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74歳男.血尿を主訴に受診し, 膀胱鏡で腫瘤を認めた.腹部骨盤CTで膀胱前壁に径5cm大の, 膀胱左側壁に径1cm大の内腔へ突出する腫瘤を認めた.所見より, 浸潤性膀胱癌T3bN0M0と診断し, 病理組織所見のため, TURBTを施行した.移行上皮癌を併発した, 膀胱平滑筋肉腫で, 術後6ヵ月後に死亡した.剖検で多発性肺転移, 骨盤内を占拠する局所再発を認めた, A 74-year-old man was admitted for asymptomatic macroscopic hematuria. He had undergone transurethral resection of bladder tumor (TURBT) due to transitional cell carcinoma 30 years ago. Pelvic CT showed two invasive bladder tumors. A 5 cm tumor was on the dome and a 1 cm tumor was on the left lateral wall. TURBT was performed. Pathological examination revealed that they were leiomyosarcoma and transitional cell carcinoma. Radical cystectomy plus bilateral cutaneousureterostomy was performed. He died of lung metastases and local recurrence after 6 months.

症例1は56歳男.左下腹部痛を主訴に受診し, 直腸内指診で前立腺癌を疑われ入院した.生検の結果.頸部リンパ節が腺癌であったことから, 遠隔リンパ節転移を伴う前立腺癌stage D2と診断しホルモン療法を行った.その後, 前立腺部の腫脹の再燃による症状の悪化を認め, 更に残存腫瘍の再燃, 骨盤内占拠及び一部体表より突出し癌死した.経過中, PSAは正常化せず, ホルモン不応性に陥っていた.症例2は66歳男.左頸部腫瘤を主訴に受診し入院となった.頸部リンパ節生検により腺癌が疑われ, 左頸部腫瘤摘出術, 経会陰的前立腺針生検を行った.その結果, 進行性前立腺癌stage D2と診断した.両側精巣摘除術後ホルモン療法を開始し, 経過観察となった.治療開始後4ヵ月現在, 傍大動脈リンパ節を含め縮小傾向を認めるが, PSAは正常化していない, We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1, 700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.

61歳女.肉眼的血尿を自覚した.腹部超音波検査で右腎腫瘍を認め, 精査加療目的で入院した.画像診断により肺腺扁平上皮癌の右腎転移と診断した.肉眼的血尿によると思われる貧血, 右腰部鈍痛, 発熱等が存在し, 転移巣は腎に限局し根治術となりうると考えられることから, 経腹膜的右腎摘除術を施行した.病理組織学的所見は, 腺癌及び扁平上皮癌が混在する腺扁平上皮癌であり, 肺癌の組織像と一致したことから肺癌からの腎転移と診断した.術後, CRP, SCGは正常化し, 自覚症状の腰部痛, 発熱も消失し, 術後18日目に退院した.術後約1年後, 左肺転移が出現し, その後骨転移, 脳転移も出現し, 腎摘除術後2年目に癌死した, A 61-year-old woman, who had undergone total right pneumonectomy 22 months before due to lung cancer (adenosquamous cell carcinoma) was admitted for macroscopic hematuria. Abdominal CT showed two renal tumors in the right kidney. Right radical nephrectomy was performed, because no imaging study showed any other metastasis. Pathological examination revealed adenosquamous cell carcinoma, which was the same pathology as the lung cancer had been. She died of the left lung metastasis 24 months after right radical nephrectomy. Her prognosis was thought to have been prolonged by the operation of right radical nephrectomy.

67歳男.排尿困難を主訴に他院を受診し, 移行上皮癌G3と診断され紹介入院となった.病理組織診断と, 多中心性尿路上皮性腫瘍の除外を目的とした経尿道的膀胱及び前立腺生検術を施行し, 前立腺原発移行上皮癌と診断した.ネオアジュバント療法としてM-VAC全身化学療法を施行し, 効果判定はNCであった.その後, 膀胱前立腺尿道摘除術, 骨盤リンパ節郭清術, 回腸導管造設術を施行した, A 67-year-old male was admitted with a three-month history of voiding difficulty. Prostate specific antigen remained within the normal limit. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of prostate was performed. Pathological examination of the resected specimens of the prostate revealed transitional cell carcinoma. Two courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) chemotherapy were performed, followed by cystoprostatourethrectomy, pelvic lymphadenectomy, and ileal conduit construction. Now one year has elapsed, with no clinical signs of recurrence.

症例は56歳男で, 右陰嚢内容の無痛性腫大を主訴とした.右陰嚢内, 精巣上体に5cm大の表面平滑, 右様硬の腫瘤を触知した.右精巣摘除術を施行した.組織学的に精巣上体腫瘍は非Hodgkin悪性リンパ腫と診断された.精巣・精索には異常はなかった.術後CTにて上腹部横隔膜近傍に傍大動脈リンパ節腫大と左上肺野に2cm大の腫瘤影を認めた.悪性リンパ腫に対し化学療法を施行し, その後左肺上葉切除術を施行した.腫瘍経は3cm大, 病理診断は中分化型腺癌であった.精巣摘除術8ヵ月後に, 原因不明のまま急死した, A 56-year-old man visited our hospital with the complaint of painless swelling of right scrotal contents. Right orchiectomy was performed. Histopathological diagnosis was malignant lymphoma of the epididymis, without involvement of the testis. Bone marrow biopsy and Ga scintigram showed a normal pattern, while a swollen retroperitoneal lymph node (3 cm) was found by computed tomography (CT). The CT also showed a small mass lesion in the left upper lung field. After 2 courses of chemotherapy for malignant lymphoma, left upper lobectomy was performed at another clinic. Pathological diagnosis of the surgical specimen was moderately differentiated adenocarcinoma. The patient died without known causes, 8 months after the orchiectomy.

1)回腸新膀胱を20例に施行した.重篤な術後早期合併症はなく, 再手術を施行した症例もなかった. 2)晩期合併症として尿管回腸吻合部狭窄が2例あり, 1例は尿管回腸新吻合術を施行, 1例は内視鏡的に狭窄部を拡張した.回腸新膀胱内結石が2例に発生し, ESWL及び砕石術をそれぞれ施行した. 3)全例が自然排尿可能であり, 夜間尿失禁を認めたものが2例(全失禁)あった.回腸新膀胱過伸展による回腸新膀胱周囲炎が1例あり創部との間に尿瘻を形成した.残尿や回腸新膀胱容量等の定期的チェックと回腸新膀胱に対する十分な教育的指導が重要と思われた. 4)術後の局所再発を2例に認めたが, 尿道再発はなかった, Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

左側胸部の2ヶ所の無痛性皮下腫瘤を訴えた76歳女で, 組織病理学的診断は淡明細胞癌であった.CT及び血管造影により左腎細胞癌と診断し, 左腎摘除を行った.組織診断は腎細胞癌, 胞状型, 明細胞亜型, グレード1であった.術後間もなく肺転移が認められた.腎摘除後数回皮膚転移を切除した, A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

68歳, 左陰嚢内の無痛性腫瘤を主訴とした.触診の所見は小指頭大, 可動性良好, 弾性硬で, 精巣・精巣上体・陰嚢との連続性は認めなかった.超音波検査では低エコーの内部均一な径1.5cmの病変として描出された.これらの所見から精巣外陰嚢内腫瘍と診断して手術を行った.腫瘤は精巣静脈と接しており, その部位を結紮切断することにより摘除できた.摘出標本は大きさ1.5×1.5×1.0cm, 割面は淡黄色均一で, 辺縁は薄い被膜に覆われていた.HE染色では, 紡錘形で好酸性の胞体に卵円形の核を有する平滑筋に類似した腫瘍細胞が束状に配列し, 互いに錯走する像が観察された.SMA染色, desmin染色とも陽性を示し, 精索平滑筋腫と診断された.術後51ヵ月の現在, 再発の徴候は認めていない, A 68-year-old male was admitted to our hospital with the complaint of left painless mass of extratesticular scrotal content. Laboratory examinations were unremarkable. The tumor was resected by operation. The removed specimen was solid, 15 x 15 x 20 mm in size. Histopathological findings revealed leiomyoma. Other cases from the Japanese publications, together with our case, are reviewed.

女子急性単純性膀胱炎の126例に対し, OFLX 300mg 1日1回3日間投与と, 同薬100mg 1日3回3日間投与の比較検討をした。UTI薬効評価可能のそれぞれ, 42例と43例とでは, ともに総合臨床効果の98%を呈するなど, 自覚症状・膿尿・細菌尿に対する効果も主治医による効果判定にも, あるいは第7病日における再発検討にても, ほとんど両群に差をみとめなかった。自覚的副作用は両群あわせてもわずかに1.2%であり, 全例に臨検値を検討しなかったため, 概括安全度に対する検討は不十分であった, A comparative study of ofloxacin (OFLX), a new oral quinolone, was carried out at the Department of Urology, Osaka University Hospital and its eighteen affiliated hospitals to evaluate the clinical efficacy and safety of daily dose of 300 mg, given either once daily dose (SID group), or in three divided doses (TID group), in the treatment of acute uncomplicated cystitis in women. Clinical efficacy was evaluated in 42 cases from the SID group, and 43 cases from TID group, respectively, according to the criteria by the Japanese UTI Committee. In the SID group, the clinical efficacy was evaluated as excellent in 29 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 98%. In the TID group, it was evaluated as excellent in 25 cases, moderate in 17 and poor in 1, with an overall clinical effectiveness rate of 98%. Safety was monitored only by subjective complaints. In the SID group, no subjective side effects appeared (0%). In the TID group, one of the 43 women (2.3%) complained of borborygmus. These findings suggest that there was no significant difference between the two groups in the safety and efficacy of ofloxacin.

67歳男.63歳時に中分化型腺癌に対し根治的前立腺全摘除術, 両側精巣摘除術を受けた.その後, 経過観察となっていたが, 肉眼的血尿を自覚し, 更に腹部骨盤CT, 膀胱鏡で膀胱右側壁に隆起性病変を認め, 精査加療目的で入院となった.遠隔転移を伴う浸潤性膀胱腫瘍と診断し, 経尿道的膀胱腫瘍切除術を施行した.術後も血尿が持続し, 血尿のコントロール目的に単純膀胱摘除術, 両側尿管皮膚瘻造設術を施行した.前立腺癌及び膀胱転移巣は共に血管侵襲, リンパ管侵襲が著明で, PSA染色が一部で陽性であることから前立腺癌の膀胱転移と診断した.内服治療で経過観察していたが, 膀胱摘除術後5ヵ月目に癌死した, We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.

37歳男.生来, 左鼠径部停留精巣を自覚していたが, 腫大を自覚し, 突如疼痛を自覚し手術目的で入院となった.画像所見, 理学的所見では精巣腫瘍は考えられなかったが, 6ヵ月前より無痛性に増大を認めていたことから左鼠径部停留精巣腫瘍の精索捻転症と診断し, 左高位精巣摘除術を施行した.精巣は外観上は腫瘍とは診断できなかった.精索は鞘膜内で360度外転していた.病理では精上皮腫であった.術後は化学療法, 放射線療法は行わず, 経過観察中であるが, 3ヵ月後の現在, 再発は無い, A 37-year-old man was admitted with a painful mass in his left inguinal region. He had an undescended testis on the left side. Six months earlier, he had noted that his left inguinal testis was larger, and he had suddenly developed pain in the left inguinal region. The levels of AFP, hCG beta and LDH were normal. We diagnosed a left undescended testicular tumor and torsion of the left testis. Left inguinal high orchiectomy showed a torsion of the left testis and histopathological examination of the specimen revealed seminoma.

症例は72歳男で, 左腰部痛を自覚し, 排泄性腎盂造影で左無機能腎を指摘され経過観察中であったが, 無尿を来たして両側水腎症, 急性腎不全を疑われた.両側逆行性腎盂造影(RP)及び右double J(DJ)カテーテル留置術を試み, 左は下部尿管で閉塞しカテーテルは通過せず, 洗浄尿細胞診はクラスIVであった.右は下部尿管で狭窄を認めたが, 4.7FrのDJカテーテルは留置可能で, 右腎盂尿細胞診はクラスIIであった.CTではRP像に一致して左下部尿管に腫瘤を認めたが, 右尿管には認めず, 膀胱は全周性に壁が肥厚していた.左尿管鏡で乳頭状腫瘍を認め, 膀胱生検では移行上皮癌pTis G3と診断した.左腎尿管摘除術を施行し, 左腎盂にも腫瘍を認めた.腎実質組織への浸潤も著明で, 尿管においては腹膜浸潤も認めた.術後, 狭窄部位に腫瘤像を認め, 尿細胞診はクラスIVで, 右尿管腫瘍と診断した.肝転移, 骨転移, 左尿管腫瘍局所再発も認めたが化学療法は拒否され, 退院4ヵ月後に癌死した, A 72-year-old male was admitted with a chief complaint of anuria. Clinical examinations showed that he was in uremic state and had bilateral hydronephroses. An endoscopic examination revealed a left ureteral tumor and a bladder tumor. Left nephroureterectomy with partial cystectomy and transurethral resection of the bladder tumor were performed. Pathological examinations showed an invasive left renal pelvic tumor (pT3, G3), an invasive left ureteral tumor (pT4, G3), and a bladder tumor (pTis, G3). Following the operation, roentgenological and urinary cytological findings showed a right ureteral carcinoma. He died of multiple liver and bone metastases and local recurrence at 5 months postoperatively.

症例は14歳男で, 肉眼的血尿を主訴とした.超音波で膀胱前壁頸部よりに1cm大の腫瘤性病変を認め, 膀胱鏡では有茎性乳頭状腫瘍を認めた.排泄性腎盂造影では上部尿路に異常所見を認めず, CT上リンパ節腫大等の異常所見はなかった.表在性膀胱腫瘍と診断し, 経尿道的膀胱腫瘍切除術を施行した.病理組織学的所見は移行上皮癌, Gl, pTa, INFα, ly-, v-であった.他の生検部位には腫瘍性病変を認めず, 術後9ヵ月経過して再発兆候はない, A 14-year-old male patient was admitted with the chief complaint of macroscopic hematuria. Abdominal ultrasonography demonstrated a tumor of the anterior wall of the bladder. Further, cystoscopic examination confirmed a papillary tumor. Transurethral resection of the bladder tumor was performed. Histopathology of the excised tumor showed transitional cell carcinoma (G1, pTa). Recurrence has not been observed for 9 months postoperatively.

1)入院加療を行った腎盂尿管腫瘍66例について検討した.2)発生部位は腎盂27例, 尿管31例, 腎盂尿管8例であった.3)発症年齢は43歳から86歳(平均年齢65歳)で, 性別は男性46例, 女性20例であった.4) DIP所見では無機能腎を呈した症例が54.1%と最も多かった.5)尿細胞診陽性例はhigh gradeが多かった.6)組織型は移行上皮癌60例, 扁平上皮癌2例, 両者の混合型が4例であった.7)膀胱腫瘍の合併は, 先行性6例, 同時性8例, 続発性13例であった.8)全体の生存率は1年生存率80%, 3年生存率68%, 5年生存率52%であった.9)所属リンパ節あるいは遠隔転移を有する症例の予後は非常に不良であった.10)各予後因子の検討では, 組織学的深達度が最もよく予後を反映していた, Sixty-six patients with renal pelvic and ureteral tumors were treated in our hospital between June 1974 and June 1991. These cases consisted of 27 renal pelvic tumors, 31 ureteral tumors and 8 renal pelvic and ureteral tumors. Their ages ranged from 43 to 86 years old (average: 65). There were 46 males and 20 females. The surgical method involved total nephroureterectomy with a cuff for 44 patients, nephroureterectomy for 3, nephrectomy for 9, total nephroureterectomy with total cystectomy for 5 and partial ureterectomy for 2. Histologically, there were 60 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC) and 4 TCC with SCC. As for the pathological stage, 13 were pTa, 16 pT1, 12 pT2, 11 pT3, 13 pT4 and 1 pTX. Subsequent bladder tumors were found in 13 patients (19.7%). The overall survival rate at 1, 3 and 5 years were 80%, 68% and 52%, respectively according to the Kaplan-Meier's method. In this series, the pathological staging was the most important prognostic factor.

1974年1月より1990年12月までの間に, 大阪労災病院泌尿器科において治療した偶然発見腎癌32例について検討した.1)男性25例, 女性7例で男女比は3.6:1であり, 年齢は39歳から84歳, 平均61歳であった.2)患側は右14例, 左17例, 両側同時期1例で左右差は認めなかった.3)年次別発生頻度では, 1987年以降年々腎癌症例数が増加してきておりそのうち偶発癌の占める割合も増加傾向にあった.4)初診時の主訴は, 人間ドックなどの健康診断で発見されたものが7例, 21.9%と最も多く, 初診時受診料では内科が19例, 59.4%と最も多かった.5)発見の契機となった検査法は90%近くが腹部超音波検査かCTスキャンであった.6)腫瘍径の大きさでは5 cm以下のものが19例, 59.4%と臨床癌群, 潜在癌群に比し有意に多く, pT分類ではpT2が多かった.7) 5年生存率は52.2%であり潜在癌群(28.9%)との間に有意差を認めたが, 臨床癌群(55.1%)との間には統計学的有意差は認められなかった, Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.

症例は59歳の男性で, 頻尿, 排尿時痛, 肉眼的血尿を主訴とし受診した.膀胱内視鏡にて全周性の腫瘍性病変を認め, 腹部超音波で両側性水腎症が存在し, 血清クレアチニン値の上昇を認めたため入院した.1996年10月頃に胃部不快感, 食欲低下から胃内視鏡検査を行い腺癌の診断で胃全摘を行い, 病理組織学的診断はmucinous adenocarcinomaであった.膀胱腫瘍の病理診断を得るためにTUR-BTを施行し, 膀胱の腫瘍は粘液の産生を示すsignet ringcell carcinomaであり, リンパ管侵襲が著明に認められ, 胃の病理組織像と比較して, 胃癌からのリンパ行性転移と診断した, A 59-year-old man was referred to our clinic with a complaint of frequent urination, voiding pain, and macroscopic hematuria. He had undergone total gastrectomy for mucinous adenocarcinoma, 21 months earlier. Pelvic computed tomography revealed a thick bladder wall all around. There were no other metastatic sites except for paraaortic lymph nodes. Transurethral resection of the bladder tumor was performed. The specimen showed signet ring cell carcinoma and revealed the same pathological findings as the primary gastric cancer. We diagnosed him with metastastic bladder tumor lymphogenously disseminated from gastric cancer. Such lymphogenous metastases from gastric cancer at the entire bladder wall without other apparent lesions have rarely been reported in the Japanese literature.

症例:72歳男.右陰嚢内容無痛性腫大および肉眼的血尿を自覚し受診.膀胱内腫瘍にて膀胱腫瘍を指摘され, 経尿道的膀胱腫瘍切除術を行った.当初陰嚢内腫瘤については右鼠径ヘルニアと診断し, 外科にて経過観察されていたが, 骨盤部CTにて陰嚢内腫瘍が疑われ再入院した.なお, 膀胱腫瘍の再発は認めなかった.画像所見より右陰嚢内脂肪腫を疑ったが確定診断には至らず増大傾向にあるため, 手術を行った.病理組織検査では悪性所見を認めず, 脂肪腫と診断した.術後7ヵ月現在外来経過観察中であるが, 陰嚢内脂肪腫, 膀胱腫瘍ともに再発の兆候を認めない, A 72-year-old male was admitted to our hospital with the complaint of right painless swelling of extratesticular scrotal content. Laboratory examinations were unremarkable. Under the diagnosis of an intrascrotal lipoma, the tumor was resected. The removed specimen weighed 115 g. Histopathological findings revealed lipoma. Other cases from the Japanese publications, together with our case, are reviewed.

18施設で, 109例の複雑性尿路感染症に対して, CRMNとCTMを, 1日量それぞれ2 gずつを分2混合投与し, 効果と安全性を検討した.効果判定基準に合致した65例では, 対膿尿改善率が54%, 菌消失率が83%, 総合有効率が72%の結果を得た.副作用の頻度は3件と低く, この2剤の併用投与は複雑性尿路感染症に対し, first choiceとして使用する場合, 十分に効果が期待でき, かつ安全な方法である, The combination of carumonam (CRMN) and cefotiam (CTM), expected to have a broader spectrum of coverage in connection with urinary tract infections, was evaluated for its effectiveness and safety at the Department of Urology, Osaka University Hospital and 17 affiliated hospitals. CRMN and CTM were given together to 109 patients with complicated urinary tract infections (UTI), of whom 65 cases satisfied the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data for women. CRMN and CTM were administered by drip or one-shot infusion at a total daily dose of 4 g (equally mixed 1 g plus 1 g each, twice a day) for 5 consecutive days or longer. The overall clinical efficacy rate in the 65 cases of complicated UTI was 72%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 72% for the 29 patients in the 1st group, 100% for the 1 patient in the 2nd group, 100% for the 7 patients in the 3rd group, 83% for the 6 patients in the 4th group, 50% for the 14 patients in the 5th group and 75% for the 8 patients in the 6th group. The disappearance rate of both urinary Gram positive cocci and Gram negative bacilli was 83.3%. Fifteen strains appeared after the treatment, only 4 of which were Gram positive cocci. Among the 109 patients treated with CRMN+CTM, no subjective side effects were recorded and the abnormalized laboratory findings observed were: eosinophilia in one patient, increases in both GPT and GOT in one patient, and lowered creatinine clearance in one patient. With a broader spectrum and safe regimen, the combination of CRMN/CTM is recommended as the first choice against complicated UTI.

A 32-year-old woman in the 36th week of pregnancy was admitted to obstetrics with a complaint of left flank pain. Magnetic resonance imaging demonstrated a left perinephric hematoma before the cesarean section. Spontaneous rupture of renal angiomyolipoma was suspected by computed tomographic scan and renal angiography after the cesarean section. We attempted partial nephrectomy, but performed nephrectomy because of perinephric adhesion. This is the 11th case of spontaneous rupture of renal angiomyolipoma during pregnancy in the Japanese literature.

膀胱乳剤にフェルビナクのエチルエステルを封入させたLM-001静注剤を尿路結石による疼痛と膀胱・前立腺手術後の膀胱切迫感に対する有効性ならびに安全性について検討した.1)尿路結石による疼痛に対しては53例中49例に効果がみられた.有効例49例中41例までが本剤投与15分以内に効果が発現した.また26例において効果が24時間以上持続した.2)膀胱・前立腺手術後の膀胱切迫感に対しても29例中25例に効果がみられた.有効例25例中16例までが15分以内に効果発現した.また13例において効果が24時間以上持続した.3)副作用として血管痛, 熱感, 視力軽度低下, 血圧の一時低下がみられたが, いずれもきわめて軽度で何ら処置することもなく短期間に消失した.また, 3例に白血球増多, 1例にA1-pの上昇がみられたが, その程度は軽度であり, すぐに正常化した.4)LM-001は尿路結石による疼痛の緩和と膀胱・前立腺手術後の膀胱切迫感に対し, 速効性で高い有効率を示し, かつ作用時間が長いこと, また副作用がきわめて少ないことから優れた薬剤と評価し得た, Clinical effect of LM-001, a prostaglandin synthetic inhibitor developed from a drug delivery system, was evaluated in 54 patients with pain from urinary tract stones (stone pain) and 32 with vesical urgency after an operation on bladder or prostate. LM-001, felbinac ethyl incorporated in lipid microsphere, wes intravenously administered at the onset of stone pain or vesical urgency. Of 54 with stones and 32 with urgency, 53 and 29 were eligible for response, respectively. The symptoms improved or disappeared in some cases just after the administration and in the majority of patients within 15 minutes, in 49 of 53 patients with stone pain. Further, the effectiveness lasted over 24 hours in 26 of the 49 responding to this agent. On one hand, improvement or disappearance of vesical urgency was recognized in 25 of 29 patients, and the effectiveness was observed shortly after injection in 16 and lasted over 24 hours in 13 cases. Toxicities of this drug were investigated in 54 patients with stone pain and 32 with urinary urgency. Side effects consisted of pain at the injection site in 4, a slight fall of blood pressure in 1, slight visual disturbance in 1, body heat sensation in 1, leukocytosis in 3 and elevation of alkaline phosphatase in 1. These symptoms were transient and disappeared without use of any agent. LM-001 is concluded to be a useful drug for controlling stone pain and vesical urgency since an immediate effect, long durability and high response rates were obtained without severe side

A 68-year-old male was admitted to our hospital with the complaint of left painless mass of extratesticular scrotal content. Laboratory examinations were unremarkable. The tumor was resected by operation. The removed specimen was solid, 15 x 15 x 20 mm in size. Histopathological findings revealed leiomyoma. Other cases from the Japanese publications, together with our case, are reviewed.

A 74-year-old man was admitted for asymptomatic macroscopic hematuria. He had undergone transurethral resection of bladder tumor (TURBT) due to transitional cell carcinoma 30 years ago. Pelvic CT showed two invasive bladder tumors. A 5 cm tumor was on the dome and a 1 cm tumor was on the left lateral wall. TURBT was performed. Pathological examination revealed that they were leiomyosarcoma and transitional cell carcinoma. Radical cystectomy plus bilateral cutaneousureterostomy was performed. He died of lung metastases and local recurrence after 6 months.

A 61-year-old woman, who had undergone total right pneumonectomy 22 months before due to lung cancer (adenosquamous cell carcinoma) was admitted for macroscopic hematuria. Abdominal CT showed two renal tumors in the right kidney. Right radical nephrectomy was performed, because no imaging study showed any other metastasis. Pathological examination revealed adenosquamous cell carcinoma, which was the same pathology as the lung cancer had been. She died of the left lung metastasis 24 months after right radical nephrectomy. Her prognosis was thought to have been prolonged by the operation of right radical nephrectomy.

A 14-year-old male patient was admitted with the chief complaint of macroscopic hematuria. Abdominal ultrasonography demonstrated a tumor of the anterior wall of the bladder. Further, cystoscopic examination confirmed a papillary tumor. Transurethral resection of the bladder tumor was performed. Histopathology of the excised tumor showed transitional cell carcinoma (G1, pTa). Recurrence has not been observed for 9 months postoperatively.

A 37-year-old man was admitted with a painful mass in his left inguinal region. He had an undescended testis on the left side. Six months earlier, he had noted that his left inguinal testis was larger, and he had suddenly developed pain in the left inguinal region. The levels of AFP, hCG beta and LDH were normal. We diagnosed a left undescended testicular tumor and torsion of the left testis. Left inguinal high orchiectomy showed a torsion of the left testis and histopathological examination of the specimen revealed seminoma.

A 72-year-old male was admitted with a chief complaint of anuria. Clinical examinations showed that he was in uremic state and had bilateral hydronephroses. An endoscopic examination revealed a left ureteral tumor and a bladder tumor. Left nephroureterectomy with partial cystectomy and transurethral resection of the bladder tumor were performed. Pathological examinations showed an invasive left renal pelvic tumor (pT3, G3), an invasive left ureteral tumor (pT4, G3), and a bladder tumor (pTis, G3). Following the operation, roentgenological and urinary cytological findings showed a right ureteral carcinoma. He died of multiple liver and bone metastases and local recurrence at 5 months postoperatively.

We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1, 700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.

We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.

A 67-year-old male was admitted with a three-month history of voiding difficulty. Prostate specific antigen remained within the normal limit. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of prostate was performed. Pathological examination of the resected specimens of the prostate revealed transitional cell carcinoma. Two courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) chemotherapy were performed, followed by cystoprostatourethrectomy, pelvic lymphadenectomy, and ileal conduit construction. Now one year has elapsed, with no clinical signs of recurrence.

A 59-year-old man was referred to our clinic with a complaint of frequent urination, voiding pain, and macroscopic hematuria. He had undergone total gastrectomy for mucinous adenocarcinoma, 21 months earlier. Pelvic computed tomography revealed a thick bladder wall all around. There were no other metastatic sites except for paraaortic lymph nodes. Transurethral resection of the bladder tumor was performed. The specimen showed signet ring cell carcinoma and revealed the same pathological findings as the primary gastric cancer. We diagnosed him with metastastic bladder tumor lymphogenously disseminated from gastric cancer. Such lymphogenous metastases from gastric cancer at the entire bladder wall without other apparent lesions have rarely been reported in the Japanese literature.

A 72-year-old male was admitted to our hospital with the complaint of right painless swelling of extratesticular scrotal content. Laboratory examinations were unremarkable. Under the diagnosis of an intrascrotal lipoma, the tumor was resected. The removed specimen weighed 115 g. Histopathological findings revealed lipoma. Other cases from the Japanese publications, together with our case, are reviewed.

A 32-year-old woman in the 36th week of pregnancy was admitted to obstetrics with a complaint of left flank pain. Magnetic resonance imaging demonstrated a left perinephric hematoma before the cesarean section. Spontaneous rupture of renal angiomyolipoma was suspected by computed tomographic scan and renal angiography after the cesarean section. We attempted partial nephrectomy, but performed nephrectomy because of perinephric adhesion. This is the 11th case of spontaneous rupture of renal angiomyolipoma during pregnancy in the Japanese literature.

A 56-year-old man visited our hospital with the complaint of painless swelling of right scrotal contents. Right orchiectomy was performed. Histopathological diagnosis was malignant lymphoma of the epididymis, without involvement of the testis. Bone marrow biopsy and Ga scintigram showed a normal pattern, while a swollen retroperitoneal lymph node (3 cm) was found by computed tomography (CT). The CT also showed a small mass lesion in the left upper lung field. After 2 courses of chemotherapy for malignant lymphoma, left upper lobectomy was performed at another clinic. Pathological diagnosis of the surgical specimen was moderately differentiated adenocarcinoma. The patient died without known causes, 8 months after the orchiectomy.

Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

A comparative study of ofloxacin (OFLX), a new oral quinolone, was carried out at the Department of Urology, Osaka University Hospital and its eighteen affiliated hospitals to evaluate the clinical efficacy and safety of daily dose of 300 mg, given either once daily dose (SID group), or in three divided doses (TID group), in the treatment of acute uncomplicated cystitis in women. Clinical efficacy was evaluated in 42 cases from the SID group, and 43 cases from TID group, respectively, according to the criteria by the Japanese UTI Committee. In the SID group, the clinical efficacy was evaluated as excellent in 29 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 98%. In the TID group, it was evaluated as excellent in 25 cases, moderate in 17 and poor in 1, with an overall clinical effectiveness rate of 98%. Safety was monitored only by subjective complaints. In the SID group, no subjective side effects appeared (0%). In the TID group, one of the 43 women (2.3%) complained of borborygmus. These findings suggest that there was no significant difference between the two groups in the safety and efficacy of ofloxacin.

Sixty-six patients with renal pelvic and ureteral tumors were treated in our hospital between June 1974 and June 1991. These cases consisted of 27 renal pelvic tumors, 31 ureteral tumors and 8 renal pelvic and ureteral tumors. Their ages ranged from 43 to 86 years old (average: 65). There were 46 males and 20 females. The surgical method involved total nephroureterectomy with a cuff for 44 patients, nephroureterectomy for 3, nephrectomy for 9, total nephroureterectomy with total cystectomy for 5 and partial ureterectomy for 2. Histologically, there were 60 transitional cell carcinomas (TCC), 2 squamous cell carcinomas (SCC) and 4 TCC with SCC. As for the pathological stage, 13 were pTa, 16 pT1, 12 pT2, 11 pT3, 13 pT4 and 1 pTX. Subsequent bladder tumors were found in 13 patients (19.7%). The overall survival rate at 1, 3 and 5 years were 80%, 68% and 52%, respectively according to the Kaplan-Meier's method. In this series, the pathological staging was the most important prognostic factor.

Of 93 patients with renal cell carcinoma treated at our hospital between January 1974 and December 1990, thirty-two cases with incidentally detected cancer were evaluated clinically and pathologically. The average age of the patients was 61 years old ranging from 39 to 84 years. There were 25 men and 7 women with a sex ratio of 3.6:1. Fourteen tumors had developed in the right kidney and 17 in the left kidney. One patient had bilateral tumors synchronously and was treated by radical nephrectomy with contralateral enucleation of the tumor. The proportion of incidental renal carcinoma has been increasing steadily; 87.5% of the cases was found by either abdominal ultrasonography or CT scan. Nineteen patients (59.4%) had a tumor smaller than 5 cm in diameter. There were 29 cases with G1 or G2 renal cancer and twenty with pT2. The five-year survival rate in the incidental cases was 52.2% with significantly better survival than in cases when metastasis was initially suspected, but there was no significant difference in survival between the incidentally found cases and the cases of symptomatic renal cancer.

The combination of carumonam (CRMN) and cefotiam (CTM), expected to have a broader spectrum of coverage in connection with urinary tract infections, was evaluated for its effectiveness and safety at the Department of Urology, Osaka University Hospital and 17 affiliated hospitals. CRMN and CTM were given together to 109 patients with complicated urinary tract infections (UTI), of whom 65 cases satisfied the "Criteria of UTI Committee for the Evaluation of Drug Efficacy in the UTI (3rd Ed.)", which was modified by adopting the midstream urine data for women. CRMN and CTM were administered by drip or one-shot infusion at a total daily dose of 4 g (equally mixed 1 g plus 1 g each, twice a day) for 5 consecutive days or longer. The overall clinical efficacy rate in the 65 cases of complicated UTI was 72%, estimated by the criteria cited above. The efficacy rate according to the infection type groupings was 72% for the 29 patients in the 1st group, 100% for the 1 patient in the 2nd group, 100% for the 7 patients in the 3rd group, 83% for the 6 patients in the 4th group, 50% for the 14 patients in the 5th group and 75% for the 8 patients in the 6th group. The disappearance rate of both urinary Gram positive cocci and Gram negative bacilli was 83.3%. Fifteen strains appeared after the treatment, only 4 of which were Gram positive cocci. Among the 109 patients treated with CRMN+CTM, no subjective side effects were recorded and the abnormalized laboratory findings observed were: eosinophilia in one patient, increases in both GPT and GOT in one patient, and lowered creatinine clearance in one patient. With a broader spectrum and safe regimen, the combination of CRMN/CTM is recommended as the first choice against complicated UTI.

Clinical effect of LM-001, a prostaglandin synthetic inhibitor developed from a drug delivery system, was evaluated in 54 patients with pain from urinary tract stones (stone pain) and 32 with vesical urgency after an operation on bladder or prostate. LM-001, felbinac ethyl incorporated in lipid microsphere, wes intravenously administered at the onset of stone pain or vesical urgency. Of 54 with stones and 32 with urgency, 53 and 29 were eligible for response, respectively. The symptoms improved or disappeared in some cases just after the administration and in the majority of patients within 15 minutes, in 49 of 53 patients with stone pain. Further, the effectiveness lasted over 24 hours in 26 of the 49 responding to this agent. On one hand, improvement or disappearance of vesical urgency was recognized in 25 of 29 patients, and the effectiveness was observed shortly after injection in 16 and lasted over 24 hours in 13 cases. Toxicities of this drug were investigated in 54 patients with stone pain and 32 with urinary urgency. Side effects consisted of pain at the injection site in 4, a slight fall of blood pressure in 1, slight visual disturbance in 1, body heat sensation in 1, leukocytosis in 3 and elevation of alkaline phosphatase in 1. These symptoms were transient and disappeared without use of any agent. LM-001 is concluded to be a useful drug for controlling stone pain and vesical urgency since an immediate effect, long durability and high response rates were obtained without severe side

Clinical experiences of HCG/HMG therapy for 100 cases of idiopathic male sterility were studied. Counts, motility rate of sperms were observed during the therapy. Nineteen cases revealed normal spermatogram (group 1), 31 cases revealed improved but not normal spermatogram (group 2) and 50 cases did not changed in the spermatogram (group 3). Sixteen pregnancies were found, in whom II cases belonged to group 1 and 5 cases belonged to group 2. For serum level of FSH measured before therapy, groups 2 and 3 were significantly higher than group 1, but for serum level of LH no significant differences in each three groups were found. The volumes of bilateral testicles measured before therapy in groups 2 and 3 were significantly smaller than those of group 1. From above findings, for cases of idiopathic male sterility HCG/HMG therapy were thought to be effective and serum level of FSH and volumes of bilateral testicles were thought to be good indicators to know the prognosis offertility.

Ceftizoxime (CZX) was given clinically to 80 patients with urogenital tract infections, in which 34 cases of complicated UTI satisfied the criteria of the UTI committee. CZX was administered for at least five days at a daily dose of 1 to 4 g in two divided doses by intravenous drip infusion. The overall clinical efficacy of CZX in 34 cases of complicated UTI was 59%, estimated by the criteria of the UTI committee. The overall clinical efficacy rate according to group of infection was: 64% for the 11 patients in the 1st group, 56% for the 9 patients in the 2nd group, 100% for the 5 patients in the 3rd group, 50% for the 4 patients in the 4th group and 20% for the 5 patients in the 5th group. No serious side effects were observed in the clinical or laboratory findings except for slight elevation in GOT & GPT values in two cases (2.5%), which returned to normal after CZX treatment. It is therefore suggested that CZX is a clinically useful and safe drug in the treatment of complicated UTI.

Three cases of metastatic renal tumor are reported. The first case was of a 61-year-old man, who had a Miles' operation for rectal adenocarcinoma 30 months before, and suffered from high fever and right flank pain. Right nephrectomy was carried out and the kidney was found to contain an adenocarcinoma identical to the one previously removed from the rectum. He died 1 year after nephrectomy. The second case was of a 35-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One month later, he was readmitted with cloudiness of consciousness and high fever. Investigations revealed right kidney, adrenal gland and brain malignancies, and which were ectomized totally. On pathological examination all ectomized tissues were metastatic squamous cell carcinoma. He died 1 month after the second operation. The third case was of a 48-year-old man, who had undergone left pneumonectomy for a squamous cell carcinoma of the bronchus. One year after pneumonectomy, abdominal CT showed a left renal tumor. Right nephrectomy was performed and pathological examination revealed a metastatic squamous cell carcinoma. He is now alive 4 months after nephrectomy without any sign of recurrence. A total of 136 cases of metastatic renal tumors including 38 cases from the Japanese literature, are reviewed.

A case of primary signet ring cell carcinoma of the urinary bladder is reported. A 52-year-old man was admitted with the complaint of gross hematuria. Cystoscopy showed non-papillary tumor on the right lateral wall. Abdominal CT, Ga scintigraphy, upper gastrointestinal series and barium enema, revealed no signs of a tumor other than the bladder carcinoma. The routine hematologic and chemistry profiles showed no abnormalities except for the serum level of carcinoembryonic antigen elevated to 210 ng/ml. Total cystectomy and right nephroureterectomy with left cutaneous ureterostomy was performed and the surgical specimen showed adenocarcinoma of the bladder. The patient died 5 months after the operation, and autopsy was performed. No tumors were found on the mucosa of the whole digestive tracts or pancreas. This case might be of primary adenocarcinoma originated from the bladder. The literature on the differential diagnosis of the cases reported as bladder adenocarcinoma are reviewed briefly.

Reticulum cell sarcoma of the testis seen in a 65-year-old man was described. For the period of 14 months following high orchiectomy with postoperative irradiation (Lineac, 4, 000 rad) as well as chemotherapy (Mitomycin, Endoxan, Toyomycin, vincristine, 5-FU and Cylocide), the patient has been doing quite well without any clinical evidence of recurrence or generalization of the tumor. Literature was reviewed briefly.

The statistics of urological operations performed at our Department from 1977 to 1981 were reviewed. During the 5 year period, 1, 816 patients were admitted to our clinic, and 1, 896 urological operations were performed on 1, 505 patients. These operations were compared with earlier statistics for three periods (1957-1966, 1967-1971 and 1972-1976), and the recent trend of urological operations was investigated. Compared with earlier periods, operations on the kidney and urinary bladder have gradually increased, but those on the urethra have greatly decreased. Nephrectomy was previously the most frequent operation, but during the recent 5 year period TUR-Bt was the most frequent. Renal al-10transplantations have increased. Autotransplantation was introduced during this period and performed on 15 patients. Transurethral operations on the bladder and the prostate have still increased. For bladder tumors, TUR-Bt or total cystectomy with urinary diversion was performed, and the indications for total cystectomy were discretely decided after TUR-Bt or TU-biopsy. The prognosis of urinary diversion such as ileal conduit and colonic conduit has been better than in the preceding 5-year period. Splenectomy was introduced during this period, and it was performed on 15 patients at renal allotransplantation to prevent the induction of leucocytopenia by immunosuppressing agents.