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To determine the follow-up schedule in patients with non-muscle-invasive bladder cancer who had remained recurrence-free for 5 or more years, we retrospectively reviewed 258 patients with Ta and T1 bladder cancer who had been free of recurrence for at least 5 years. Of these 258 patients, subsequent recurrences developed in 100 patients. In spite of our recommendation that cystoscopic follow-up be done at 12-month intervals for patients who remained recurrence-free for more than 5 years, 45 had been followed at intervals of more than 12 months (range, 13-77 months) when the recurrences were found. Of 100 recurrent tumors, 20 (20.0%) showed bladder muscle invasion. Muscle-invasive cancer was identified more often in the patients with cytoscopic intervals of more than 12 months than in those of less than 12 months (35.6% versus 7.3%). Therefore, we recommend that cystoscopy be performed at intervals of less than 12 months in patients with non-muscle invasive bladder cancer for recurrence detection before tumors become muscle invasive, even when patients remain free of recurrence for a long period.

血尿の程度が強いと有用でなかった.ROC曲線により求めたcut off値は9.2u/mlとなった.この時感受性は血尿症例で91.7%, 尿路上皮癌経過観察中の症例で81.8%であった.本邦で推奨されているcut off値12.0u/mlを用いると感受性は低下し, pT2以上の膀胱癌で感受性75.0%であった.NMP22は尿路上皮癌の診断に有用であるが, 本邦で推奨されているcut off値はやや高い可能性がある, We evaluated the availability of NMP22 for the diagnosis of urothelial cancer. Of 154 patients with gross hematuria or microscopic hematuria, 14 patients with bladder cancer and 4 patients with upper urothelial cancer were detected. Of 73 patients continued to be followed for urothelial cancers, 11 patients with bladder cancer were detected. NMP22 was not available when a large number of RBC was present in urine. Also, NMP22 was significantly higher in patients with urothelial cancers. Interpretation of the ROC curve indicated an optimal cutoff value of 9.2 u/ml. Using 9.2 u/ml as a cutoff, the sensitivity and specificity were, respectively 87.0% and 64.0% in patients with hematuria, and 81.8% and 78.7% in patients with a history of TCC. This indicated that when NMP22 was used for the diagnosis of urothelial cancers, 12.0 u/ml, the value recommended as a cutoff in Japan, might be too high to differentiate patients with urothelial cancers.

54歳男。患者は著明な食欲低下(2ヵ月で7kgの体重減少), 倦怠感, 低血圧を主訴とした。内科的精査では診断がつかず, 低血圧に対して昇圧剤を処方されたが改善しなかった。心療内科を受診し, 鬱病の診断で抗鬱剤を投与されたが症状は改善しなかった。そこで, 男性更年期外来を受診したところ, Late-onset hypogonadism様症候群検査のため測定したtestosterone値および症状から副腎不全が疑われ, adrenocorticotrophic hormone(ACTH), cortisolを測定した結果, ともに感度以下の低値であった。一方, 一般血液生化学検査ではNa低値や低蛋白, 貧血傾向を認めるも, 他の下垂体前葉ホルモン, MRIでは異常を認めず, これらのことから本症例はACHT単独欠損症と診断された。治療としてHydrocortisoneの補充を開始し, 著明な改善が認められた。目下は6ヵ月経過でhydrocortisone 10mg/日の補充を継続しているが, 治療前に認められた症状は改善し, 副作用は認められていない。, We present a case of isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) in a late onset hypogonadism (LOH) clinic, not diagnosed by examinations in internal medicine. A 54-year-old man showed body weight loss with severe appetite loss, general malaise and hypotension. He visited our clinic for a checkup for LOH after general examinations in internal medicine. His hormonal examination showed undetectable ACTH and cortisol levels. However, the values of other pituitary hormones and testosterone were normal. A load test for anterior pituitary hormone (CRH + TRH + LHRH + GRH test) revealed that the ACTH-cortisol system showed no response although the other pituitary hormones responded. These findings confirmed the diagnosis of isolated ACTH deficiency. Administration of hydrocortisone dramatically improved his symptoms. Symptoms of IAD are similar to those of LOH syndrome and depression. Thus, we should consider IAD as one of the differential diagnoses in LOH clinics.

PNL開始後11年間の173例178腎の治療成績をまとめた.完全排石は61.8%, 4mm以下の残石は34.3%であった.PNL後半年以上経過し, 完全排石が確認された症例は105例であった.これらの累積再発率は1年4.2%, 3年16.6%, 5年29.2%, 7年34.4%, 10年55.4%であった.Risk factorで統計学的に有意なものはみられなかった, A total of 178 renal units in 173 patients with renal and upper ureteral calculi were treated by percutaneous nephrolithotripsy (PNL) between November 1984 and October 1995. PNL was performed as a monotherapy in 70 kidneys, while extracorporeal shock wave lithotripsy (ESWL) was combined in 108 kidneys. At the time discharged 110 (61.8%) kidneys were stone-free and the overall success rate, defined as no residual stone or fragments 6 months of follow-up, the cumulative stone recurrence rate was 4.2% at 1 year, 16.6% at 3 years, 29.2% at 5 years, 34.4% at 5 years and 55.4% at 10 years. None of the pretreatment parameters, such as stone size, number, location, composition, past history of urolithiasis and upper urinary tract obstruction, had a significant influence on stone recurrence.

ESWL後完全排石し3年以上経過した2, 335人の累積再発率は, 3年13.1%, 5年23.9%, 10年40.1%であった.59歳以下の症例, 多発結石, 結石の既往のある症例に再発が多かった, During the 11-year period from September 1984 through August 1995, extracorporeal shock wave lithotripsy (ESWL) was performed on 5, 558 patients using a Dornier HM3 apparatus. A recurrence questionnaire was sent out to 2, 379 of those who had had complete elimination of the calculi and for whom at least 3 years had passed since the ESWL. The last day of follow-up was defined as follows: the day of completion of the questionnaire in the recurrence-free group (n = 787), the day when recurrence of calculi was diagnosed in the recurrence group (n = 415) and the day of the last visit to the outpatient clinic in the miscellaneous group (n = 1, 133). The cumulative recurrence rates were calculated by the Kaplan-Meier equation. The resultant data were analyzed for statistically significant differences by the log rank test and the generalized Wilcoxon test. Ap value of < or = 0.05 was considered to indicate significance. The recurrence rate was examined for differences in relation to the following risk factors: the patients' age and sex, the stone location, size and number, the presence or absence of past history of lithiasis, the composition of the stone (s), and the presence or absence of urinary tract complications. The cumulative recurrence rates for the total cases were 2.0% at one year, 13.1% at 3 years, 23.9% at 5 years, 30.7% at 7 years and 40.7% at 10 years. Significantly higher recurrence rates were found for patients under 60 years of age, those with multiple stones and those with a past history of disease.

外来新患の主なる疾患は, 膀胱炎, 上部尿路結石症, 前立腺炎, 前立腺肥大症であり, これら主疾患を合せると69.5%を占めた。その他, 亀頭包皮炎, STD, 包茎, 腎嚢胞であった。男子では, 上部尿路結石症, 前立腺炎, 前立腺肥大症が主なるもので, この3主疾患を合わせると64.6%を占めた。その他包皮炎, STD, 包茎であった。女子では, 膀胱炎が約60%, つぎに上部尿路結石症16.2%, そのほか, 腎盂腎炎, 腎下垂であった, We report the clinical statistics of new outpatients for five years since 1989 at our hospital. The average total number of new outpatients in a year was 8309.8 (8122-8691) and new outpatients tended to show little change. The male to female ratio was 1.57:1, and 24.3% of the outpatients were referred to us by others sources. The representative operations on outpatients were circumcision, vasectomy, resection of condyloma and resection of caruncle. A statistical study was made on new outpatients according to the international classification of disease. There were 140.6 (1.97%) malignant urogenital tumors per year. Sexually transmitted diseases showed a tendency to increase for the last five years. In males the major disease was upper urinary tract stone (21-24%), prostatistis (21-24%) and benign prostatic hypertrophy (17-20%) and in females they were cystitis (58-61%), upper urinary tract stone (15-17%) and pyelonephritis (3-4%). We conclude that our hospital plays a major role as a private urological hospital.

1)患者総数は8, 750例であった.2)主要疾患は尿路結石症4, 134例, 前立腺肥大症1, 529例, 膀胱腫瘍410例, 腎不全313例, 腎盂腎炎282例であった.3)おもなる手術術式はendourologyが中心でESWL:2, 589例, TUR-P:1, 295例の他, TUL, TUR-BT, renal cyst puncture等であった, A clinical statistic survey was carried out on the patient admitted, diseases and operations experienced at our urological clinic during 1985-1989. The total number of inpatients was 8, 750 (The male to female ratio was 2.8:1). The major diseases of the inpatients were urolithiasis (4, 134 cases, 47.2%) and benign prostatic hypertrophy (1, 529 cases, 17.5%). Among the operations extracorporeal shock-wave lithotripsy 2, 589 cases (44.6%) and transurethral resection of prostate 1, 295 cases (22.3%) were predominant.

1)男27例, 女12例に施行した.2)治療回数は1回が33例, 他機種により2回目を施行したのは6例であった.砕石効果は, 84.6%であった.3) ESWL治療後21日目での排石効果は, 完全排石は37例中14例, 4 mm以下の残石が37例中18例であった.4.1 mm以上の残石は5例であった.追跡不能は2例であった.4) ESWL術中, 術直後の臨床的, 血液生化学検査において, 変動はなかった.5)有用度判定で有用は37例中24例, やや有用が13例であった, Thirty-nine patients, 27 males and 12 females with renal and ureteral stones, were treated using the Modulith SL 20 between October 1990 and January 1991. Thirty-three of the 39 cases had a single session of extracorporeal shockwave lithotripsy (ESWL) and the other six cases had two sessions. The pulverization rate of ESWL by this device was 84.6%. According to the X-rays taken 21 days after ESWL, of the 37 cases, 14 (37.8%) were stone-free, 18 (48.7%) had residual sandy stones less than 4 mm in diameter, five (13.5%) had residual stone fragments larger than 4.1 mm in diameter, and two cases were not clear. Using the criterion of cases which can be expected to have spontaneous passage, in other words, residual stones less than 4 mm in diameter, lithotripsy with the Modulith SL 20 was regarded as "effective" in 32 of the 37 cases (86.5%). As side effects of this treatment, hematuria was observed for several days after ESWL in all patients, but not other serious complications were observed. Among the 37 cases in which the grade could be evaluated the evaluation for 24 (64.9%) was "useful" and that for 13 (35.1%) "useful to some extent". Therefore, ESWL was performed very successfully.

To determine the follow-up schedule in patients with non-muscle-invasive bladder cancer who had remained recurrence-free for 5 or more years, we retrospectively reviewed 258 patients with Ta and T1 bladder cancer who had been free of recurrence for at least 5 years. Of these 258 patients, subsequent recurrences developed in 100 patients. In spite of our recommendation that cystoscopic follow-up be done at 12-month intervals for patients who remained recurrence-free for more than 5 years, 45 had been followed at intervals of more than 12 months (range, 13-77 months) when the recurrences were found. Of 100 recurrent tumors, 20 (20.0%) showed bladder muscle invasion. Muscle-invasive cancer was identified more often in the patients with cytoscopic intervals of more than 12 months than in those of less than 12 months (35.6% versus 7.3%). Therefore, we recommend that cystoscopy be performed at intervals of less than 12 months in patients with non-muscle invasive bladder cancer for recurrence detection before tumors become muscle invasive, even when patients remain free of recurrence for a long period.

We present a case of isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) in a late onset hypogonadism (LOH) clinic, not diagnosed by examinations in internal medicine. A 54-year-old man showed body weight loss with severe appetite loss, general malaise and hypotension. He visited our clinic for a checkup for LOH after general examinations in internal medicine. His hormonal examination showed undetectable ACTH and cortisol levels. However, the values of other pituitary hormones and testosterone were normal. A load test for anterior pituitary hormone (CRH + TRH + LHRH + GRH test) revealed that the ACTH-cortisol system showed no response although the other pituitary hormones responded. These findings confirmed the diagnosis of isolated ACTH deficiency. Administration of hydrocortisone dramatically improved his symptoms. Symptoms of IAD are similar to those of LOH syndrome and depression. Thus, we should consider IAD as one of the differential diagnoses in LOH clinics.

We evaluated the availability of NMP22 for the diagnosis of urothelial cancer. Of 154 patients with gross hematuria or microscopic hematuria, 14 patients with bladder cancer and 4 patients with upper urothelial cancer were detected. Of 73 patients continued to be followed for urothelial cancers, 11 patients with bladder cancer were detected. NMP22 was not available when a large number of RBC was present in urine. Also, NMP22 was significantly higher in patients with urothelial cancers. Interpretation of the ROC curve indicated an optimal cutoff value of 9.2 u/ml. Using 9.2 u/ml as a cutoff, the sensitivity and specificity were, respectively 87.0% and 64.0% in patients with hematuria, and 81.8% and 78.7% in patients with a history of TCC. This indicated that when NMP22 was used for the diagnosis of urothelial cancers, 12.0 u/ml, the value recommended as a cutoff in Japan, might be too high to differentiate patients with urothelial cancers.

We herein report the clinical statistics on new outpatients over five years from 1994 at our hospital. The average number of new outpatients per year was 8, 534.4 (8, 366-8, 658) and there was only a slight variation in the number over the last five years. The male to female ratio was 1.61:1. Twenty-one percent of the outpatients were referred to us by other sources. The representative operations on outpatients were circumcision, vasectomy, resection of condylomas and resection of caruncles. A statistical study was made on new outpatients according to the international classification of disease. There were 197.0 (2.3%) malignant urogenital tumors per year. There was a tendency for sexually transmitted diseases to increase over the last five years. In males, the major diseases were upper urinary tract stones (23-27%), benign prostatic hypertrophy (19-26%) and prostatitis (15-24%). In females, they were cystitis (57-59%), upper urinary tract stones (17-18%) and neurogenic bladder (3-4%). We conclude that our hospital plays a major role as a private urological hospital.

A total of 178 renal units in 173 patients with renal and upper ureteral calculi were treated by percutaneous nephrolithotripsy (PNL) between November 1984 and October 1995. PNL was performed as a monotherapy in 70 kidneys, while extracorporeal shock wave lithotripsy (ESWL) was combined in 108 kidneys. At the time discharged 110 (61.8%) kidneys were stone-free and the overall success rate, defined as no residual stone or fragments 6 months of follow-up, the cumulative stone recurrence rate was 4.2% at 1 year, 16.6% at 3 years, 29.2% at 5 years, 34.4% at 5 years and 55.4% at 10 years. None of the pretreatment parameters, such as stone size, number, location, composition, past history of urolithiasis and upper urinary tract obstruction, had a significant influence on stone recurrence.

During the 11-year period from September 1984 through August 1995, extracorporeal shock wave lithotripsy (ESWL) was performed on 5, 558 patients using a Dornier HM3 apparatus. A recurrence questionnaire was sent out to 2, 379 of those who had had complete elimination of the calculi and for whom at least 3 years had passed since the ESWL. The last day of follow-up was defined as follows: the day of completion of the questionnaire in the recurrence-free group (n = 787), the day when recurrence of calculi was diagnosed in the recurrence group (n = 415) and the day of the last visit to the outpatient clinic in the miscellaneous group (n = 1, 133). The cumulative recurrence rates were calculated by the Kaplan-Meier equation. The resultant data were analyzed for statistically significant differences by the log rank test and the generalized Wilcoxon test. Ap value of < or = 0.05 was considered to indicate significance. The recurrence rate was examined for differences in relation to the following risk factors: the patients' age and sex, the stone location, size and number, the presence or absence of past history of lithiasis, the composition of the stone (s), and the presence or absence of urinary tract complications. The cumulative recurrence rates for the total cases were 2.0% at one year, 13.1% at 3 years, 23.9% at 5 years, 30.7% at 7 years and 40.7% at 10 years. Significantly higher recurrence rates were found for patients under 60 years of age, those with multiple stones and those with a past history of disease.

We report the clinical statistics of new outpatients for five years since 1989 at our hospital. The average total number of new outpatients in a year was 8309.8 (8122-8691) and new outpatients tended to show little change. The male to female ratio was 1.57:1, and 24.3% of the outpatients were referred to us by others sources. The representative operations on outpatients were circumcision, vasectomy, resection of condyloma and resection of caruncle. A statistical study was made on new outpatients according to the international classification of disease. There were 140.6 (1.97%) malignant urogenital tumors per year. Sexually transmitted diseases showed a tendency to increase for the last five years. In males the major disease was upper urinary tract stone (21-24%), prostatistis (21-24%) and benign prostatic hypertrophy (17-20%) and in females they were cystitis (58-61%), upper urinary tract stone (15-17%) and pyelonephritis (3-4%). We conclude that our hospital plays a major role as a private urological hospital.

A clinical statistic survey was carried out on the patient admitted, diseases and operations experienced at our urological clinic during 1985-1989. The total number of inpatients was 8, 750 (The male to female ratio was 2.8:1). The major diseases of the inpatients were urolithiasis (4, 134 cases, 47.2%) and benign prostatic hypertrophy (1, 529 cases, 17.5%). Among the operations extracorporeal shock-wave lithotripsy 2, 589 cases (44.6%) and transurethral resection of prostate 1, 295 cases (22.3%) were predominant.

Thirty-nine patients, 27 males and 12 females with renal and ureteral stones, were treated using the Modulith SL 20 between October 1990 and January 1991. Thirty-three of the 39 cases had a single session of extracorporeal shockwave lithotripsy (ESWL) and the other six cases had two sessions. The pulverization rate of ESWL by this device was 84.6%. According to the X-rays taken 21 days after ESWL, of the 37 cases, 14 (37.8%) were stone-free, 18 (48.7%) had residual sandy stones less than 4 mm in diameter, five (13.5%) had residual stone fragments larger than 4.1 mm in diameter, and two cases were not clear. Using the criterion of cases which can be expected to have spontaneous passage, in other words, residual stones less than 4 mm in diameter, lithotripsy with the Modulith SL 20 was regarded as "effective" in 32 of the 37 cases (86.5%). As side effects of this treatment, hematuria was observed for several days after ESWL in all patients, but not other serious complications were observed. Among the 37 cases in which the grade could be evaluated the evaluation for 24 (64.9%) was "useful" and that for 13 (35.1%) "useful to some extent". Therefore, ESWL was performed very successfully.

The total number of new outpatients in 1987 was 8, 062 (male 5, 056, female: 3, 006) and the male to female ratio was 1.68:1. They had urogenital diseases definitely diagnosed (7, 197), urogenital diseases indefinitely diagnosed (536), no diseases (269), and diseases other than urogenital (60). Thirty percent of the outpatients were referred to us by other sources. The number of operations on new outpatients was 216, circumcision, resection of condyloma and vasectomy were representative. The peak of the age distribution was in the thirties for males and in the fifties for females. A statistical study was made on new outpatients according to the international classification of disease. There were 125 malignant (urogenital) tumors (1.6%). The major diseases of the new outpatients were cystitis (acute or chronic: 22.0%), upper urinary tract stone (15.9%), prostatitis (13.9%), and benign prostatic hypertrophy (11.9%). In males the major diseases were prostatitis, upper urinary tract stone, benign prostatic hypertrophy, balanoposthitis, phimosis and in females they were cystitis, upper urinary tract stone, pyelonephritis, renoptosis, and neurogenic bladder. We conclude that our hospital plays a major role as a private urological hospital.

1) ESWL(体外衝撃波腎結石破砕機)による治療が最も困難であるとされている完全鋳型結石64例につき, 2) ESWL単独療法は30例(46.8%)であり, 他の34例(53.2%)では補助的な操作が必要であった.3) ESWL治療後, 44例(68.7%)に疼痛および発熱が認められたが, 化学療法および補助的処置(尿管口切開・UUL・PNS)で改善した.4) 12週間以上の経過観察では97.4%が著効と考えられた.5)当院における完全鋳型結石の治療方針はi)腎杯の拡張および尿路の狭窄がない者にはESWL単独療法を, ii) obstructive pyelonephritisを併発し化学療法のみで改善しないものには補助的療法(PNS・UUL・etc)を, iii)腎杯の拡張例, 狭窄例, 尿路変更例, 単腎症例に対してはcombined treatmentを行う, This report describes the treatment of 64 cases of complete staghorn calculi using extracorporeal shock wave lithotripsy (ESWL). Thirty cases (46.8%) were successfully treated using ESWL monotherapy and the rest of the cases (53.2%) required ESWL combined with an auxiliary procedure. Forty-four of the cases (68.7%) had symptoms such as fever and pain after ESWL. These cases were treated with chemotherapeutic agents and an auxiliary procedure. X-ray examination showed that the result of ESWL treatment was satisfactory in 97.4% of the 34 cases followed up for more than 12 weeks after ESWL. Based on the results of this study, the following plan of treatment for complete staghorn calculi has been adopted in our hospital. ESWL monotherapy is performed in cases without a dilated collecting system or stricture. ESWL combined with an auxiliary procedure is performed in cases with a dilated collecting system, stricture, ileal conduit and solitary kidney.

東札幌三樹会病院を開設した1978年11月1日より1983年末日までの, 入院患者の臨床統計をおこなった.1)主要疾患は, 全尿路結石症982例(24.1%), 前立腺肥大症923例(22.7%)であった.2)おもなる術式は, 経尿道的前立腺切除術(TURP) 604例(32.7%), 切石術11.2%, 経尿道的膀胱腫瘍切除術(TUR-BT) 193例(10.4%)であった, A clinical statistic survey was carried out on the patients admitted, diseases and operations experienced at our urological clinic during 1978-1983. The total number of inpatients was 4, 070. (The male to female ratio was 2.93:1) Major diseases of the inpatients were urolithiasis (982 cases, 24.1%), and BPH (923 cases, 22.7%). Among the operations, TUR-P (32.7%), TUR-BT (10.4%) and ureterolithotomy (7.7%) were predominant.

A statistical study was performed on new outpatients. The total number of new outpatients in 1983 was 5, 901 (male: 3, 712, female: 2, 189) and the male to versus female ratio was 1.7: 1. They had urogenital diseases definitely diagnosed (4, 773), indefinitely diagnosed (445), normal (272), and diseases other than urogenital (411). The outpatients who were referred to by other sources accounted for 30% of the total number. The number of operation in new outpatients was 300, circumcision and vasectomy were representative. In our experience, manual operations without surgery gave good results in the outpatients who visited our hospital at an early stage of torsion of testis. The age, range had a peak in the thirties for males and in the 20s in females. A statistical study was made on new outpatients according to the international diseases classification. The number of the malignant (urogenital) tumors was 101 (1.9%). The major diseases of the new outpatients were cystitis (acute or chronic: 22.4%), prostatitis (16.7%), benign prostatic hypertrophy (10.4%), upper urinary tract stone (10.2%). In male the major diseases were prostatitis, benign prostatic hypertrophy, upper urinary tract stone, balanoposthitis, and in female they were cystitis, upper urinary tract stone, pyelonephritis, renalptosis. From these results, we may conclude that our hospital playing its role as a private urological hospital.

double pigtail stentを内視鏡下挿入法により12例, 手術時挿入法により10例経験した.この方法は腎瘻, 尿管皮膚瘻に比して手術侵襲も小さく, とくに悪性疾患による水腎症のように全身状態などを含めて, riskの高い症例に対しては, 経皮腎瘻術とともに試みられるべき方法である.そのうえ, カテーテルが体外へ出ないため生活の質の向上が得られるという利点がある.手術時において, 長期の尿管カテーテル留置が必要な場合, 留置中の活動が制限されず, 苦痛が少なく, 良い方法と考えられる.complicationはとくに重篤なものは見られなかった, Double pigtail ureteral stent was inserted by endoscope in 12 cases and by operation in 10 cases. It was retained for 12 to 155 days without any trouble in 19 cases. Distal migration was experienced in 3 cases, but no severe side effects were experienced. The quality of life of the patient was improved since no external collection appliance was necessary.

1)1978年11月から1987年2月までの約9年間に1, 892例の前立腺手術を経験した.2)このうちBPH(前立腺肥大症)は1, 812例あり, TUR-Pは1, 645例(90.7%), CRYOは136例(7.5%), SPPは31例(1.8%)であった.3)TUR-Pの年齢は60歳代, 70歳代で約80%を占めた.また切除重量は20 g以下が70%であった.手術時間は60分以内が約90%であった.4)潜在癌は54例(3.3%)であった.年齢でみると高齢になるに従い, 潜在癌の発見率は有意に上昇する.しかし切除重量とは関連がなかった.stage A1に比較し, stage A2は有意に高齢であった.このため70歳以上の高年齢のBPHに対しては積極的にTUR-Pを行うべきと考えられた, During the last 9 years, 1, 892 patients underwent surgery of the prostate. Benign prostatic hypertrophy (BPH) accounted for 1, 812 cases, and prostatic cancer 80 cases. In the case of BPH, transurethral resection was done in 1, 645 cases, cryosurgery in 136 cases, and suprapubic prostatectomy in 31 cases. Latent cancer was detected in 54 (3.3%) of the BPH cases. The average patient age of the patients with latent cancer (73.6 +/- 6.9 years) was higher than that of those without latent cancer (69.5 +/- 7.7 years). This suggested a significant relationship between the age of the patient and the occurrence of latent cancer.

過去9年間で1, 664例のTUR-Pのうち切除重量が100 gを超えた11症例について検討した.切除重量は最高180 g, 手術時間は最高140分であった.400 mlから1, 600 ml, 平均890 mlの輸血を必要とした.合併症は術後尿路狭窄が1例, 軽度の敗血症性ショックが1例であり, TUR反応はみられなかった.術後の経過は良好であり, 200 g以下のBPHに対してはTUR-Pが施行可能であることが示された, Transurethral resection of prostate was done on 11 prostates weighing over 100g among 1664 cases seen during the last 9 years. The largest prostate weighed 180g and needed 140 minutes for resection. From 400 ml up to 1, 600 ml, mean 890 ml of blood were transfused in these patients. No severe complication or death occurred. In conclusion, a prostate weighing less than 200 g can be operated by transurethral resection.

1)泌尿器系悪性腫瘍は94例で有疾患数6, 250例に対して1.5%であった.2)外来新来患者の主疾患は膀胱炎22.8%, 前立腺炎17.0%, 上部尿路結石症12.9%, 前立腺肥大症10.1%が主疾患であった.前年度に比し上部尿路結石症が2.7%, 淋菌感染が0.8%と増加した以外は, 前年度より新来患者数は増加しているが, その主疾患の割合は前年の割合と同様であった, A statistical study was performed on new outpatients. The total number of new outpatients in 1984 was 6, 890 (male: 4, 381, female: 2, 509) and the male to female ratio was was 1.75:1. They had urogenital diseases definitely diagnosed (5, 925), indefinitely diagnosed (325), normal (282), and diseases other than urogenital (358). Thirty percent of the outpatients were referred to by other sources. The number of operations on new outpatients was 191, circumcision, resection of condyloma and vasectomy were representative. The peak of the age distribution was in the thirties for males and in the twenties for females. For the first time in Japan, we treated renal and upper ureteral stones using Extracorporeal Shock Wave Lithotripsy (ESWL) on September 1st 1984. The results of ESWL at our hospital have been satisfactory. A statistical study was made on new outpatients according to the international disease classification. There were 94 malignant (urogenital) tumors (1.5%). The major diseases of the new outpatients were cystitis (acute or chronic: 22.8%), prostatitis (17.0%), upper urinary tract stone (12.9%), benign prostatic hypertrophy (10.1%). In males the major diseases were prostatitis, benign prostatic hypertrophy, upper urinary tract stone, balanoposthitis, gonorrhea, and in female they were cystitis, upper urinary tract stone, pyelonephritis, renoptosis. We conclude that out hospital plays a major role as a private urological hospital.

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1, 225 patients (1, 320 cases) underwent 1, 647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.

ESWL (Extracorporeal Shock Wave Lithotripsy)施行後3ヵ月を経過した60症例のうち経過観察が可能であった53例中, 3ヵ月以内に結石の完全排出をみたのは, 46例86.8%であった, Fifty three out of 60 cases treated with Extracorporeal Shock Wave Lithotripsy (ESWL), were followed up for 3 months. Forty four of the patients had renal stones (2 had bilateral renal stones, 3 had staghorn calculi, 2 had incomplete staghorn calculi, 10 had multiple renal stones), 2 had the unilateral renal and ureteral stones and 16 had ureteral stone. The stone had been discharged completely within 3 months in 47 cases (86.8%), and residual stones were noticed in 6 cases (11%), two of which had stone discharge after retreatment with ESWL. The other cases are being followed up without further treatment, because the residual sandy stones are thought to be able to be discharged spontaneously.

A statistical study was performed on new outpatients. The total number of new outpatients in 1988 was 8, 389 (male: 5, 284, female: 3, 105) and the male to female ratio was 1.70:1. They had urogenital diseases definitely diagnosed (7, 486), urogenital diseases indefinitely diagnosed (576), no diseases (260), and diseases other than urogenital (67). Thirty-five percent of the outpatients were referred to us by other sources. The number of operations on new outpatients was 139, circumcision, vasectomy and resection of condyloma were representative. The peak of the age distribution was in the thirties for males and in the fifties for females. A statistical study was made on new outpatients according to the international classification of disease. There were 146 malignant (urogenital) tumors (1.8%). The major diseases of the new outpatients were cystitis (acute or chronic: 20.7%), upper urinary tract stone (18.5%), prostatitis (13.0%), and benign prostatic hypertrophy (11.2%). In males the major diseases were prostatitis, upper urinary tract stone, benign prostatic hypertrophy, balanoposthitis, phimosis and in females they were cystitis, upper urinary tract stone, pyelonephritis, renoptosis, and neurogenic bladder. We conclude that our hospital plays a major role as a private urological hospital.

1) 1985年新来患者の主疾患は, 膀胱炎1, 522例(20.6%), 上部尿路結石1, 433例(19.4%), 前立腺炎997例(13.5%), 前立腺肥大症792例(10.7%)であった.2) 1985年の新来患者の男・女の主疾患は, 男子では前立腺炎997例(21.3%), 上部尿路結石978例(20.9%), 前立腺肥大症792例(16.9%)であった.女子では, 膀胱炎は1, 474例(54.4%), 上部尿路結石455例(16.5%), 腎下垂83例(3.1%)であった.3) 1985年新来患者の年齢層にみた主疾患を検討した結果, 男子では31～50歳代は, 前立腺炎と結石症が中心で, 高年齢は前立腺肥大症が中心であった.女子では全年齢層にわたり, 膀胱炎が中心であった, A statistical study was performed on new outpatients, the total number of which was 7, 786 (male: 4, 953, female: 2, 833) in 1985. The male to female ratio was 1.75:1. They had urogenital diseases definitely diagnosed (6, 786), tentatively diagnosed (600), normal (260), and diseases other than urogenital (140), and 36.2% of them had been referred to us by other sources. On these outpatients 206 operations had been performed circumcision, resection of condyloma and vasectomy were representative. The peak of the age distribution was in the thirties for males and in the twenties for females. For the first time in Japan, we treated renal and upper ureteral stones using extracorporeal shock wave lithotripsy (ESWL) on September 1, 1984. The results of ESWL at out hospital have been satisfactory. A statistical study was made on new outpatients according to the international disease classification. There were 152 malignant (urogenital) tumors (2.1%). The major diseases of the new outpatients were cystitis (acute or chronic: 20.6%), upper urinary tract stones (19.4%), prostatitis (13.5%), benign prostatic hypertrophy (10.7%). In males the major diseases were prostatitis, upper urinary tract stones, benign prostatic hypertrophy, balanoposthitis, and phimosis, and in females they were cystitis, upper urinary tract stone, pyelonephritis, and renoptosis. We conclude that our hospital plays a major role as a private urological hospital.

Two cases of phenotypic males with 46XX karyotype are reported. The first case is a 41-yearold married man. He complained of sterility and had hypoplastic testes without other clinical symptoms of abnormal sexual development. The second case is a 35-year-old married man. He also complained of sterility. The external genitalia appeared normal in size, but small testes and gynecomastia were noted. In each cases, pituitary gonadotropin excretion was elevated. Serum testosterone level was low in one case. To certify the hypothesis that H-Y antigen is essential for testicular differentiation, we studied two our cases. H-Y antigen can be detected by the cytotoxicity test in vitro. Blood cells from two XX males (our cases) expressed H-Y antigen. The clinical features, etiology of XX male syndrome are discussed and the literature is reviewed.

1984年度(1984年1月1日～1984年12月31日)の入院患者1, 314例の臨床統計をおこなった.1)主要疾患は全尿路結石症452例(34.4%), 前立腺肥大症297例(22.6%)であった.2)おもなる手術術式は, endourologyが中心であった.経尿道的前立腺切除術(TUR-P) 224例(34.5%), 体外衝撃波による腎尿管結石破砕術(ESWL) 214例(33.0%), 経尿道的膀胱腫瘍切除術45例(6.9%)であった, A clinical statistic survey was carried out on the patients, diseases and operations experienced at our urological clinic in 1984. The total number of inpatients was 1314, the male to female ratio being 2.97:1. The major diseases of the inpatients were urolithiasis (452 cases, 34.4%), and BPH (297 cases, 22.6%). Among the operations, TUR-P 34.1%, ESWL 33.0%, TUR-BT 6.9% were predominant.

Two double J ureteral stents indwellt for 3 months and 1 year and 5 months were disrupted. These residual stents were removed by ureterorenoscopy and nephroscopy without surgery. One PCN pigtail catheter indwellt for 1 year 7 months was also disrupted. This residual catheter was removed by nephroscopy.

Thirty-five patients (37 renal units) were treated by PNL. Nine had complete staghorn calculi, 2 multiple reno-ureteral stones, 12 solitary renal stone, and 14 upper ureteral stone. The success rate was 94.6%. No severe complications were seen.

Forty-two (44 renal units) were treated by combination of ESWL and percutaneous nephrostomy or PNL. Staghorn calculi were found in 33, renal stones in 6 and ureter stones in 5. Residual stone rate was 18.2% in staghorn calculi. No severe complications were seen.

ESWL has been used to treat distal ureteral stones in ten patients. All stones were broken up to sandy fragments. In six patients, all fragments were discharged completely within 3 days and in two patients within 20 days without any additional manipulation. The other two patients were lost to follow up regarding complete discharge.

Two cases of phenotypic males with 46XX karyotype are reported. The first case is a 41-yearold married man. He complained of sterility and had hypoplastic testes without other clinical symptoms of abnormal sexual development. The second case is a 35-year-old married man. He also complained of sterility. The external genitalia appeared normal in size, but small testes and gynecomastia were noted. In each cases, pituitary gonadotropin excretion was elevated. Serum testosterone level was low in one case. To certify the hypothesis that H-Y antigen is essential for testicular differentiation, we studied two our cases. H-Y antigen can be detected by the cytotoxicity test in vitro. Blood cells from two XX males (our cases) expressed H-Y antigen. The clinical features, etiology of XX male syndrome are discussed and the literature is reviewed.

We report our 3-year experience with extracorporeal shock wave lithotripsy (ESWL) since we first used it for upper urinary tract stones on September 1st, 1984. A total of 1, 225 patients (1, 320 cases) underwent 1, 647 sessions with ESWL; They consisted of 855 males (70%) and 370 females (30%). Treated stone locations were 593 renal stones, which contained 112 complete staghorn calculi, 504 ureteral stones, 110 renoureteral stones, and 1 bladder stone. ESWL monotherapy was performed on 90% of cases with renal and ureteral stones, and 46% of cases with complete staghorn calculi. In all the cases so far observed for more than 12 weeks after ESWL, 84.9% of the former showed complete discharge of the stones, and 0.7% showed no change. Only 48.9% of the later showed the complete discharge of the stones, 43.3% of which had residual stones, and 7.8% had fragments of the size of small beans. Complications, which were fever and pain, were noticed in 33.6% of the cases with renal and ureteral stones, and 64.3% of the cases with complete staghorn calculi. After ESWL, hematuria was noticed in almost cases, but the average volume of hemorrhage was 28 +/- 33 ml/day. The only contraindication of ESWL was severe obesity, and in the cases in which spontaneous stone discharge can be expected.

During the last 9 years, 1, 892 patients underwent surgery of the prostate. Benign prostatic hypertrophy (BPH) accounted for 1, 812 cases, and prostatic cancer 80 cases. In the case of BPH, transurethral resection was done in 1, 645 cases, cryosurgery in 136 cases, and suprapubic prostatectomy in 31 cases. Latent cancer was detected in 54 (3.3%) of the BPH cases. The average patient age of the patients with latent cancer (73.6 +/- 6.9 years) was higher than that of those without latent cancer (69.5 +/- 7.7 years). This suggested a significant relationship between the age of the patient and the occurrence of latent cancer.

The total number of new outpatients in 1987 was 8, 062 (male 5, 056, female: 3, 006) and the male to female ratio was 1.68:1. They had urogenital diseases definitely diagnosed (7, 197), urogenital diseases indefinitely diagnosed (536), no diseases (269), and diseases other than urogenital (60). Thirty percent of the outpatients were referred to us by other sources. The number of operations on new outpatients was 216, circumcision, resection of condyloma and vasectomy were representative. The peak of the age distribution was in the thirties for males and in the fifties for females. A statistical study was made on new outpatients according to the international classification of disease. There were 125 malignant (urogenital) tumors (1.6%). The major diseases of the new outpatients were cystitis (acute or chronic: 22.0%), upper urinary tract stone (15.9%), prostatitis (13.9%), and benign prostatic hypertrophy (11.9%). In males the major diseases were prostatitis, upper urinary tract stone, benign prostatic hypertrophy, balanoposthitis, phimosis and in females they were cystitis, upper urinary tract stone, pyelonephritis, renoptosis, and neurogenic bladder. We conclude that our hospital plays a major role as a private urological hospital.

Thirty-five patients (37 renal units) were treated by PNL. Nine had complete staghorn calculi, 2 multiple reno-ureteral stones, 12 solitary renal stone, and 14 upper ureteral stone. The success rate was 94.6%. No severe complications were seen.