(Background) Papillary renal cell carcinomas (PRCCs) are genotypically distinct from nonpapillary renal cell carcinomas.
(Methods) We studied the clinical, pathomorphological, immunohistochemical features in 34 PRCCs and 7 papillary renal adenomas. Immunohistochemical studies were performed using lectins and antibodies against cytokeratins, epithelial membrane antigen, and Tamm-Horsfall protein.
(Results) PRCCs were divided into two types based on the features of tumor cells and vascular stalks. Fifteen PRCCs displayed small cuboidal cells with basophilic cytoplasm and thin, short vascular stalks (type 1, micropapillary). Nineteen PRCCs displayed large columnar cells with eosinophilic cytoplasm and edematous or fibrous thick stalks (type 2, macropapillary). Infiltration of foam cells was more common in type 1. Co-existence of papillary renal adenomas was recognized in three cases among type 1, but in only case among type 2. In type 1, a male to female predominance was evident (13:2), and the majority of tumors in type 1 were in lower nuclear grade and lower stage. The 5-year survival rates of patients in type 1 and 2 were 87% and 46%, respectively. Immunohistochemically, 15 (100%) cases in type 1 were diffusely positive for cytokeratin 7 (CK7), 15 (100%) were positive for cytokeratin 19 (Progen 19) and 11 (73%) were positive for dolichos biflorus agglutinin (DBA). In type 2, only 4 (19%) cases focally stained for CK7, 10 (53%) were stained for Progen 19 and only 2 (10%) were positive for DBA. The staining pattern in papillary renal adenoma was similar to that of type 1, all cases were positive for CK7, four of five cases (80%) were positive for Progen 19 and five of seven cases (71%) were positive for DBA.
(Conclusion) The pathomorphologic and immunohistochemical features suggested that it is possible to divide PRCCs into 2 types and that PRCCs in type 1 confer an favorable prognosis. Furthermore, our results supported the possibility of adenoma-carcinoma sequence.

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(Purpose) To confirm the clinical efficacy of the combined therapy to complicated urinary tract infection (UTI), we conducted a comparative clinical study of the combined therapy with ciprofloxacin (CPFX) and clarithromycin (CAM) acting an biofilm elimination or CPFX alone in patients with complicated UTI.
(Patients and Methods) The study was carried out in patients with complicated UTI having WBCs with 5/hpf or more in urinary sediment and bacteriuria at least 10⁴CFU/ml. The combined therapy was CPFX and CAM, each 600mg/day, for 14 days, and the single therapy group CPFX, 600mg/day, for 14 days. On Day 7 and 14, the eradication rate and efficacy rate (according to the criteria of the Japanese UTI committee) were determined. In the patients with indwelling catheter, the surface of the catheter tip was observed under a scanning electron microscope (SEM) on Day 14.
(Results) In both cases with and without catheters, clinical efficacy was higher in the combined therapy group than in the single therapy group. In paricular, the efficacy rates at 14 Day were significantly higher in the former group. Furthermore, we investigated the theraupetic effect in the below MIC breakpoint of CPFX in complicated UTI. The combined therapy group showed a higher clinical efficacy in both cases with and without indwelling catheter than the single therapy group, although there was not statistically significant. Biofilm on the surface of the catheter tip was eliminated in 75% of the combined therapy group. However, none of the biofilm was eliminated in the single therapy group.
(Conclusion) From the above results, we surmise that the combined use of CPFX and CAM will show some degree of efficacy in eliminating both the causative organism and its biofilm in the complicated UTI.

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(Purpose) We determine the significance of c-erbB-2 and p53 gene in the progression of renal pelvic and ureteral carcinomas.
(Methods) Overexpression of c-erbB-2 and p53 oncoprotein was investigated using immunohistochemical staining with reference to pathological features. The expression of Ki-67 antigen was also studied as a proliferation marker.
(Results) Forty-seven cases were examined, and the overexpression of c-erbB-2 oncoprotein was revealed in 25 (53%) cases. It was not related both tumor grade (G) and tumor stage (pT).
The overexpression of p53 oncoprotein was revealed in 29 (62%) cases. There were 13 p53 positive cases in 27 low grade (G1, G2) tumors, and 16 in 20 high grade (G3) tumors. There were also 8 p53 positive cases in 21 low stage (pTa, pT1) tumors, and 21 in 26 high stage (pT2-4) tumors. Thus, p53 oncoprotein was more frequently overexpressed in high grade tumors (p<0.05) and in high stage tumors (p<0.01).
Ki-67 labelling index (LI, mean±SD) was 10.7±8.9 in low grade tumors and 26.3±12.5 in high grade tumors. It was also 9.0±8.1 in low stage tumors and 24.0±12.4 in high stage tumors. Thus, Ki-67 LI was higher in high grade tumors (p<0.01) and in high stage tumors (p<0.01). The c-erbB-2 status and Ki-67 LI were not correlated, while the LI of p53 positive cases (21.7±13.6) was significantly higher (p<0.01) than it of p53 negative cases (10.3±8.5). The difference of LI between p53 positive cases and p53 negative cases was significant (p<0.05) in lowgrade tumors, but in high grade tumors LI was higher than it of low grade tumors independentlyof p53 expression.
(Conclusion) p53 but not c-erbB-2 was considered to be associated with rapid tumor progression in renal pelvic and ureteral carcinoma and play an important role in its progression especially in low grade tumors.

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(Background) Prostate specific antigen (PSA) is the most available marker for early detection of prostate cancer. Nevertheless, the standard upper range of PSA (4.0ng/ml) does not demonstrate sufficient specificity. Thus, we evaluated the distribution of PSA by age and prostate volume in urological patients, and determined PSA reference ranges by the each parameter. Diagnostic efficacy was also evaluated.
(Methods) Three-hundred-seventy-five patients who visited the urological outpatient clinic between January, 1994 and February, 1996, and were considered not to have prostate cancer, were analyzed PSA levels by age. Among them, two-hundred-seventy-six patients in whom prostate volumes were presumed by means of transabdominal ultrasonography, were evaluated a correlation of PSA values with prostate volumes. Using the age-specific and volume-specific reference ranges determined by this analysis, sensitivity, specificity, and positive predictive value were compared with those in case using the 0.0 to 4.0ng/ml reference range and the 0.0 to 11.7ng/ml reference range, in 72 patients (cancer 24, noncancer 48) in whom histological examinations were performed in the same period.
(Results) We found statistically significant slight correlations among age, prostate volume, and PSA. By using the age-specific reference range, volume-specific reference range, and 0.0 to 11.7ng/ml reference range, we could elevate the specificity and positive predictive value approximately by 65% and 35%, respectively, compared with those of the 0.0 to 4.0ng/ml reference range.
(Conclusion) In order to decrease the number of rather invasive than necessary prostate biopsies, age-specific and volume-specific reference ranges are useful in urological outpatient clinic.

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(Background) Inverted papilloma (IP) of the urinary bladder is generally considered to be a benign lesion by histological examination. In recent years, however, there have been several cases of IP simultaneously accomparried with transitional cell carcinoma (TCC), elsewhere in the bladder or combinated as a single urothelial lesion. So we investigated proliferating character of IP by DNA ploidy analysis and immunohistostaining with proliferating cell nuclear antigen (PCNA).
(Methods) Six cases of IP of the urinary bladder were analyzed and 12 cases of TCC of G1 and G3 grade were included in this study as a control. As DNA ploidy analysis, all specimens were feulgen stained using CAS DNA staining kit and examined by image cytometry (CAS 200R system). For the PCNA immunohistochemistry, all specimens were stained with anti-PCNA monoclonal antibody (Novocastra Lab.: PC10) according to ABC (avidin-biotin-complex) standard method. We determined that the DNA Index of the case under 1.20 was diploid and the others was aneuploid. PCNA staining were determined by only one pathologisit as follows: negative (-) and positive (+), (2+) and (3+).
(Results) As DNA ploidy, 5 of 6 cases of TCC G3 group as a control were aneuploid. But in spite of all cases of TCC G1 group were diploid, among IP cases, only 1 out of 6 was aneuploid. As PCNA staining, 2 of 6 in TCC G1 group and 5 of 6 in G3 group were positive. And it was noted that of 6 IPs, 5 were negative, but only 1 case, which was recognized as aneuploid by DNA ploidy examination was positive.
(Conclusion) There have been no recurrence since transurethral resection in all IP in this study including the case recognaized as anueploid and positive for PCNA staining. But the present results suggest that among IPs, considered generally as a benign tumor, the case which has high proliferating character exists.

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(Objective) To study the outcome of the patients with renal cell carcinoma (RCC) coexisting with renal cystic disease.
(Subjects and Methods) The nation-wide survey conducted in 1989 enrolled 223 patients with RCC coexisting with renal cystic disease. Of those 223, we could follow up 216 patients in the second survey in 1994.
(Results) Renal cystic diseases coexisting with RCC included simple renal cysts in 69 cases, acquired cystic disease of the kidney (ACDK) in 61, cystic RCC in 54, multilocular renal cysts in 19, polycystic kidney in 3, miscellaneous cysts in 9, and unspecified cyst in 1. The overall 5-year survival was 84%. The mean survival of the patients without any symptoms was significantly higher than that of those with symptoms. The survival of those with ACDK was lowest, and that will cystic RCC was highest. The survival was significantly different between the two groups, however the disease specific survival excluding the effect of dialysis was not significantly different between the two groups. Regarding TNM category, those with pT1 or pT2, comprising 87% of the subjects, carried a prognosis more favorable than those with pT3 or pT4. Among those undergoing cyst puncture (47 patients), positive cytology resulted in poorer prognosis. However, there was no such difference in the prognosis between pnunctured group and non-punctured group.
(Conclusion) Those with RCC coexisting with renal cystic disease carried a favorable prognosis. Cyst puncture were not concluded to exert an unfavorable effect on the prognosis at least in this study.

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A 31-year-old woman with a history of spina bifida occulta became pregnant after ileocystoplasty for her neurogenic bladder. During the pregnancy she had frequent episodes of febrile urinary tract infections, and progressive hydronephrosis appeared in the second trimester. At 25 weeks gestation she was complicated by severe pyelonephritis requiring the intervention with the placement of double pigtail ureteral stent. However, long term efficacy of ureteral stent was questionable and this indwelling catheter caused bacteriuria which was not eradicated by intravenous antibiotics. Classical cesarean section was performed at 32 weeks of gestation due to the fear of fetal distress. Neobladder and mesenteric blood supply were adherent to the anterior surface of the uterus.
Urinary tract infection is extremely common during pregnancy after enterocystoplasty. The most important point is prophylactic antibiotics throughout the pregnancy. At the time of cesarean section, a reconstructive urological surgeon should be part of the operative team and take great care to avoid injury to the blood supply of cystoplasty.

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A 67-year-old man with hormone-refractory (stage D2) prostate cancer was admitted to the hospital because of general malaise and bone pain. The patient had been receiving hormonal therapy, which was discontinued after admission. Instead, 10mg per day of prednisolone was administered orally. His symptoms improved, and the serum prostate specific antigen (PSA) level decreased markedly. After 18 weeks of treatment with prednisolone, the serum PSA level rose again, and bone pain worsened. The patient died of cancer one month later.

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