Determination was made of serum PSA in the early detection of prostate cancer in a population of 1, 227 men aged 55 years or older who visited a “human dock”. “Human dock” is a unique health examination facility open to public in Japan. Recommendation for biopsy was made based solely on this parameter when its value exceeded 2.0ng/ml in IMx immunoenzymetric assay (Dinabot Co.). Of these, 162 (13.2%) had elevated values. The proportion of males with serum PSA greater than 4.0ng/ml was only 3.6%. Of the 109 males who underwent ultrasound guided biopsies, 17 cancers were detected, the cancer detection rate thus being 1.4%. Most of these cases (82.4%) were clinically localized cancers. Eight patients with cancer had serum PSA levels below 4.0ng/ml including 6 less than 3.0ng/ml. Radical prostatectomy was conducted on 14 patients. All had histologic features of clinically significant cancer and 64.3% were pathologically confined. Oriental elderly males appear to have lower serum PSA than western counterparts. The optimal cutoff of serum PSA for early detection should be examined further in oriental male populations. Differences in the incidence of prostate cancer between ethnic groups may have been overestimated in previous studies owing in part to unawareness by the physician and general public. Though the application of PSA for early detection will likely disclose greater numbers of prostate cancers in Japan, whether early detection reduces mortality by minimizing risk of death from cancer remains a point to be clarified.
(Background) Recently, autologous blood transfusion has been widely endorsed, because of the adverse effects attributed to homologous blood transfusion. We found that the administration of recombinant human erythropoietin (rH-EPO) permitted the preoperative collection of an adequate volume of autologous blood in a short period of time. This reduced or eliminated the need for homologous blood transfusion. (Methods) To determine optimal dosage of rH-EPO, I conducted a randomized, controlled trial in 86 patients with benign prostatic hypertrophy (BPH) scheduled for transurethral resection of the prostate (TUR-P). The patients from whom approximately 10% of their total blood volume was removed, received six different doses of rH-EPO either intravenously or subctaneously. All patients received iron sulfate 100mg orally once a day during the study. (Results) I found that 9, 000 IU of rH-EPO given intravenously daily or 10, 500 IU of rH-EPO injected subcutaneously every third day for a week were optimal dosages. These schedules ennabled us to withdraw approximately 400ml of blood prior to operation without adverse effects. (Conclusion) I conclude that the efficacy of rH-EPO is greater when administered subcutaneously rather than intravenously. It is clear that rH-EPO increases the ability of patients about to undergo selective surgery to donate greater amounts of blood for future autologous transfusion.
(Background) Although the international prostate symptom score (IPSS) is now often used to assess the symptoms of BPH, whether or not patients answer the questions correctly has not been validated objectively. (Methods) Reliability of IPSS was evaluated by 24-hour uroflowmetry in 20 hospitalized male patients. Six of them had prostatic hypertrophy or cancer, and the evaluation was performed before and after TURP or hormonal therapy in these six patients. The objective scores for frequency and nocturia were obtained from the time recorded on IC card. The objective score for intermittency was calculated from the uroflow curves. (Results) The answer about frequency was not correct compared with the objective scores for frequency. The answers about nocturia and intermittency were almost the same as the corresponding objective scores. The answer for weak stream correlated with the average of peak flow rate. However, the threshold of peak flow rate for “weak stream” fluctuated markedly before and after the treatment in the same individuals. The answer for hesitancy had no correlation with the hesitation time. Patients seemed to understand the question translated in Japanese as “have you need force to urinate?”. (Conclusion) Before wider use of IPSS in Japan, the correct translation of the questions and verification of the usefullness of the questions in large number of Japanese patients seem necessary.
(Background) Endopyeloureterotomy has been established as a valuable procedure for ureteropelvic junction or upper ureteral stenosis. In order to evaluate ureteropelvic function after endopyeloureterotomy, I examined electromyographic change in ureteral peristalsis, measured urine bolue volume, and monitored ureteral compliance in dogs following ureterotomy. (Methods) Tweleve adult mongrel dogs were anesthetized with pentobarbital, and the upper part of the left ureters was incised longitudinally for a distance of 2cm. After the incision of the left ureter, a polyurethane splint was inserted through the kidney to the lower part of the ureter and left for four weeks. At 5 (n=4), 12 (n=4), and 24 (n=4) weeks after the operation, electromyography in ureteral peristalsis, urine bolue volume, and ureteral compliance at the incised part of the ureter were investigated. During the measurement of peristaltic frequency and urine bolus volume, saline was infused to the renal pelvis at a constant rate through a nephrostomy. I also investigated these factors in 4 dogs without ureterotomy and defined this group as control. (Results) When the infusion rate increased, ureteral peristaltic frequency and/or urine bolus volume gradually increased in the groups of 12, 24 weeks and control group after the operation; in the group of 5 weeks, ureteral peristaltic frequency and bolus volume had not increased significantly. Peristaltic velocity at the incised area decreased significantly at 5 weeks and 12 weeks following the operation compared to the velocity in the control group, but recovered at 24 weeks. Ureteral compliance decreased significantly at 5 weeks compared to that in the incised area of control dog ureter, but increased gradually and recovered at 12 weeks. In the incised ureter the defect was healed with granulation tissue within 5 weeks, and covered by smooth muscle within 12 weeks. (Conclusion) These results indicate that ureterotomy had harmful effects on ureteral peristalsis 5 weeks following surgery, but that ureteral function generally returned at 12 weeks, and recovered completely at 24 weeks. It was supposed that endopyeloureterotomy would improve ureteral function in patients with ureteropelvic junction and upper ureteral stenosis.
(Background) Histological grading, especially the Gleason Score (GS), is considered to be of value in determining the prognosis of patients with prostate cancer. However, subjective histological grading is characterized by low reproducibility. On the other hand, estimate of Mean Nuclear Volume (MNV), which was developed by Gunderson and Jensen based on a sterological technique, is a very easy method with high reproducibility. Furthermore, it had been reported that MNV provides accurate prognosis of bladder cancer. In this study we compared MNV with two histological grading methods in determining the survival of prostate cancer. (Method) A retrospective, prognostic study of 49 patients with prostate cancer diagnosed by Transurethral Resection of the Prostate (TUR-P) or Needle punch biopsy between Jan. 1983 and Jul. 1994 was performed. Unbiased estimates of MNV were cmpared with age at the time of diagnosis, clinical stage, histological grading according to, the general rules for clinical and pathological studies on prostatic cancer of the Japanese Urological Association (J. U. A.) and GS on the prognostic value. (Results) Although age at the time of diagnosis, J. U. A. classification and GS had no value as prognostic criteria, clinical stage (p=0.0018) and MNV (p=0.0087) correlated significantly with survival of prostate cancer. (Conclusion) Results of this study indicate that estimates of MNV and clinical stage are prognostically superior to age at the time of diagnosis and morphologic grading of malignancy, such as J. U. A. classification and GS, in prostate cancer.
(Background) Experimental autoimmune orchitis (EAO) has been studied as an animal model for human male immunological infertility. Most EAO models have been induced by immunization with testis antigens in artificial adjuvants. In this paper, we report a more clinical EAO model. (Methods) Ten to 20 needle punctures were made to the unilateral testis of mice and it was crushed by a needle-holder. (Results) Contralateral EAO (so-called “sympathetic orchitis”) was gradually induced starting on Day 28. Delayed type hypersensitivity (DTH), one of the cell-mediated immunities, to autologous testicular cells (TC) as well as anti-TC antibodies, humoral immunity, were both detected in those mice. Repeated crush(es) of the ipsilateral testis two weeks later (and four weeks later) as a booster did not enhance the contralateral lesion or autoimmune responses. (Conclusion) Our present injury model mimics clinical testicular trauma; therefore, this testicular injury model can be very useful in studying the immunological mechanism of EAO and of human immunological male infertility.
(Background) We studied the clinical efficacy of sclerotherapy with injection of 3% polidocanol for hydrocele testis. (Methods) From July, 1992 to March, 1995 sclerotherapy with single injection of polidocanol was performed for 11 patients with 12 hydrocele testis on an outpatient basis. We instilled 3 or 5ml of 3% polidocanol after complete removal of fluid in the hydrocele testis. (Results) Complete disappearance on ultrasonography was observed in 75% of the hydrocele testis 6 months after this sclerotherapy. There was neither pain during instillation of 3% polidocanol nor any other complication. Two patients with fluid reaccumulation undertwent hydrocelectomy 16 and 6 months after sclerotherapy, respectively. (Conclution) This procedure seems to be a safe and useful technique as primary treatment for hydrocele testis.
(Background) The internal urethral ostium is usually closed both on the ejaculation and on the urine collection, although the difference of the closing characteristics have not been known. (Methods) The difference in closing style of bladder neck (internal urethral ostium) between on the phenylephrine administration corresponding state to the ejaculation and on the filling of urinary bladder corresponding state to the urinary continence was evaluated by Stereo-UPP method using mongrel dogs. (Results) On phenylephrine administration, the length between verumontanum and bladder neck was lengthened, and a remarkable pressure increase was observed in the area. On the urinary continence filling physiological saline in the bladder, the length of the urethra on the UPP curve of the anterior wall of urethra was lengthened (10%) and the base of bladder was gradually become flat. The pressure in the bladder neck was not relatively increased. (Conclusions) The internal urethral ostium was closed both on the phenylephrine administration and on the urine collection, although the closing characteristics of each was very different. It was demonstrated that on the phenylephrine administration the area between the verumontanum and the bladder neck was lengthened, together with the rise of pressure in the area, whereas on the urine collection bladder neck was closed in low pressure by flattening the base of bladder.
(Background) The aim of this study is to evaluate the therapeutic efficacy of artificial urinary sphincter AMS 800 implants for male patients with urinary incontinence. (Methods) Eleven male patients with urinary incontinence were treated by implantation of the artificial urinary sphincter AMS 800 between 1988 and 1992. Patient age at the surgery ranged from 14 to 79 years, with a mean age of 58 years. At presentation, 9 patients (82%) had true incontinence and 2 had overflow incontinence, and medical treatments and/or surgical procedures (Teflon injections in 2 and Sling procedure in 1) had been attempted previously elsewhere in all patients. The etiologies of incontinence were post-prostatectomy (transurethral resection in 4 and radical retropubic prostatectomy in 4) in 8 patients (73%) and myelomeningocele, spinal cord injury, pelvic trauma in one each. There were 5 patients with abnormal cystometrogram, and 2 of them were performing intermittent self catheterization. Vesicoureteral reflux was determined in 2 patients preoperatively, which were surgically corrected one year before AMS 800 implant in a patient and simultaneously in another patient. The cuff was placed around the bulbous urethra (9), pendulous urethra (1) or bladder neck (1). The device was activated 6 weeks post implantation, and the assessment of therapeutic effects was started 2 weeks after activation. (Results) Follow up ranged from 3 weeks to 75 months, with a mean of 56 months, if 3 cases done explantation due to periprosthetic infections were excluded. After AMS 800 implantation 5 patients (45%) were completely continent, 4 (36%) required the use of not more than 1 pad per day, while a patient was not satisfied with the results and another patient was not definitive because of early explantation before device activation. Hence complete or near complete continence was achieved in 9 patients (81%). A patient is performing intermittent self catheterization in conjunction with the AMS 800 without any complications up until now. There were 3 periprosthetic infections (27%) associated with 2 cuff erosions, that consequently required explantation. Besides periprosthetic infection, neither complications nor mechanical device failures was experienced. (Conclusion) In conclusion, the AMS 800 artificial urinary sphincter was safe with reasonable mechanical reliability and offered acceptable and satisfactory urinary control to the selected patients with incontinence.
(Object) In differential diagnosis of BPH and early stages prostate cancer (PC), PSA-density (PSAD) was evaluated in 63 cases with BPH and 82 cases of PC (stage A: 8, B: 17, C: 17, D: 40). (Methods) Serum PSA values were determined by MARKIT-F PA, and prostate volume was calculated by transabdominal ultrasonography, in which every glands including peripheral zone was visualized in the transverse and sagittal planes, and predicted prostate volume was calculated by three dimension (a×b×c×0.52). PSAD was determined by serum PSA divided by prostate volume. (Results) PSAD values were 0.106±0.006 (mean±SD) in BPH, 0.538±0.094 in stage A and B of PC, and 2.973±0.764 in all PC cases. There was a statistical significance (p<0.005) between BPH and each other groups of PC by student's t-test. In using 0.208 (mean±2SD of PSAD in BPH group) as a cut-off value, the detection sensitivity was 84% in stage A and B of PC and the specificity was 97% using BPH groups as a control, therefore the efficacy was 93%. In 18 out of 19 cases with BPH having PSA values more than 3.6ng/ml (false positive group), PSAD values were less than 0.208. (Conclusion) PSAD is suggested to be a useful tool for differential diagnosis of BPH and early stages of PC.
A thirty-year-old clerk presented with a history of left supraclavicular lymph node swelling of a month duration and newly detected multiple lung and mediastinal tumors. Abdominal computed tomography showed two retroperitoneal masses, but no abnormality in both testes was found by physical and ultrasonographic examination. Biopsy of supraclavicular lymph nodes revealed pure choriocarcinoma. Furthermore, β-subunit of human chorionic gonadotropin was elevated up to 700ng/ml but alfafetoprotein was normal, resulting in the diagnosis of primary retroperitoneal pure choriocarcinoma. Two cycles of combination chemotherapy with etoposide (VP-16), ifosfamide and cisplatin (VIP) was given and followed by bleomycin, etoposide and cisplatin (BEP) (2 cycles) because of cystitis symptom due to ifosfamide. Since post chemotherapeutic evaluation revealed only partial response, we surgically removed all residual masses in the lung, mediastinum and retroperitoneum, which histologically proved to be necrotic fibrous tissue. He has remained disease-free 15 months after surgery without additional therapy. In order to improve prognosis of primary retroperitoneal pure choriocarcinoma, intense chemotherapeutic regimen like VIP should be given, regularly repeated and followed by aggressive surgical resection of residual masses.
A 63-year-old man was admitted with right flank pain, nausea and chill. CT scan revealed right hydronephrosis and rupture of ureter, but tumor or stone was not detected in the CT scan. However retrogradepylelography revealed right lower ureteral tumor, and this patient was treated by right nephroureterectomy and partial cystectomy. Histopathological examination of ureteral tumor showed transitional cell carcinoma. Spontaneous rupture of ureter due to ureteral cancer is a rare case, which has not been reported in the Japanese literature. Clinical study was performed about cases of spontaneous rupture of ureter which have been previously reported.