(Background) The pathophysiology of prostatodynia still remains unknown. Recently, it was reported using three dimentional magnetic resonance venography (3D-MRV) that intrapelvic venous congestion (IVC) was found predominantly in patients with prostatodynia, and was designated this condition as IVC syndrome (IVCS). The present study was designed to reveal the prevalence of IVCS in taki drivers and office workers. (Methods) A total of 605 men (584 drivers and 21 office workers) in a taxi company in Kyoto city was enrolled in this study. They completed the IVCS symptom score, which was developed originally, including 5 questions (pain or discomfort at 1: the urethra during voiding, 2 lower abdomen, 3: perineal region, 4: inguinal region, 5: during ejaculation). The score of each question was graded from 0 to 5 points, and a total symptom score was obtained by adding these 5 scores to give a range of 0 to 25 points. 3D-MRV was performed to evaluate IVC. The diagnosis of IVC was determined based on the findings of the dilation of the prostatic capsular vein and/or the venous plexus of the lateral ligament of the bladder. (Results) Out of 603 men, 494 (81.9%), 40 (6.6%), 30 (5.0%) and 39 (6.5%) had a total symptom score of 0, 1, 2 and 3 or more. 3D-MRV was performed in 16 symptomatic men (scores of 3 or more), demonstrating IVC in 7 of them (43.8%). These 7 men were considered to have IVCS. In contrast, IVC was recognized in only one (6.3%) of 16 asymptomatic men (score of 0), were selected at random from 494 men scored 0 (p<0.05). (Conclusion) IVCS symptom score could be used as a screening tool for the detection of IVCS.
(Purpose) The efficacy of the reduction time (τ) after castration as a prognostic factor was examined by comparing to Gleason score. (Materials and Methods) The change of prostatic volume after castration was observed from the castration to 3 months after in 24 cases of prostatic cancer. Prostatic volume was examined by transrectal ultrasonography of the prostate. Survival curves was calculated by Kaplan-Meier method. Differences among survival curves were analyzed using Cox-Mantel test. (Results) τ had a close relationship to the prognosis of each case (Wilcoxon test: p<0.05, Cox-Mantel test: p<0.05). Gleason score had a weak relationship to prognosis (Wilcoxon test: N. S., Cox-Mantel test: p<0.05). (Conclusions) τ was efficient as prognostic factor compared to Gleason score.
(Background) We tried to establish new classification of histological grade and indication of elective nephron-sparing surgery (ENSS) in renal cell carcinoma (RCC), and studied histological changes according to tumor size. (Methods) We made whole area histological sections on 142 cases with RCC and investigated histological aspects and prognosis. (Results) (1) To classify the grade of the cases, the worst grade which occupied more than 10% of the tumor provided most appropriate prognosis. (2) In 144 cases (kidneys), satellite tumor lesions (STL) were observed in 69 cases (47.9%), and the cases with vein invasion were observed in 75 cases (51.4%). Incidence of these two factors increased with tumor size. (3) From the point of view of location of STL and vein invasion, ENSS was possible with taking more than 2cm surgical margin in the cases with less than 4cm in size and slow growing type. But indication of ENSS should not be decided with ease. (4) Incidence of the cases with multiple structural and cell types and grades increased with tumor size. (5) Incidence of the cases with solid structure, spindle or pleomorphic cell type and high grade increased with tumor size. (6) It was supposed that tumor heterogeneity and progression could be associated with tumor growth in each cases. (Conclusion) These results suggest the necessity of treatment of the cases with RCC as small as possible. If the tumor is less than 4cm, prognosis tends to be good, and ENSS might be possible in some cases.
(Background) The ideal urological management for the patients with cervical spinal cord injury (CSCI) is to obtain catheter free urination and to prevent urinary tract complications. We have evaluated cases that had undergone transurethral anterior sphincterotomy from the viewpoint of the operative indications and the efficacy. (Methods) We carried out sphincterotomy 166 times on 133 male patients with CSCI in our Center. Before the operations were performed, all patients suffered from urinary incontinence, and they were unable to catheterize themselves for low level activity of daily life. Before and after the operation, their detrusor functions with sphincter reactions were assessed by urodynamic study. In principle we have followed up these cases by cystogram combined with cystometry, cystogram and excretory-pyelography or abdominal ultrasonography. (Results) In post-operative evaluations, more than 80% of cases attained hypotonic detrusor contractions and residual urine was significantly decreased. In long term follow-up, 96% of patients had obtained catheter free urination and about 85% of patients had no urinary tract complications, such as bladder deformity, vesicoureteral reflux, or hydronephrosis, with the exception of common unavoidable urinary infections. About 20% of cases had to be re-operated upon, and some cases showed hypertonic detrusor contractions or detrusor-sphincterdyssynnergia during follow-up. (Conclusion) The operative indications of sphincterotomy should be decided when the CSCI patients is unable to perform self-catheterization, and when due to the dysfunction of the urethral sphincter, these patients suffered from voiding difficulties or autonomic dysreflexia, or when the urinary tract complications might occur. In the majority of cases the aims of the sphincterotomy were achieved but some cases underwent another operation or had recurrent dysfunction of the urethral sphincter, indicating the need for careful follow-up.
(Purpose) The efficacy and the optimum interval of mass screening for prostatic cancer were investigated by a case-control study. (Materials and Methods) A matched pairs analysis by 1:5 was conducted between 31 cases of advanced prostatic cancer in stage C and D detected by mass screening and 155 controls of normal subjects selected at random. In all cases and controls, the history of taking part of the mass screening for last 3 years, then the estimates of odds ratios (OR) and 95% confidence intervals (95% CI) were calculated on discordant pairs of the matched analysis. (Results) OR to suffer from advanced prostatic cancer was 0.22 (95% CI: 0.07-0.70) in the group to submit to mass screening 1 year ago in comparison with the group not to submit once for 3 years. According to the analysis on the interval of submission to mass screening, the effect of screening to prevent the progression to advanced stages might be valied for 1 year. (Conclusion) Mass screening for prostatic cancer every year might be efficient to reduce the number of patients progressing to advanced stages.
(Purpose) Preliminary experience of radical retropubic prostatectomy using an endoscopic stapler is reported. (Methods) An endoscopic stapler was applied for ligation and division of the lateral prostatic ligaments and the deep dorsal vein complex during radical retropubic prostatectomy in 8 patients. (Results) Procedures with stapler were easily performed and almost always effective for hemostasis. Mean total blood loss was 663ml, mean 575ml of autologous blood was given. None of patients was transfused allogeneic blood. (Conclusion) These results indicate that an endoscopic stapler may facilitate radical retropubic prostatectomy.
A 67-year-old man visited our hospital with the chief complaint of painless swelling of the left scrotal content. An elastic hard mass was palpable in the left scrotum. Resection of the tumor, including the left scrotal skin, was performed. The tumor originated from the scrotal wall and did not communicate with the testis, the epididymis or spermatic cord. Histologically, the tumor was diagnosed as a malignant mesenchymoma composed of liposarcoma, chondrosacoma and osteosarcoma. Malignant mesenchymoma is very rare, especially in the scrotum. Our case that originated from the scrotal wall is the first one reported in Jpaan.
We present a case of juxtaglomerular cell tumor measuring 8mm in diameter in the right kidney, The hypertension was cured and plasma renin activity returned to normal level following tumor resection with partial nephrectomy. We studied histopathologic, electron microscopic, and immunohistochemical findings of the tumor. The majority of tumor cells stores renin granules in cytoplasm. In situ hibridization comfirmed us that the most tumor cells produce renin. We use the digoxigenin labeled 0.6-kb length RNA probe of human renal renin. the specificity was analyzed by competition assay (1:50).
We report a case of papillary cystadenoma of the right epididymis in a 48-year-old man. He consulted our hospital complaining of a small, painless mass at the upper pole of the right testis. There did not seem to be any remarkable problem of the mass. At 52 years old, the mass caused him pain, we diagnosed this case as chronic epididymitis, and performed right epididymectomy. On cut section, the tumor was multicystic and well encapsulated. The fluid within the cystic spaces was hemorrhagic. Microscopically, multimicrocysts were covered by tumor cells, which did not show any atypism or mitotic features. A papillary growth pattern was formed by vacuolated tumor cells around the capillaries in the microcysts, and a diagnosis of papillary cystadenoma of the epididymis was made. Papillary cystadenoma of the epididymis is considered a comparatively uncommon disease. To our knowledge, about 50 cases have been reported in the world literature, and this is the 17th case in Japan. Histologically, this tumor is similar in appearance to well-differentiated renal cell carcinloma, so it should be differentiated from metastatic renal cell carcinoma and multicystic papillary adenocarcinoma of the rete testis. The patient remains well with no evidence of recurrence or complication 8 months after excision. There is no evidence of renal cell carcinoma, nor features of von Hippel-Lindau's disease in this patient or his family.