a thrombus was extended into the right atrium. In the remaining three patients, the RCC was confined to a small portion of the IVC and operated by caval sleeve resection. Radical operation in such patients free of any distant metastasis, may raise the survival rate.

1)原発性膀胱腫瘍325例全体の2, 4, 6, 8, 10年生存率は77%, 68%, 62%, 58%, 51%であった.2)男女比と腫瘍数別で生存率に有意差は認められなかったが, 腫瘍が大きくなるにつれ, 発育形態が非乳頭状や広基性になるにつれ, 全摘群, 悪性度が高くなるにつれ, 浸潤度が進行するにつれ生存率が有意に低下した, To study the relationship between clinical features and prognosis of the bladder tumor, 325 patients who were treated in our hospital were analyzed. The overall 5-year and 10-year actual survival rates were 65% and 51%. There was no statistical significance in the actual survival rate between the single and multiple tumor group. Although, there was a significant difference in tumor size, tumor growing type and the mode of treatment. The ten-year survival rates for grades 1, 2 and 3 cases were 76%, 57% and 18%, respectively. There was a significant difference between grades 1 and 3 (p less than 0.001) and grades 2 and 3 (p less than 0.001). The ten-year survival rates for stages Ta, T1, T2, T3a, T3b and T2-4 M1 were 79%, 68%, 43%, 0%, 19% and 5%, respectively. There was a significant difference between the Ta, 1 and T2-4 group (p less than 0.001).

We analyzed 325 primary bladder tumor patients who were treated in our hospital during the past 15 years. There were 242 males and 83 females who were between 20 and 84 years old with an average age of 63 years old. The most frequent complaint was macroscopic hematuria in 76.9% of the patients (250/325). Cystoscopically, a single tumor was seen in 71%, the tumor was medium sized (1 to 3 cm) in 32%, and 56% were papillary tumors with a stalk. Histologically, 300 (92.3%) cases were transitional cell carcinoma. There were 42, 206 and 52 patients with grades 1, 2 and 3 transitional cell carcinoma and stage Tis, Ta, T1, T2, T3a, T3b, T2-4M1 and Tx were 2, 46, 151, 30, 15, 16, 37 and 3 cases each. Transurethral resection was performed in 231 (71.1%), partial cystectomy in 6 (1.8%) and total cystectomy in 44 (12.5%) cases each.

Two hundred and thirty one patients who underwent transurethral resection of a bladder tumor (TUR-Bt) at our hospital during the past 15 years were analyzed. There were 176 males and 55 females, and the average age at the initial TUR-Bt was 62 years old. Histopathologically, 225 cases were of transitional cell carcinoma, 4 cases of papilloma and 2 cases of squamous cell carcinoma. Grading and staging of 225 transitional cell carcinoma cases revealed grades 1, 2 and 3 in 32, 132 and 21 cases, and stages Ta, T1, T2, T3 and T2-4M1 in 48, 135, 20, 17 and 11 cases, respectively. The frequency of TUR-Bt varied from 1 to 10 times. Among the 231 cases TUR-Bt was done once, twice and three times in 149 (64.5%) and 41 (17.8%), and 22 (9.6%) cases, respectively and the total number of TUR-Bt was 400 times. The duration of the TUR-Bt operation was from 5 min. to 160 min. (mean: 32.4 min.) and the resected weight of tumor between 0.5 g and 85 g (mean: 5.4 g). As a complication of TUR-Bt, TUR-fulguration was necessary to control postoperative bleeding in 7 cases (1.7%), and blood transfusion was required in 13 cases (3.3%) during TUR-Bt. Postoperatively blood transfusion was required in 8 cases (2%), intraperitoneal perforation in 2 cases (0.5%), extraperitoneal perforation in 6 cases (1.5%) and hyponatremia in 1 case (0.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

The clinical efficacy of oxybutynin hydrochloride was studied on 21 patients with neurogenic bladder or unstable bladder complaining of urinary frequency, urgency and urgent incontinence. Oxybutynin hydrochloride (1 mg/tablet) was administered orally for 26.7 days, on average, 3 mg per day in 3 and 6 mg per day in 18 patients and the usefulness of this drug was assessed subjectively and objectively. Of 21 patients treated, 9 had neurogenic bladder and 10 had unstable bladder. Urinary frequency was normalized in 6 out of 16 (37.5%), urgency ceased in 6 out of 17 (35.7%) and urgent incontinence disappeared in 9 out of 14 (50%) patients. The mean volume at the first desire to void and the maximum cystometric capacity increased significantly on the cystometrogram after the administration of oxybutynin hydrochloride (p less than 0.01). Furthermore, the maximum vesical pressure decreased significantly (p less than 0.05). The maximum urinary flow rate increased slightly (p less than 0.1) and the residual urine volume significantly increased (p less than 0.05) after medication, although no changes were observed in tidal voiding volume or mean urinary flow rate. Of 20 patients, 9 showed improvement globally (45%), although no subjective or objective improvement was observed in 4 (20%) patients. Marked side effects were observed in 5 cases (two of acute urinary retention, each of increased urgency, residual urine and liver dysfunction), and side effects were seen in 10 of the 21 (47.6%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of congenital penile curvature is reported. A 21-year-old man was admitted because of penile pain curvature to the left at the erection and the difficulty of intercourse. He had no signs of Peyronie's disease and no history of penile fracture so that he was considered to have congenital penile curvature. By Nesbit's method the curvature of the penis was appropriately corrected. There were no signs of recurrence at either 1 or 5 months after the operation.

13歳女に発生した腎細胞癌.Wilms腫瘍, 腎細胞癌の両腎腫瘍中に占める腎細胞癌の割合は, 11～15歳において, 既に44.4%に達しており, この年齢においてはWilms腫瘍と約同頻度で腎細胞癌も認められることを留意する必要がある, A case of renal cell carcinoma (RCC) in a teenage patient is reported. A 13-year-old girl visited our hospital with the complaint of dyspnea and right abdominal mass. CT scan and chest X-P revealed a right renal tumor with multiple lung metastasis. Wilms' tumor was suspected and a combination chemotherapy consisting of actinomycin D and vincristin was performed. Since the tumor was insensitive to these agents, open biopsy was done. The pathological findings showed clear cell renal cell carcinoma. Despite the administration of alpha interferon, 5-FU and cimetidine, the disease was progressive and the patient died 5 months after diagnosis. It is important to consider the possibility of renal cell carcinoma in teenage patients with a renal mass, since more than 40% of the renal tumors in this age group are renal cell carcinomas.

A case of solitary metastasis with renal cell carcinoma to the thyroid gland is presented. The patient was a 54-year-old man found to have an abnormal mass in the neck. He had a past history of radical nephrectomy orignating from the right renal cell carcinoma 5 years earlier (pT2N0M0, G2 > 3, alveolar type, clear cell subtype). Ultrasonography revealed a tumor mass in the right hemithyroid gland. Right hemithyroidectomy was performed on April 19, 1995. Histopathologically, the removed thyroid tumor showed clear cell carcinoma. The possibility of a primary thyroid tumor was ruled out by immunohistochemical thyroglobulin staining, and the present case was thus diagnosed as of metastatic thyroid tumor of renal cell carcinoma. The present case is the 12th case of thyroid solitary metastasis of renal cell carcinoma reported in Japan to date.

Leiomyosarcoma of the prostate gland is rare, and only 44 of these neoplasms have been reported in Japan. We experienced a case in a 17-year-man suffering from leiomyosarcoma and lung metastasis. The patient was treated with chemotherapy consisting of cis-platin, etoposide and methotrexate. He improved considerably and was discharged after five months. However the disease recurred in the pelvis and the lungs. The patient was unresponsive to further chemotherapy and died six months later.

We report a case (62-year-old male) of transitional cell carcinoma (grade 2) of solitary right renal pelvis which was successfully treated with tumor excision followed by bacillus Calmette-Guerin instillation therapy. He had a past history of left radical nephroureterectomy for renal pelvic tumor 11 years earlier. Kidney-preserved surgery with BCG instillation therapy is expected to be an alternative for radical forms of therapy, especially in the patients with a solitary kidney.

Fifty patients with localized prostate cancer, clinical stage T1-T2N0M0 were studied. The therapy started with androgen deprivation therapy for 3 months to reduce the volume of prostate about 35%. High-energy transurethral microwave thermotherapy (TUMT) was then performed. Transurethral resection of the prostate (TURP) was performed in radical fashion at least 3 months after TUMT to confirm the treatment effect. Thorough pathological study of all the TURP chips revealed no cancer cells in 39 of the 50 patients. Among 11 patients who revealed remnant of cancer cells, 4 patients were with viable cancer cells, and 7 were with devitalized cancer cells.

A total of 110 patients were treated with primary transitional cell carcinoma (TCC) of the urinary bladder from 1990 to 2000. During the follow-up period, which was for at least two years, four patients (3.6 percent) had subsequent upper urothelial cancer at an average of 61.5 months after initial treatment of the bladder tumor. Two of the four patients received transurethral resection several times, and the remaining two patients underwent radical cystectomy for the initial bladder tumor. The histopathological findings of subsequent upper urothelial cancer were almost the same as those for the initial bladder tumor. One patient had accompanying carcinoma in situ (CIS) and the other had adenocarcinoma with TCC. Since 1) high grade, 2) multiple, 3) recurrent and 4) occupational bladder tumors, 5) concomitant CIS, 6) vesicoureteral reflux and 7) tumor invasion of the intravesical ureters have been reported to be risk factors for developing subsequent upper urothelial cancer, patients with bladder tumors who have these risk factors should be followed-up closely.

A 53-year-old female visited our out-patient department complaining of right flank pain. Ultrasonography revealed a solid mass lesion in the lower pole of the right kidney and further evaluation was scheduled. A few days later, she suddenly felt pain at the abdominal enlarged mass. Computed tomographic (CT) scan revealed a huge retroperitoneal mass with heterogenous density. Spontaneous rupture of renal tumor was suspected and emergency nephrectomy was performed. The ruptured tumor was pale, elastic firm and invaded directly to the duodenum. Histopathological findings revealed fibrous cells with frequent nuclear mitosis. Smooth muscle actin was identified immunohistochemically. Therefore, the tumor was diagnosed as leiomyosarcoma. The patient died 2 months after operation due to perforation of the intestine.

To investigate the efficacy and safety of bicalutamide (Casodex(R)) with its clinically recommended dose, the randomized early phase II study was performed in 124 patients with prostatic cancer (stage C, D). The patients were given 50, 80 or 100 mg of bicalutamide orally once a day in fixed doses for 12 weeks ; 122 patients were eligible for evaluation. The overall response rate was 50.0% (20/40); 61.0% (25/41) and 53.7% (22/41) in the 50 mg, 80 mg and 100 mg groups, respectively. The response rate in prostate lesion, bone and lymph node metastases was slightly higher in the 80 mg group than in the 50 mg and 100 mg groups. The proportion of patients showing a response with regard to serum PSA (CR and PR) was 84.2, 92.7 and 97.6% in the 50, 80 and 100 mg groups, respectively. The incidence of adverse reactions was 65.0, 61.0 and 61.0% in the 50, 80 and 100 mg groups, respectively, and there was no significant difference in overall safety rating in the three groups. Frequent adverse reactions were gynecomastia and breast pain. Only one patient in the 80 ing group was withdrawn due to shortness of breath. Serum concentrations of LH, testosterone and estradiol increased significantly after treatment. Bicalutamide was concluded to be effective and well tolerated in patients with prostatic cancer, and its recommended dose was 80 mg once daily.

A case of solitary metastasis with renal cell carcinoma to the thyroid gland is presented. The patient was a 54-year-old man found to have an abnormal mass in the neck. He had a past history of radical nephrectomy orignating from the right renal cell carcinoma 5 years earlier (pT2N0M0, G2 > 3, alveolar type, clear cell subtype). Ultrasonography revealed a tumor mass in the right hemithyroid gland. Right hemithyroidectomy was performed on April 19, 1995. Histopathologically, the removed thyroid tumor showed clear cell carcinoma. The possibility of a primary thyroid tumor was ruled out by immunohistochemical thyroglobulin staining, and the present case was thus diagnosed as of metastatic thyroid tumor of renal cell carcinoma. The present case is the 12th case of thyroid solitary metastasis of renal cell carcinoma reported in Japan to date.

A case of congenital penile curvature is reported. A 21-year-old man was admitted because of penile pain curvature to the left at the erection and the difficulty of intercourse. He had no signs of Peyronie's disease and no history of penile fracture so that he was considered to have congenital penile curvature. By Nesbit's method the curvature of the penis was appropriately corrected. There were no signs of recurrence at either 1 or 5 months after the operation.

A case of renal cell carcinoma (RCC) in a teenage patient is reported. A 13-year-old girl visited our hospital with the complaint of dyspnea and right abdominal mass. CT scan and chest X-P revealed a right renal tumor with multiple lung metastasis. Wilms' tumor was suspected and a combination chemotherapy consisting of actinomycin D and vincristin was performed. Since the tumor was insensitive to these agents, open biopsy was done. The pathological findings showed clear cell renal cell carcinoma. Despite the administration of alpha interferon, 5-FU and cimetidine, the disease was progressive and the patient died 5 months after diagnosis. It is important to consider the possibility of renal cell carcinoma in teenage patients with a renal mass, since more than 40% of the renal tumors in this age group are renal cell carcinomas.

A 37-year-old man was found to have large calcification in the left kidney in a health check. This calcification has not changed in size during 3 years with computerized tomographic (CT) studies. However, a suspicious lesion for a malignant tumor with the calcification was suggested by a magnetic resonance image (MRI) study. Thus, the patient underwent tumor enucleation and the histology showed the mixed typed renal cell carcinoma. Although it remains controversial, partial nephrectomy or tumor enucleation would be considered in a case of renal cell carcinoma with calcification, which is usually considered to have a favorable prognosis compared to that of a tumor without a calcification.