Search

We develop a general framework to compute photometric variations induced by the oblique rotation of a star with an axisymmetric inhomogeneous surface. We apply the framework to compute lightcurves of white dwarfs adopting two simple models of their surface inhomogeneity. Depending on the surface model and the location of the observer, the resulting lightcurve exhibits a departure from a purely sinusoidal curve that are observed for a fraction of white dwarfs. As a specific example, we fit our model to the observed phase-folded lightcurve of a fast-spinning white dwarf ZTF J190132.9+145808.7 (with the rotation period of 419s). We find that the size and obliquity angle of the spot responsible for the photometric variation are $\dts \approx 60^\circ$ and $\thetaS \approx 60^\circ$ or $90^\circ$, respectively, implying an interesting constraint on the surface distribution of the magnetic field on white dwarfs., 25 pages, 9 figures, accepted for publication in PASJ

We report a one-second-cadence wide-field survey for M-dwarf flares using the Tomo-e Gozen camera mounted on the Kiso Schmidt telescope. We detect 22 flares from M3-M5 dwarfs with rise times and amplitudes ranging from $5\, \mathrm{sec} \lesssim t_\mathrm{rise} \lesssim 100\,\mathrm{sec}$ and $0.5 \lesssim \Delta F/F_{\star} \lesssim 20$, respectively. The flare light curves mostly show steeper rises and shallower decays than those obtained from the Kepler one-minute cadence data and tend to have flat peak structures. Assuming a blackbody spectrum with temperatures of $9,000-15,000\,\mathrm{K}$, the peak luminosities and bolometric energies are estimated to be $10^{29}\,\mathrm{erg\,sec^{-1}} \lesssim L_\mathrm{peak} \lesssim 10^{31}\,\mathrm{erg\,sec^{-1}}$ and $10^{31}\,\mathrm{erg} \lesssim E_{\rm bol} \lesssim 10^{34}\,\mathrm{erg}$, which constitutes the bright end of fast optical flares for M dwarfs. We confirm that more than 90\% of the host stars of the detected flares are magnetically active based on their H$\alpha$ emission line intensities obtained by LAMOST. The estimated occurrence rate of the detected flares is $\sim 0.7$ per day per an active star, indicating they are common in magnetically active M dwarfs. We argue that the flare light curves can be explained by the chromospheric compression model; the rise time is broadly consistent with the Alfv\'en transit time of a magnetic loop with a length scale of $l_\mathrm{loop} \sim 10^4\,\mathrm{km}$ and a field strength of $1,000\,\mathrm{G}$, while the decay time is likely determined by the radiative cooling of the compressed chromosphere down to near the photosphere with a temperature of $\gtrsim 10,000\,\mathrm{K}$. These flares from M dwarfs could be a major contamination source for a future search of fast optical transients of unknown types., Comment: 39 pages, 13 figures, accepted for publication in PASJ

Highly purified specimen of saltpetre, kept in two glass jars are stored in the collections of the Natural History Museum, London, United Kingdom. Historic catalogs of the specimen collection record their acquisition date as 17th March, 1881. The specimen represent heritage of the saltpetre industry during the times of the colonial British India. Chemical analysis shows that they are highly refined, containing only traces of impurities. Dual isotopic composition (δ15N and δ18O) of nitrate implies their intrinsic origin as British India. In addition, relative to highly radiogenic signature of Sr widespread throughout India, less radiogenic strontium (87Sr/86Sr = 0.707859–0.714168) in the specimens suggests that final stages of the refining took place in western India where relevant waters containing pristine Sr were used. Stable isotope geochemistry in combination with history and socio-economy provide new insights into this research area which is not yet fully understood.

We analyze 5108 AFGKM stars with at least five high precision radial velocity points as well as Gaia and Hipparcos astrometric data utilizing a novel pipeline developed in previous work. We find 914 radial velocity signals with periods longer than 1000\,d. Around these signals, 167 cold giants and 68 other types of companions are identified by combined analyses of radial velocity, astrometry, and imaging data. Without correcting for detection bias, we estimate the minimum occurrence rate of the wide-orbit brown dwarfs to be 1.3\%, and find a significant brown dwarf valley around 40 $M_{\rm Jup}$. We also find a power-law distribution in the host binary fraction beyond 3 au similar to that found for single stars, indicating no preference of multiplicity for brown dwarfs. Our work also reveals nine sub-stellar systems (GJ 234 B, GJ 494 B, HD 13724 b, HD 182488 b, HD 39060 b and c, HD 4113 C, HD 42581 d, HD 7449 B, and HD 984 b) that have previously been directly imaged, and many others that are observable at existing facilities. Depending on their ages we estimate that an additional 10-57 sub-stellar objects within our sample can be detected with current imaging facilities, extending the imaged cold (or old) giants by an order of magnitude., 39 pages, 14 figures, 5 tables, published in The Astrophysical Journal Supplement Series

A 31-year-old man was referred to our hospital with urinary retention. Cystoscopy revealed multiple edematous papillary tumors on the bladder trigone and neck, which were removed by transurethral resection. The pathological diagnosis was typical type cystitis glandularis. This relapsed six months after surgery and transurethral resection was repeated. Because immunohistochemical findings revealed positive epithelial cyclooxygenase-2 (COX-2) signals, we prescribed an oral COX-2 inhibitor. The tumor revealed shrinkage for six months after medication.

We develop a new retrieval scheme for obtaining two-dimensional surface maps of exoplanets from scattered light curves. In our scheme, the combination of the L1-norm and Total Squared Variation, which is one of the techniques used in sparse modeling, is adopted to find the optimal map. We apply the new method to simulated scattered light curves of the Earth, and find that the new method provides a better spatial resolution of the reconstructed map than those using Tikhonov regularization. We also apply the new method to observed scattered light curves of the Earth obtained during the two-year DSCOVR/EPIC observations presented by Fan et al. (2019). The method with Tikhonov regularization enables us to resolve North America, Africa, Eurasia, and Antarctica. In addition to that, the sparse modeling identifies South America and Australia, although it fails to find the Antarctica maybe due to low observational weights on the poles. Besides, the proposed method is capable of retrieving maps from noise injected light curves of a hypothetical Earth-like exoplanet at 5 pc with noise level expected from coronagraphic images from a 8-m telescope. We find that the sparse modeling resolves Australia, Afro-Eurasia, North America, and South America using 2-year observation with a time interval of one month. Our study shows that the combination of sparse modeling and multi-epoch observation with 1 day or 5 days per month can be used to identify main features of an Earth analog in future direct imaging missions such as the Large UV/Optical/IR Surveyor (LUVOIR)., 17 pages, 9 figures; revised assumptions of distance to a planet and telescope size in section 5; accepted for publication in the Astrophysical Journal

The time series of light reflected from exoplanets by future direct imaging can provide spatial information with respect to the planetary surface. We apply sparse modeling to the retrieval method that disentangles the spatial and spectral information from multi-band reflected light curves termed as spin-orbit unmixing. We use the $\ell_1$-norm and the Total Squared Variation norm as regularization terms for the surface distribution. Applying our technique to a toy model of cloudless Earth, we show that our method can infer sparse and continuous surface distributions and also unmixed spectra without prior knowledge of the planet surface. We also apply the technique to the real Earth data as observed by DSCOVR/EPIC. We determined the representative components that can be interpreted as cloud and ocean. Additionally, we found two components that resembled the distribution of land. One of the components captures the Sahara Desert, and the other roughly corresponds to vegetation although their spectra are still contaminated by clouds. Sparse modeling significantly improves the geographic retrieval, in particular, of cloud and leads to higher resolutions for other components when compared with spin-orbit unmixing using Tikhonov regularization., 26 pages, 10 figures, accepted for publication in ApJ

Photometric monitoring by the Transiting Exoplanet Survey Satellite (TESS) has discovered not only periodic signals by transiting exoplanets but also episodic or quasi-periodic dimming around young stellar objects. The mechanisms of the dimming of these objects, so-called "dippers", are thought to be related to the property of the accretion or the structure of protoplanetary disks especially in regions close to the host star. Recently, we have created the catalog of dippers from the one year of TESS Full Frame Image (FFI) data. In this paper, we report spectral features of four newly found dippers in that catalog and show that they potentially shed light on the dimming mechanisms. We found that all of the targets exhibit the H alpha emission line, which is an indicator of an ongoing accretion. Based on its line profiles and/or their variability, we characterized the properties of the disks of each source, which can support the dimming mechanisms due to a dusty disk wind or an accretion warp. Also, we found an interesting dipper (TIC 317873721), "close-in binary dipper," showing the complex variability of the line profile and the large radial velocity variation. Since the dimming intervals are similar to the orbital period of the binary, we suggest that the dips are caused by dust in the warp of accretion from a circumbinary disk onto stars. Such a close-in ($, Comment: 15 pages, 10 figures, accepted for publication in ApJS

Granulocyte colony-stimulating factor (G-CSF)-producing urothelial carcinomas (UCs) are rare and have a poor prognosis. According to the literature, treatment for G-CSF-producing UCs is very difficult. We experienced 2 cases of UC presenting with leukocytosis. In these cases, serum G-CSF levels were higher than the reference value with leukocytosis at diagnosis, and the resected specimens were positive for anti-G-CSF immunostaining. One case had a good prognosis and the other case died after 9 months from diagnosis. A change in serum G-CSF levels was reportedly an effective tumor marker in several reports. In the present cases, evaluation of serum G-CSF levels was found to be more sensitive than computerized tomography. The treatment and outcomes of UC-producing G-CSFs and the efficacy of serum G-CSF as a tumor marker are discussed based on our cases and a review of the literature.

A 55-year-old man underwent right radical nephrectomy after the diagnosis of right renal cell carcinoma (RCC). He did not show any relapse or metastasis for 3 years and 5 months after surgery. He was admitted to the hospital in April 2014 with a throat discomfort. Laryngoscopy revealed a 5 mm supraglottic mass. The tumor was locally excised and pathology revealed metastatic RCC. While RCC frequently metastasizes to the lungs, bones, lymph nodes, and brain, an isolated metastasis of RCC to the larynx is an extremely rare event. We report a case of isolated RCC metastasis to the supraglottic larynx 3 years and 5 months after radical nephrectomy.

Spatial correlations among proto-planetary disk orientations carry unique information on physics of multiple star formation processes. We select five nearby star-forming regions that comprise a number of proto-planetary disks with spatially-resolved images with ALMA and HST, and search for the mutual alignment of the disk axes. Specifically, we apply the Kuiper test to examine the statistical uniformity of the position angle (PA: the angle of the major axis of the projected disk ellipse measured counter-clockwise from the north) distribution. The disks located in the star-forming regions, except the Lupus clouds, do not show any signature of the alignment, supporting the random orientation. Rotational axes of 16 disks with spectroscopic measurement of PA in the Lupus III cloud, a sub-region of the Lupus field, however, exhibit a weak and possible departure from the random distribution at a $2\sigma$ level, and the inclination angles of the 16 disks are not uniform as well. Furthermore, the mean direction of the disk PAs in the Lupus III cloud is parallel to the direction of its filament structure, and approximately perpendicular to the magnetic field direction. We also confirm the robustness of the estimated PAs in the Lupus clouds by comparing the different observations and estimators based on three different methods including sparse modeling. The absence of the significant alignment of the disk orientation is consistent with the turbulent origin of the disk angular momentum. Further observations are required to confirm/falsify the possible disk alignment in the Lupus III cloud., Comment: 26 pages, 8 figures, accepted for publication in ApJ

We perform a systematic search for rings around 168 Kepler planet candidates with sufficient signal-to-noise ratios that are selected from all the short-cadence data. We fit ringed and ringless models to their lightcurves, and compare the fitting results to search for the signatures of planetary rings. First, we identify 29 tentative systems, for which the ringed models exhibit statistically significant improvement over the ringless models. The lightcurves of those systems are individually examined, but we are not able to identify any candidate that indicates evidence for rings. In turn, we find out several mechanisms of false-positives that would produce ring-like signals, and the null detection enables us to place upper limits on the size of rings. Furthermore, assuming the tidal alignment between axes of the planetary rings and orbits, we conclude that the occurrence rate of rings larger than twice the planetary radius is less than 15 percent. Even though the majority of our targets are short-period planets, our null detection provides statistical and quantitative constraints on largely uncertain theoretical models of origin, formation, and evolution of planetary rings., 36 pages, 13 figures, 3 tables, accepted for publication in the Astronomical Journal

Objectives To characterize the site and clinical implications of intravesical recurrence after radical nephroureterectomy for upper urinary tract urothelial carcinoma. Methods Patients who underwent radical nephroureterectomy for upper urinary tract urothelial carcinoma between 2000 and 2011 at 12 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were included in the present study. Those who underwent prior or simultaneous radical cystectomy were excluded. The site of intravesical recurrence was investigated, and the survival curves after radical nephroureterectomy were analyzed retrospectively using the Kaplan–Meier method. Multivariate analyses of factors predicting survival were carried out. Results A total of 534 patients were eligible for the present study. With a median follow up of 47 months, 205 patients (38.4%) had intravesical recurrence. The intravesical recurrence-free survival rates at 1, 2, and 5 years were 74.6%, 62.5% and 56.3%, respectively. In a subset of 137 patients with intravesical recurrence who did not have bladder cancer before or at the diagnosis of upper urinary tract urothelial carcinoma, the most frequent site of intravesical recurrence was around the cystotomy (52.6%), followed by at the posterior wall (39.4%) and at the bladder neck (35.8%). A total of 36 patients (17.6%) developed muscle-invasive bladder cancer after radical nephroureterectomy. On multivariate analyses for the subset of patients with non-muscle invasive (≤pT1) upper urinary tract urothelial carcinoma, intravesical recurrence was an independent predictor of cancer-specific survival (HR 4.27, P = 0.016) and overall survival (HR 3.00, P = 0.018). Conclusions Most intravesical recurrences occur around the site of bladder mucosal injury within 1 year after radical nephroureterectomy, providing important insight into the mechanism of intravesical recurrence. Intravesical recurrence after radical nephroureterectomy had an impact on oncological outcomes of patients with non-muscle invasive upper urinary tract urothelial carcinoma.

We visually inspected the light curves of 7557 Kepler Objects of Interest (KOIs) to search for single transit events (STEs) possibly due to long-period giant planets. We identified 28 STEs in 24 KOIs, among which 14 events are newly reported in this paper. We estimate the radius and orbital period of the objects causing STEs by fitting the STE light curves simultaneously with the transits of the other planets in the system or with the prior information on the host star density. As a result, we found that STEs in seven of those systems are consistent with Neptune- to Jupiter-sized objects of orbital periods ranging from a few to $\sim$ $20\,\mathrm{yr}$. We also estimate that $\gtrsim20\%$ of the compact multi-transiting systems host cool giant planets with periods $\gtrsim 3\,\mathrm{yr}$ on the basis of their occurrence in the KOIs with multiple candidates, assuming the small mutual inclination between inner and outer planetary orbits., Comment: 12 pages, 6 figures, 4 tables, accepted by ApJ

Aim: The aim of the study was to evaluate the clinicopathological and prognostic significance of morphological subtyping of papillary renal cell carcinoma (PRCC). Methods: The patients treated for renal cell carcinoma in our department from January 1985 to March 2006 were evaluated retrospectively. Thirty-two of the 591 patients (5.4%) were diagnosed with PRCC. To determine the prognostic factors, we re-evaluated the pathological stage according to the 2002 TNM classification of malignant tumors, and the tumor type of renal cell carcinoma according to the 2004 World Health Organization histological classification. Survival was analysed using the Kaplan-Meier method and the log-rank test. Results: The age at diagnosis ranged from 33 to 81 years (median: 63 years old) and the follow-up time after the surgical treatment ranged from 4 to 191 months (median: 54 months). The cancer-specific 5-year survival rate of the 32 PRCC patients was 74%. Pathologically, 17 patients (53%) and 15 patients (47%) were diagnosed with type 1 and type 2 PRCC, respectively. The type 2 PRCC patients had a significantly higher tumor grade (P

PURPOSE: We retrospectively evaluated the characteristics and long-term prognosis of incidentally detected renal cell carcinoma by health checkup. MATERIALS AND METHODS: From January 1987 to December 2005, 556 patients were treated for renal cell carcinoma in our department. Among them, 56 patients were detected by abdominal ultrasonography in health checkup of our health care center. We reevaluated the pathological stage according to 2002 TNM classification and tumor type of renal cell carcinoma according to 2004 World Health Organization histological classification. Survival analysis was determined by Kaplan-Meier's method and log-rank test. RESULTS: Of the patients, 50 were male and 6 were female. The age of the patients ranged 37 to 68 years old at diagnosis (median 54 years). The tumors were located in the right kidney in 22 patients and in the left kidney in 34. Pathologically T1a tumors were found in 40 patients (71%), T1b in 13 (23%), T2 in 2 (4%) and T3b in 1 patients (2%). One case of T3b had N2 and M1 disease. The followup time after the operation ranged 3 to 215 months (median 121 months). Seven patients died of renal cell carcinoma. One of the 7 patients in T1a disease died at 64 months, 4 in T1b at 47, 91, 119, 163 months, 1 in T2 at 39 months and 1 in T3b at 13 months, postoperatively. The cause specific 10-year survival rate was 97% for T1a disease and 57% for T1b (p < 0.01), respectively. CONCLUSION: Most of renal cell carcinomas were T1a disease, which were detected incidentally by health checkup. The cause specific survival rate was significantly higher for T1a disease than for T1b. Our data suggested that early detection was important for good prognosis. The abdominal ultrasonography was only method for detection in routine health checkup and should be broadly implemented.

of postoperative renal dysfunction, and NACT was recommended for those patients. In selecting eligible NACT patients, this algorithm has a prediction ability with 76% (25/33) sensitivity and 77% (358/467) specificity. CONCLUSIONS: We developed a preoperative selection algorithm for the eligible NACT patients in UTUC. This algorithm might contribute to effective decision making in regard to providing NACT.

To overcome the disadvantages inherent in the standard surgical approach to the kidney, we introduced a novel surgical technique via a midline extraperitoneal approach. The surgical technique is not substantially different from that of the standard midline transperitoneal approach, except no entry is made into the peritoneal cavity. Although the peritoneum itself is extremely thin and fragile, the peritoneum together with underlying subperitoneal fascia can be dissected readily as a substantial layer, if the proper plane is dissected. Further medial mobilization of the peritoneal sac en bloc by pursuing the fusion fascia plane allows full exposure of the kidney, ureter and great vessels. This approach was adopted for consecutive 51 patients during a 10-month period in 2003. All operations, including 33 radical nephrectomies and 11 nephroureterectomies were completed successfully without significant technical difficulties and differences in operation time and estimated blood loss compared to the transperitoneal approach. No intra- or perioperative complication occurred. All patients did seem to have a much more comfortable postoperative period with minor pain and few abdominal complaint, and the clinical impression was that they resumed the physical activity and oral intake earlier than those after the transperitoneal approach (P = 0.056). There are no operation-related problems such as intra-abdominal adhesion or abdominal muscle weakness resulting in some deformity at 2-year or more follow up. This approach combines the advantages of the transperitoneal midline and extraperitoneal flank approach. Its use will undoubtedly reduce the complications inherent in the transperitoneal approach or the flank approach.

Background: To investigate normal changes in the bulbocavernosus reflex (BCR) during the micturition cycle, we examined the change in BCR during the micturition cycle using an evoked potential reaction of the BCR (BCR-EP). Methods: Fourteen normal subjects were examined in the study. The BCR-EP was recorded at empty bladder, filled bladder, during voiding and at empty bladder after voiding. To elicit the BCR-EP, the dorsal nerve of the penis was stimulated by two ring electrodes and an electromyogram of the external urethral sphincter was recorded. The maximum amplitude was measured to evaluate changes in the BCR. Results: The amplitude of the BCR was increased by bladder filling and the ratio of the amplitude at filled bladder/amplitude at empty bladder was 1.32 ± 0.39. The stable BCR-EP elicited by stimulation at empty bladder disappeared during voluntary voiding in 13 of 14 subjects. However, as stimulation was increased in seven subjects, the BCR-EP was again seen clearly. Conclusions: The BCR varies during the micturition cycle, although in normal subjects this variation occurs within a relatively narrow range. Changes in the BCR out of the normal range (e.g. large acceleration by bladder filling or insufficient inhibition during voiding) could suggest the existence of neurogenic disease.

A 71-year-old woman was examined at the department of urology in our hospital, with the chief complaint of macrohematuria. She was diagnosed as having bladder cancer and was hospitalized. After three courses of chemotherapy with cisplatin and epirubicin hydrochloride, total bladder resection and ileostomy were performed. Although the operation was curative, the hematuria persisted. Her renal function rapidly deteriorated. Hemolytic anemia and thrombocytopenia were found, and schistocytes were detected in a peripheral blood smear. Seizures occurred in the patient’s clinical course. A diagnosis of thrombotic microangiopathy (TMA) was made. The patient died despite receiving treatment. An autopsy was performed, and the renal microscopic findings showed crescentic glomerulonephritis (Cres GN). We present a rare case of Cres GN associated with TMA.

Detection of a planetary ring of exoplanets remains as one of the most attractive but challenging goals in the field. We present a methodology of a systematic search for exoplanetary rings via transit photometry of long-period planets. The methodology relies on a precise integration scheme we develop to compute a transit light curve of a ringed planet. We apply the methodology to 89 long-period planet candidates from the Kepler data so as to estimate, and/or set upper limits on, the parameters of possible rings. While a majority of our samples do not have a sufficiently good signal-to-noise ratio for meaningful constraints on ring parameters, we find that six systems with a higher signal-to-noise ratio are inconsistent with the presence of a ring larger than 1.5 times the planetary radius assuming a grazing orbit and a tilted ring. Furthermore, we identify five preliminary candidate systems whose light curves exhibit ring-like features. After removing four false positives due to the contamination from nearby stars, we identify KIC 10403228 as a reasonable candidate for a ringed planet. A systematic parameter fit of its light curve with a ringed planet model indicates two possible solutions corresponding to a Saturn-like planet with a tilted ring. There also remain other two possible scenarios accounting for the data; a circumstellar disk and a hierarchical triple. Due to large uncertain factors, we cannot choose one specific model among the three., 45 pages, 20 figures, accepted for publication in AJ

Shinichi Yamashita*, Akihiro Ito, Sendai, Japan; Ichiro Shintaku, Higashimatsushima, Japan; Masataka Aizawa, Sendai, Japan; Tatsuo Tochigi, Natori, Japan; Fumihiko Soma, Hachinohe, Japan; Shozo Ota, Takashige Namima, Sendai, Japan; Kazuhiko Orikasa, Kesennuma, Japan; Atsushi Kyan, Shirakawa, Japan; Kenji Numahata, Yamagata, Japan; Atsushi Takeda, Ichinoseki, Japan; Shinnosuke Katoh, Yuzawa, Japan; Yasuhiro Kaiho, Haruo Nakagawa, Naomasa Ioritani, Yoichi Arai, Sendai, Japan

surgery for LRRCC was 66 years. All patients underwent extensive staging prior to surgery and were found to have no distant metastasis. The median follow-up after surgery for LRRCC was 32 months. At the time of analysis 14 patients (36%) died from RCC and 5 patients(13%) died from other causes. Overall survival rates were determined with the Kaplan Meier method. Mantel-Haenszel hazard ratios were calculated. Comparisons were made with the log rank test. RESULTS: In the whole sample, overall survival after 5 years was 65% (95% CI 0,45-0,79) and 10-year overall was 40% (95% CI 0,21-0,59). The median survival after LRRCC was 8 years. Overall survival differed significantly by the time period between primary surgery and occurrence of LRRCC [

Background: A 63-year-old woman presented with right flank pain and macroscopic hematuria. Results/Methods: A plain film showed a calcific shadow on the right iliac bone. On excretory urography, the right kidney was seen in the normal position, but the left kidney was not. Bilateral retrograde pyelogram revealed the S-shaped kidney and mild obstruction from a 12 × 5 mm calculus in the proximal ureter of the crossed kidney. The patient was successfully treated with in situ extracorporeal shock wave lithotripsy (ESWL) treatment and is stone free at 1 month follow up. Conclusion: We believe this is the first case of successful ESWL in a crossed kidney.

PURPOSE The change of sacral reflex activity of the striated urethral sphincter in the urine storage phase is investigated using evoked potential reaction of the bulbocavernosus reflex (BCR). METHODS Eleven normal male subjects and 13 male patients with neurogenic bladder due to suprasacral (C3-C7) spinal cord injury (SCI patients) were investigated. Within the SCI patients, five were complete SCI and 8 were incomplete SCI. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR was recorded with a concentric needle electrode from the periurethral striated muscle. BCR was performed both at empty and at filled bladder respectively, and changes of the amplitudes (AMP) were examined. Moreover, the changes of AMP affected by bladder filling were compared between the normal subjects and the SCI patients. RESULTS In both the normal subjects and the SCI patients, AMP increased at the filled bladder as compared with that of the empty bladder. In addition, the change of AMP was statistically bigger in the SCI patients (a ratio of amplitude at filled bladder/amplitude at empty bladder: 4.73 +/- 3.90) than in the normal subjects (the ratio: 1.32 +/- 0.44). CONCLUSION Sacral reflex activity was accelerated by bladder filling in both the normal subjects and SCI patients. And the acceleration in the SCI patients was more remarkable than that in the normal subjects. In addition to the conventional evaluation of the integrity of sacral reflex arc by BCR examination, the observation of changes of BCR affected by bladder filling may provide the information for the continuity of sacral segment and supraspinal micturition center.

A 59-year-old man with spinal arteriovenous malformation at L-1 level was referred to our clinic for urinary retardation and urinary protraction. Bulbocavernosus reflex (BCR) was performed at empty bladder and at the storage phase during cystometry. BCR was evoked by compressing the glans penis. The evoked reflexes were examined by palpatating the contractile responses of the bulbocavernosus muscle and bipolar surface electrodes on each side of para-perineal raphe. Evoked response of BCR couldn't be detected at empty bladder, but obvious responses of BCR were detected at about 300 ml bladder filled. For further evaluation, a concentric needle electrode was inserted into the periurethral striated muscle to examine the evoked potential of BCR. The responses were unstable at empty bladder, but stable evoked potentials were obtained at storage phase. BCR performed only at empty bladder may cause false negative result.

PURPOSE Among spinocerebellar degeneration, syndromes categorized as multiple system atrophy (MSA) are commonly associated with neurogenic bladder, and urinary disturbances change with the disease progression. Accordingly, the changes in the urodynamic findings during the progression of the disease have been studied in the case of Olivopontocerebellar atrophy (OPCA) and OPCA type of MSA. METHODS Urodynamic study (UDS) was performed more than twice in eight patients (5 males, 3 females, age 48-76, mean 55.0). The interval range between the first examination and follow up examination was 9-93 months (mean 42.4). UDS included cystogram, intravenous pyelography, residual urine volume, cystometry, urethral pressure profilometry, and external sphincter electromyography. RESULTS The bladder was deformed in almost all patients with the progression of the disease, but the upper urinary tract was properly preserved. Residual urine volume tended to increase, and residual urine rate worsened significantly. The stable detrusor activity seemed to become overactive accompanied by detorusor hyperreflexia, and finally seemed to be acontractile. The normal sphincter activity seemed to become overactive accompanied by detrusor-sphincter dyssynergia, and finally complete relaxation could't be observed. CONCLUSION These results suggest that urinary disturbance deteriorates together with other neuropathies as the disease progresses in OPCA. These patients should be continuously observed along with proper urinary management depending on the disease progression.

PURPOSE The aim of this study was to investigate the sacral reflex activity at the striated urethral sphincter relaxation by evoking the potential of the bulbocavernosus reflex (BCR). METHODS 17 normal male subjects were investigated. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR (BCR-EP) was recorded by a concentric needle electrode at the periurethral striated muscle. In normal subjects BCR was performed at rest and during voluntary voiding. In 8 of the normal subjects electrical stimulation was increased gradually during voluntary voiding, and changes of BCR-EP were studied. 3 male patients with neurogenic bladder suffering from urinary incontinence caused by involuntary sphincter relaxation (IVSR) were also investigated. In these patients with neurogenic bladder, BCR was performed at rest and during voluntary voiding as well as during involuntary voiding. RESULTS In the normal subjects stable BCR-EP was elicited at rest and disappeared during voluntary voiding. But a gradually increased larger stimulation clearly demonstrated BCR-EP during voluntary voiding. In 3 patients with neurogenic bladder, stable ECR-EP was elicited at rest. During involuntary voiding caused by IVSR obvious BCR-EP was also elicited, but its amplitude was slightly less than the amplitude of BCR-EP at rest. During voluntary voiding in 2 of the 3 patients BCR-EP was recognized but the amplitude was much less, and in the third patient BCR-EP could not be recognized. CONCLUSION BCR-EP was suppressed during voluntary voiding in normal subjects, but insufficiently suppressed in the patients with neurogenic bladder. In these patients BCR-EP during voluntary voiding was suppressed more distinctly than BCR-EP during involuntary voiding due to IVSR. In urodynamic study, the detrusor contraction and the sphincter relaxation were common phenomenon in both voluntary voiding and involuntary voiding, but the difference in the degree of the BCR suppression depended on whether micturition was voluntary or involuntary. It was suggested that the measurement of BCR-EP could distinguish involuntary voiding caused by pathological urethral sphincter relaxation from voluntary voiding.

The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRI-linked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latency of the first cortical components were 63.8 +/- 9.2 ms for DPN, 39.8 +/- 3.0 ms for PTN and 20.7 +/- 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 +/- 10.8 fT for DPN, 160.2 +/- 50.1 fT for PTN and 335.2 +/- 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.

PURPOSE A comparative study about the contractility of the external urethral sphincter in the pelvic floor muscle (PFM) and about that of the periurethral striated sphincter (PUS), which is independent of PFM, was made by employing adult male mongrels. METHODS This study was done by using the compression-time curve. Moreover, the study about the formation of muscle fibers was carried out by the aid of ATPase staining. RESULTS Stimulus to one side of pudendal nerve increased each sphincter M-wave amplitudes and its compressive differences in contraction. Easy repetitions of the experiment made it possible to use the compression-time curve. The compressive differences in the urethral contraction was significantly greater in the urethra of PUS than in that of PFM. Data obtained from the compressive-time curve showed PUS premotor time was significantly longer than PFM in electromyograms, PUS motor time and time to peak force was significantly shorter, and PUS rate of force development was significantly faster. The histochemical study showed that fast muscles account for 70% in PUS, while they account for approximate 50% in PFM, which supported the results of the compression-time curve. CONCLUSION The above suggested the contractility of PUS apparently differed from that of PFM; PUS contracts quickly, while PFM contracts slowly. Also, it seemed that forming conjectures with the compression-time curve on the formation of muscle fibers in the striated urethral sphincters were possible to some degree.

Purpose We evaluated the efficacy of a single early intravesical instillation of pirarubicin (THP) in the prevention of bladder recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma (UUT-UC). Patients and Methods From December 2005 to November 2008, 77 patients clinically diagnosed with UUT-UC from 11 institutions participating in the Tohoku Urological Evidence-Based Medicine Study Group were preoperatively enrolled in this study. Patients were randomly assigned to receive or not receive a single instillation of THP (30 mg in 30 mL of saline) into the bladder within 48 hours after nephroureterectomy. Cystoscopy and urinary cytology were repeated every 3 months for 2 years or until the occurrence of first bladder recurrence. Results Seventy-two patients were evaluable for efficacy analysis, 21 of whom had a subsequent bladder recurrence. Significantly fewer patients who received THP had a recurrence compared with the control group (16.9% at 1 year and 16.9% at 2 years in the THP group v 31.8% at 1 year and 42.2% at 2 years in the control group; log-rank P = .025). No remarkable adverse events were observed in the THP-treated group. Based on multivariate analysis, THP instillation (hazard rate [HR], 0.26; 95% CI, 0.07 to 0.91; P = .035) and open surgery (HR, 0.28; 95% CI, 0.09 to 0.84; P = .024) were independently predictive of a reduced incidence of bladder recurrence. Conclusion In this prospective randomized phase II study, a single intravesical instillation of THP seemed to reduce bladder recurrence after nephroureterectomy. A phase III, large-scale, multicenter study is needed to confirm these observations.

We reported three cases of neurogenic bladder due to neuro-Bechet disease. Case 1 (24-year-old male) and case 3 (54-year-old male) had complaint of urinary frequency and urinary incontinence. Case 2 (35-year-old male) had a complaint of urinary retention. Uro-dynamic study were performed repeatedly in each case. Two cases showed overative detrusor activity in storage phase and normal or hypo detrusor activity in voiding phase. One case (case 2) showed normal detrusor activity in storage phase and acontractile in voiding phase. All cases showed detrusor-sphincter dyssynergia (DSD). All cases were managed with clean intermittent catheterization. Six months later case 2 complained of urge incontinence. Repeated uro-dynamic study revealed that bladder function changed from normal detrusor to overactive detrusor in storage phase. These findings suggest that neurogenic bladder due to neuro-Bechet disease is characterized uro-dynamical by overactive detrusor in storage phase and DSD in voiding phase.

426 Background: Most upper urinary tract urothelial carcinomas (UTUC) are invasive and advanced with a poor prognosis. Patients often relapse after treatment with radical nephroureterectomy (RNU). However, little is known about an association between sites of recurrence after RNU and oncological outcomes. The present study retrospectively evaluated the impact of a first recurrence site on survival. Methods: A total of 650 patients with UTUC treated by RNU at 12 institutions that participated in the Tohoku Urological Evidence-Based Medicine Study Group between 2000 and 2011 were initially enrolled. Patients who experienced relapse other than intravesical recurrence after RNU were included in this study. Those who had metastasis at the time of UTUC diagnosis or missing data regarding the time and location of relapse were excluded. Finally, 173 patients were eligible to participate in this study. Survival rates were analyzed using Kaplan-Meier curves and the log-rank test, and factors predicting survival were assessed using multivariate analyses. Results: The median follow-up after relapse was nine months. The cancer-specific survival rates at one and two years after relapse were 49% and 22%, respectively. Cancer in 59 (34%), 32 (18%), 23 (13%), and 94 (53%) patients recurred in the lung, liver, bone and lymph nodes, and 23 (13%) had local recurrence. The one-year cancer-specific survival rates were 44%, 27%, 22% and 52% among patients with metastasis of the lungs, liver, bone and lymph nodes respectively, and 41% among those with local recurrence. The survival rate was worse among 48 patients with metastasis at multiple sites, than in those with metastasis at a single site. Fourteen (8%) patients with a single lymph, lung or local recurrence survived for over three years after a first relapse. Multivariate analyses selected the liver, bone and local recurrence as critical factors for cancer-specific survival. Conclusions: Liver or bone metastasis was a negative prognostic factor for UTUC with relapse after RNU. Information about recurrence sites might be helpful for patient counseling.

The aim of the study was to evaluate the clinicopathological and prognostic significance of morphological subtyping of papillary renal cell carcinoma (PRCC).The patients treated for renal cell carcinoma in our department from January 1985 to March 2006 were evaluated retrospectively. Thirty-two of the 591 patients (5.4%) were diagnosed with PRCC. To determine the prognostic factors, we re-evaluated the pathological stage according to the 2002 TNM classification of malignant tumors, and the tumor type of renal cell carcinoma according to the 2004 World Health Organization histological classification. Survival was analysed using the Kaplan-Meier method and the log-rank test.The age at diagnosis ranged from 33 to 81 years (median: 63 years old) and the follow-up time after the surgical treatment ranged from 4 to 191 months (median: 54 months). The cancer-specific 5-year survival rate of the 32 PRCC patients was 74%. Pathologically, 17 patients (53%) and 15 patients (47%) were diagnosed with type 1 and type 2 PRCC, respectively. The type 2 PRCC patients had a significantly higher tumor grade (P0.001), a more advanced stage (P0.001), more frequent vascular invasion (P0.001), and a higher sarcomatoid component (P = 0.038) compared to the type 1 PRCC patients. The type 1 patients had a better cancer-specific 5-year survival rate than the type 2 patients (94% vs 50%) (P = 0.008).The morphological subtyping of PRCC is significantly associated with clinicopathological features and the prognosis. Our results provide evidence of the clinical utility of dividing PRCC into two subtypes.

We retrospectively evaluated the characteristics and long-term prognosis of incidentally detected renal cell carcinoma by health checkup.From January 1987 to December 2005, 556 patients were treated for renal cell carcinoma in our department. Among them, 56 patients were detected by abdominal ultrasonography in health checkup of our health care center. We reevaluated the pathological stage according to 2002 TNM classification and tumor type of renal cell carcinoma according to 2004 World Health Organization histological classification. Survival analysis was determined by Kaplan-Meier's method and log-rank test.Of the patients, 50 were male and 6 were female. The age of the patients ranged 37 to 68 years old at diagnosis (median 54 years). The tumors were located in the right kidney in 22 patients and in the left kidney in 34. Pathologically T1a tumors were found in 40 patients (71%), T1b in 13 (23%), T2 in 2 (4%) and T3b in 1 patients (2%). One case of T3b had N2 and M1 disease. The followup time after the operation ranged 3 to 215 months (median 121 months). Seven patients died of renal cell carcinoma. One of the 7 patients in T1a disease died at 64 months, 4 in T1b at 47, 91, 119, 163 months, 1 in T2 at 39 months and 1 in T3b at 13 months, postoperatively. The cause specific 10-year survival rate was 97% for T1a disease and 57% for T1b (p0.01), respectively.Most of renal cell carcinomas were T1a disease, which were detected incidentally by health checkup. The cause specific survival rate was significantly higher for T1a disease than for T1b. Our data suggested that early detection was important for good prognosis. The abdominal ultrasonography was only method for detection in routine health checkup and should be broadly implemented.

To overcome the disadvantages inherent in the standard surgical approach to the kidney, we introduced a novel surgical technique via a midline extraperitoneal approach. The surgical technique is not substantially different from that of the standard midline transperitoneal approach, except no entry is made into the peritoneal cavity. Although the peritoneum itself is extremely thin and fragile, the peritoneum together with underlying subperitoneal fascia can be dissected readily as a substantial layer, if the proper plane is dissected. Further medial mobilization of the peritoneal sac en bloc by pursuing the fusion fascia plane allows full exposure of the kidney, ureter and great vessels. This approach was adopted for consecutive 51 patients during a 10-month period in 2003. All operations, including 33 radical nephrectomies and 11 nephroureterectomies were completed successfully without significant technical difficulties and differences in operation time and estimated blood loss compared to the transperitoneal approach. No intra- or perioperative complication occurred. All patients did seem to have a much more comfortable postoperative period with minor pain and few abdominal complaint, and the clinical impression was that they resumed the physical activity and oral intake earlier than those after the transperitoneal approach (P = 0.056). There are no operation-related problems such as intra-abdominal adhesion or abdominal muscle weakness resulting in some deformity at 2-year or more follow up. This approach combines the advantages of the transperitoneal midline and extraperitoneal flank approach. Its use will undoubtedly reduce the complications inherent in the transperitoneal approach or the flank approach.

Objective We performed a 2 year longitudinal survey of health-related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer. Patients and methods We measured 112 patients who underwent RP with SF-36 and University of California, Los Angeles Prostate Cancer Index before and 3, 6, 12, 18 and 24 months after surgery. Results Patients who underwent RP showed problems in some domains of general HRQOL, but these problems diminished over time. Mental health significantly improved throughout the follow-up period. The urinary function substantially declined at 3 months and continued to recover gradually but never returned to the baseline. Urinary bother at 3 months showed a significant decrease, but at 6 months it returned to baseline. The data of sexual function and bother showed a substantially lower score after RP. Patients lost their sexual desire significantly throughout the post-operative period. After 12 months, the nerve sparing group had significantly better improvement in sexual function than the non-nerve sparing group and this improvement continued up to 2 years after operation. Conclusion Despite reports of problems with sexuality and urinary continence, general HRQOL was mostly unaffected by RP after 6 months. RP had a favorable impact on mental health. Although urinary function did not completely return to the baseline level even at 2 years after RP, recovery from urinary bother was rapid. RP had serious consequences on libido, erectile function and sexual activity. In the second year, the sexual function of those who underwent RP with bilateral nerve sparing procedure continued to improve.

Background: Optimal therapy for stage I testicular tumors is still controversial. This study evaluated the efficacy of a surveillance policy for patients with testicular stage I seminomas and nonseminomatous germ cell tumors (NSGCT). Methods: From 1984 to 1996, 24 patients with stage I semi noma and 20 with stage I NSGCT were fol lowed after radical orchiectomy with tumor markers and imaging studies. All patients were followed for at least 2 years except for those who recurred within 2 years. Recurrent patients were treated with cisplatin-based chemotherapy. Results: The median follow-up periods for seminoma and NSGCT patients were 41 and 54 months, respectively. Recurrences were detected in 2 seminoma (8.3%) and 10 NSGCT (50%) patients. Eleven of the 1 2 recurrent patients (92%) were detected within 2 years after orchiectomy. The seminoma patients both recurred in the retroperitoneal lymph nodes, while 70% of the NSGCT patients recurred in the lung and/or retroperitoneal lymph nodes. The recurrent seminoma patients were treated with chemotherapy and are alive without disease for 1 7 and 24 months after orchiectomy. One NSGCT patient died of cancer, but the other 9 recurrent NSGCT patients are alive without disease at 25 to 11 3 months after orchiectomy. Conclusions: Surveillance alone is reliable for monitoring patients with stage I testicular seminoma and NSGCT. The majority of recurrences occurred within 2 years, necessitating intensive follow-up for 3 years. As the lung metastatic rates in NSGCT patients were high, a more accurate assessment for lung metastasis is desirable in these patients.

UNLABELLED: PURPOSE AND MATERIALS: Out of 84 patients with meningomyelocele repaired at birth, 14 (15. 7%) children (6 boys and 8 girls, average 8.8 year-old) who underwent cord untethering for tethered cord syndrome of delayed onset (Delayed TCS) were urologically evaluated. RESULTS: Eleven (78.5%) children were detected orthopedically by deterioration of lower extermities function and only 3 (21.5%) were detected urologically. Preoperative urodynamic study, however, revealed in 5 children aggravation of urinary tract dysfunction, including accelerated uninhibited contraction in 4, impaired bladder compliance in 3, decreased bladder capacity in 2 and recurrence of VUR in 1. Although there were no particular urinary symptom for detection of Delayed TCS, acceleration of uninhibited contraction seemed to be one of the most important findings. After untethering, deterioration or normalization of urological dysfunction was not seen. Six of 14 children had favorable clinical results, such as improvement of uninhibited contraction, increasing of bladder compliance and capacity, prolongation of dry time and disappearance of VUR. In 3 children Delayed TCS were detected by postoperative improvement of urinary tract function. Consequently, of 14 children who were evaluated preoperatively and postoperatively 8 (52. 7%) had urological impairment compatible with Delayed TCS. CONCLUSIONS: It is not easy to detect the urological deteriorations associated with Delayed TCS behind initial neuro-urological deficits. Careful and regular follow-up examinations are required to early detection of Delayed TCS. The fact that urinary tract dysfunction improved in some cases after untethering encourages aggressive surgical untehtering of Delayed TCS.