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Background: To develop a nomogram of urinary volume and flow based on the data of Japanese men without lower urinary tract symptoms and multiple flows per participant whose characteristics were clear. Methods: Overall, 101 Japanese male volunteers without lower urinary tract symptoms aged between 20 and 59 years were enrolled. A portable uroflowmeter (P-Flowdiary®) was used to record urinary information (flow rate and volume) for 2 successive days. The model (quadratic, linear, or logarithmic regression) most fit for the relationship between maximum flow rate and voided volume was determined. The maximum flow rate at > 150 mL was compared among the 20-29-, 30-39-, 40-49-, and 50-59-year age groups. Nomograms appropriate for the age groups were created. Results: The mean age, International Prostate Symptom Score, and Overactive Bladder Symptom Score were 38.5 years, 0.42, and 0.24, respectively. The quadratic regression model was the most fit because its mean coefficient determination was 0.93 ± 0.06. The mean maximum flow rate was significantly lower in the 50-59-year age group (21.8 ± 5.05 mL/s, P < 0.01) than in the younger groups (24.14 ± 4.94, 24.05 ± 6.99, and 24.64 ± 5.72 mL/s). The 2 nomograms are Y = 28.99 {1 - exp(- 0.01 × X)} and Y = 25.67 {1 - exp(- 0.01 × X)} for the 20-49- and 50-59-year age groups, respectively. Conclusions: The nomogram can predict maximum flow rate based on voided volume in Japanese men aged 20-59 years without lower urinary tract symptoms., 博士（医学）・甲第858号・令和4年12月22日, © 2022. The Author(s). Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

PURPOSE: We objectively investigated the relationship between sleep quality/efficiency and factors associated with micturition using at-home electroencephalogram assessment. MATERIALS AND METHODS: Participants were recruited from among those enrolled in the Fujiwara-kyo Study, a community based longitudinal evaluation that began in Nara Prefecture, Japan, in 2007. Included participants were men at least 65 years old who woke up in the middle of the night/early morning at least 3 times per week with the urge to void. We evaluated lower urinary tract symptoms using the I-PSS and subjective sleep quality using the Pittsburgh Sleep Quality Index. Uroflowmetry and 3-day frequency volume charting measurements were also obtained. Electroencephalogram recordings were obtained during sleep to evaluate objective sleep quality. RESULTS: Final analysis included data from 47 participants. I-PSS-quality of life score and slow wave sleep time were independent predictors of good subjective sleep quality as determined by Pittsburgh Sleep Quality Index scores. Nocturnal urinary volume was an independent predictor of greater sleep efficiency. Maximum flow rate was an independent predictor of longer slow wave sleep time. CONCLUSIONS: In elderly men with nocturia, sleep quality is associated with lower urinary tract function. Higher subjective sleep quality is associated with longer slow wave sleep time and less severe lower urinary tract symptoms. Higher objective sleep quality is further associated with a higher urinary flow rate and lower nocturnal urinary volume., 博士（医学）・甲第669号・平成29年3月15日, Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

OBJECTIVES: To evaluate how guidance on water-intake impacts the degree of nocturia. METHODS: A total of 67 male patients were enrolled in the present study. Patients were asked to adjust their water and food intakes so that their 24-h urine production/bodyweight would be equal or lower than 30 mL/kg. One month after the treatment, the therapeutic gain from and adverse effects of fluid restriction were examined by comparing the pretreatment and post-treatment value of various parameters. RESULTS: Overall, 65 eligible patients were evaluated. In 44 patients (67%), the frequency of nocturia was improved to one or more times. The change in frequency of nocturia showed a positive correlation with the change in nocturnal urine volume. The change in nocturnal urine volume showed a positive correlation with the changes in 24-h urine production/bodyweight, 24-h drinking volume and daytime drinking volume. The changes in 24-h urine production/bodyweight and daytime drinking volume were independent factors influencing therapeutic effect. None of the participants reported any adverse event. CONCLUSIONS: In patients with a 24-h urine production/bodyweight equal or higher than 30 mL/kg, guidance on water intake might be considered effective and safe as a lifestyle therapy. Water restriction should be carried out not only in the evening, but also during daytime., 博士（医学）・乙第1348号・平成26年12月3日, © 2014 The Japanese Urological Association

A 24-year-old man was referred to our hospital with a painless mass on the left side of his neck. Ultrasonographydetected right testicular tumor and computerized tomographyscanning revealed a left supraclavicular lymph node mass and bulky retroperitoneal lymph node mass. He initially underwent right high orchiectomy, combination chemotherapy and retroperitoneal lymph node dissection for advanced testicular non-seminomatous germ cell tumor. Six years later, late relapse was detected in the lung. After complete remission of the lung metastasis with chemotherapy, the serum alpha-fetoprotein began to increase because of superior vena caval thrombus extending into the right atrium. Emergencysurgical excision was performed successfullyusing extracorporeal circulation to prevent pulmonaryembolism and the resected specimen pathologicallyrevealed adenocarcinoma interpreted as teratoma malignant transformation. Adjuvant chemotherapyconsisting of paclitaxel, ifosfamide and nedaplatin were administered for subsequent slight elevation of serum F-human chorionic gonadotropin β, resulting in successful normalization again. Later, he suddenlydied of cerebral infarction without anyevidence of recurrence 138 months after his initial presentation. We report herein an extremelyuncommon case of advanced testicular germ cell tumor with development of superior vena caval thrombus extending into the right atrium.

A 47-year-old man had a retroperitoneal tumor measuring 18 cm in maximum diameter of the left kidney that was diagnosed with computed tomography (CT)-guided needle biopsy as small cell carcinoma. Microscopically, the tumor cells showed immunohistochemical reaction for neural cell adhesion molecule antibodies. This patient with advanced renal small cell carcinoma and multiple metastatic lesions was treated with the first-line combination chemotherapy of cisplatin, etoposide and ifosphamide, which showed a partial response of primary renal tumor and a complete response of liver metastasis, and with the second-line chemotherapy of cisplatin and irinotecan, which showed a complete response of Virchow's nodal metastasis. Thereafter, in spite of salvage chemotherapy of amurubicin hydrochloride for persistent and refractory renal small cell carcinoma, he died 32 months after the first presentation due to local progression. However, combination chemotherapy of these anticancer agents made his prognosis more favorable than we expected before treatment. The extrapulmonary small cell carcinomas are generally known to be more aggressive and malignant than the lung small cell carcinomas, and small cell carcinoma arising from the kidney is an extremely rare malignant neoplasm, with only 34 cases reported in the English or Japanese literature. The prognosis of renal small cell carcinomas is currently limited as compared with the lung small cell carcinomas, and therefore a cumulative investigation of a larger number of cases treated with multidisciplinary modalities including combination chemotherapy is necessary., 47歳, 男性に左腎由来の最大径18cmの後腹膜腫瘍を認め, CTガイド下針生検にて小細胞癌と診断した。組織診断で, 腫瘍細胞は神経細胞接着分子抗体を用いた免疫染色に陽性であった。多発転移を伴う進行性腎小細胞癌の本患者は, cisplatin, etoposide, ifosphamideによるfirst-lineの多剤併用化学療法を施行され, 腎原発巣のpartial responseと肝転移巣のcomplete responseを得た。さらに, cisplatinとirinotecanを用いたsecond-lineの化学療法にて, Virchowリンパ節転移巣のcomplete responseを得た。その後, 執拗に残存し再燃する腎原発巣に対して, amurubicin hydrochlorideによるsalvage化学療法を施行したが, 初診より32ヵ月後に局所進展のため癌死した。しかし, 本症例については, これらの抗癌剤を用いた化学療法により, 治療前に予想した以上に患者の予後は良好なものとなった。一般的に肺外小細胞癌は, 肺小細胞癌よりも侵襲的で, より悪性度の高い腫瘍として知られている。その中でも, 腎由来の小細胞癌はきわめて稀な悪性新生物であり, 英文あるいは邦文論文報告も僅かに34件である。現況では, 腎小細胞癌の予後は, 肺小細胞癌の予後に比べて不良であり, 何らかの多剤併用化学療法を含めた集学的治療による, より多くの症例での治療経験の集積とその調査が必要である。(著者抄録)

41歳男性.患者は左精巣腫瘍(seminoma, stage I)に対する左精巣摘除術後1年3ヵ月目に左上肢尺側の疼痛, 歩行困難が出現し, 精査加療目的で著者らの施設へ紹介入院となった.入院時, 腫瘍マーカーでhCG-βの上昇を認め, MRIでは第1胸椎体にT1にて低信号域の病変, 左神経根への浸潤を認め, 骨シンチグラムでは第1胸椎体および右坐骨に異常集積がみられた.生検の結果, seminomaの骨単独転移と診断し, 化学療法2コースと局所放射線療法を行ったが, hCG-βは陰性化せず, 末梢血幹細胞輸血併用大量化学療法を2コースを追加した.以後, hCG-βは陰性化し, 胸椎, 右坐骨の転移巣の消失を認め, 神経症状は独歩可能なまでに回復した, A 40-year-old man with stage I left testicular seminoma who had been followed for 18 months after orchiectomy, complained of pain in his left upper extremity and dysbasia. Magnetic resonance imaging (MRI) and bone scintigraphy suggested multiple bone lesions in the thoracic vertebrae and right ischium, and bone biopsy revealed metastasis of seminoma. There was no evidence of other metastatic lesions. After he was treated with 2 courses of first-line chemotherapy consisting of peplomycin, etoposide, and cisplatin, which were followed by 2 courses of high-dose chemotherapy with carboplatin, etoposide, and ifosfamide, the metastatic lesions were nearly in complete response on MRI and bone scintigraphy and the result of fluorodeoxyglucose-positron emission tomography was negative, but the hCG-beta level remained slightly elevated. In most advanced testicular tumors, bone metastasis usually coexists with other metastatic lesions and appears as a secondary lesion. Herein, we report this rare case of primary and solitary bone metastasis from testicular seminoma after orchiectomy.

A 68-year-old man presented with the chief complaint of swelling of the penis. A pencil had been inserted into his urethra by a commercial sex worker for sexual stimulation. On a computed tomography (CT) scan, a foreign object was visible throughout the urethra and in the urinary bladder. Cystoscopy performed under spinal anesthesia showed a pencil in the urethra. We attempted removing the object endoscopically by using a Holmium laser. However, the endoscopic procedure failed and finally, we removed the object by transvesical open surgery. At the same time, suprapubic cystostomy was performed for the disorder of the urethra. An anterior urethrocutaneous fistula was formed 5 days after the operation. After removal of the urethral catheter, he was managed with only suprapubic cystostomy. Conservative management of the urethrocutaneous fistula was effective. The fistula was completely closed 26 days after the operation. He was discharged 33 days after the operation.

35歳女.高血圧を主訴とした.23歳時に高血圧の原因精査を行ない, 内分泌検査および画像所見から膀胱および骨盤腔内のparaganglioma疑いを指摘されたが放置していた.今回, 12年前より存在する膀胱paragangliomaの再精査・加療のため当科紹介入院した.経尿道的膀胱腫瘍生検を施行し, 病理組織学的にparagangliomaと診断し, 多発性腫瘍であり両側骨盤腔内リンパ節転移の可能性があったため, 下腹部正中切開, 後腹膜アプローチで膀胱部分切除術および骨盤腔内腫瘍摘除術を施行した.病理所見では, 膀胱筋層内に多発性のある大型細胞が胞巣状ないし充実性の増生を認めた.フローサイトメトリーによるDNA量解析では右骨盤腔内腫瘍のみにaneuploidパターンを認めたが, 他の膀胱部および左骨盤腔内腫瘍はdipoidパターンであった.術前に高値であった血中ドーパミン, 血中ノルアドレナリン, 尿中ノルアドレナリンは術後全て正常となり, 現在腫瘍の再発はない, A 35-year-old woman, who had a past history of hypertension due to paraganglioma of the urinary bladder and in the pelvis, was referred to us 12 years after the initial diagnosis of paraganglioma. Before coming to us and during the follow-up after enucleation of myoma uteri, she was again diagnosed as having a bladder tumor by a gynecologist. Cystoscopy revealed a non-papillary broad-based tumor, measuring 2 cm in diameter, on the trigone of the urinary bladder. Magnetic resonance imaging also showed two solid tumors, each measuring 2 cm in diameter, on the bilateral peri-vesical sides in the pelvis. Endocrinologic examination disclosed increased levels of serum and urinary catecholamines. Histopathologic examination revealed that the bladder tumor specimen obtained by transurethral resection was paraganglioma. She underwent partial cystectomy and resection of these intrapelvic tumors via a retroperitoneal approach. These tumors were histopathologically diagnosed as multiple paragangliomas. She has been followed up for 10 months after operation without any evidence of recurrence. Herein, we report this rare case of vesical paraganglioma and present a brief review of the relevant literature.

Page kidney is caused by the accumulation of blood in the perinephric or subcapsular space, resulting in compression of the involved kidney, renal ischemia and high renin hypertension. We describe a case of domestic violence-related Page kidney. This report also reviews previously described cases of Page kidney.

A 40-year-old man with stage I left testicular seminoma who had been followed for 18 months after orchiectomy, complained of pain in his left upper extremity and dysbasia. Magnetic resonance imaging (MRI) and bone scintigraphy suggested multiple bone lesions in the thoracic vertebrae and right ischium, and bone biopsy revealed metastasis of seminoma. There was no evidence of other metastatic lesions. After he was treated with 2 courses of first-line chemotherapy consisting of peplomycin, etoposide, and cisplatin, which were followed by 2 courses of high-dose chemotherapy with carboplatin, etoposide, and ifosfamide, the metastatic lesions were nearly in complete response on MRI and bone scintigraphy and the result of fluorodeoxyglucose-positron emission tomography was negative, but the hCG-beta level remained slightly elevated. In most advanced testicular tumors, bone metastasis usually coexists with other metastatic lesions and appears as a secondary lesion. Herein, we report this rare case of primary and solitary bone metastasis from testicular seminoma after orchiectomy.

A 35-year-old woman, who had a past history of hypertension due to paraganglioma of the urinary bladder and in the pelvis, was referred to us 12 years after the initial diagnosis of paraganglioma. Before coming to us and during the follow-up after enucleation of myoma uteri, she was again diagnosed as having a bladder tumor by a gynecologist. Cystoscopy revealed a non-papillary broad-based tumor, measuring 2 cm in diameter, on the trigone of the urinary bladder. Magnetic resonance imaging also showed two solid tumors, each measuring 2 cm in diameter, on the bilateral peri-vesical sides in the pelvis. Endocrinologic examination disclosed increased levels of serum and urinary catecholamines. Histopathologic examination revealed that the bladder tumor specimen obtained by transurethral resection was paraganglioma. She underwent partial cystectomy and resection of these intrapelvic tumors via a retroperitoneal approach. These tumors were histopathologically diagnosed as multiple paragangliomas. She has been followed up for 10 months after operation without any evidence of recurrence. Herein, we report this rare case of vesical paraganglioma and present a brief review of the relevant literature.