(Background) The objective of this study is to determine age-specific PSA reference ranges in Japanese healthy men and investigate the effectiveness of these ranges as the cut-off values in the mas screening for prostatic cancer.
(Methods) The study included a total of 5, 206 male aged from 55 to 89 years old who wished to submit the mass screening for prostatic cancer in an urban area of Kyoto in 1995-1997, but had no evident prostatic cancer. We measured serum PSA levels by the filter paper method (Delfia PSA kit).
(Results) We found the increase in serum PSA levels with the advancing age. With the 95th percentile for serum PSA as the upper limit, the age-specific PSA reference ranges were determined to be 2.1ng/ml for patients aged 55 to 59 years old, 3.2ng/ml for 60 to 69 years old, 4.4ng/ml for 70 to 79 years old, 6.5ng/ml for 80 to 89 years old. If we used these ranges as the cut-off values in the mass screening this time, five cases from 76 to 89 years old of prostatic cancer were overlooked.
(Conclusion) We found the increase in serum PSA levels with advancing age. But the positive proof of using this range to a mass screening for prostatic cancer was not certified, because time incidence of prostatic cancer in the examinees was uncertain and there is a possibility of overlooking some cases.

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(Background) Despite the strenuous efforts in improving detection of prostate cancer, no standard technggne for prostatic biopsy has been established to date. Extended tissue sampling in peripheral zone may possibly lead to enhanced prostate cancer detection.
(Methods) Four hundred thirty-three candidates for ultrasound-guided prostatic biopsy were alternately assigned to two groups regarding biopsy techniques between January 1997 and June 1998, Group A, sextant biopsy group and Group B, two additional lateral peripheral zone sampling after standard sextant biopsy. The outcomes of prostatic biopsy were compared.
(Results) Cancer detection rates were 19.2% (43/217) in Group A and 18.5% (40/216) in Group B. No statistically significant difference was noted (p>0.05). Clinical stage, Gleason score and the presence of metastasis did not differ significantly between groups (p>0.05). The incidence and duration of hematuria, hematospermia were essentially the same between groups (p>0.05). High fever due to possible bacteremia developed only in Group B patients (p=0.04).
(Conclusions) Routine use of additional peripheral zone biopsy is not recommended owing to the equivalent cancer detection rates between groups. The application of additional biopsy should be determined carefully since this may lead to increased incidence of serious complications.

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(Background) It is well known that the effectiveness of venous surgery declines during the follow-up period. The onset of recurrence after surgery varies greatly among patients. There are only a few studis which have evaluated the effectiveness of venous surgery with objective tests.
(Methods) We treated 123 cases of cavernous erectile dysfunction with venous surgery, and evaluated the results objectivery. We performed intracavernous injection tests using 20 micrograms of prostaglandin E1 every 3 months until the recurrence of cavernous erectile dysfunction.
(Results) Mean follow up period was 32 months (0.2-134.0 months). According to the Kaplan-Meier analysis, the effectiveness of surgery at 1 year, 3 years, 5 years, and 10 years was 85%, 61%, 30%, and 26%, respectivery.
(Conclusion) There was no statistically significant difference between the outcomes following deep dorsal vein surgery and crural ligation surgery. Operative complications were more frequent, however in deep dorsal vein surgery.

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(Background) We evaluated the validity of the Sapporo Medical University-sexual function questionnaire, comparing the response to each question of patients having sexual dysfunction with those of normal volunteers as controls.
(Patients and Methods) Responses from 335 patients with sexual dysfunction and 490 normal volunteers aged from 20 to 39 years old were evaluated. We compared mean scores of each question for patients having sexual dysfunction with those for controls. Discriminant analysis was used for evaluating which questions contributed more strongly to discriminating patients having the disease from controls. The analysis was also used for validating the questionnaire.
(Results) Mean scores for patients with sexual dysfunction were significantly lower than those for controls in all questions. Nine of the 11 questions were statistically useful to discriminate these two groups with discriminant analysis. The analysis also revealed that questions about frequency of erection, rigidity of the erectile penis and duration of erection highly contributed to discriminate these two groups. The discriminant analysis achieved high sensitivity and specificity for classifying the groups.
(Conclusion) These results suggest that the use of the Sapporo Medical University-sexual function questionnaire is valid for discriminating patients with sexual dysfunction from subjects with normal sexual function.

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A 45-year-old man with spinal injury and diabetes mellitus who complained high fever and progressive enlargement of left intrascrotal mass visited to our hospital. Preoperative ultrasonography demonstrated epididymitis and abscess formation. Left high orchiectomy was performed because testicular tumor could not be denied. Epididymis was replaces by bright yellow mass associated with abscess and adhered to testis strongly. Histopathologically, the mass diagnosed xanthogranulomatous epididymitis consisted of foamy macrophages and chronic inflammatory cells. This is the first case in Japanese medical literature.

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A 23-year-old man visited hospital with the complaints of hematuria and miction pain. Computed tomography and magnetic resonance imaging of the pelvis showed a large pelvic tumor contiguous to the urinary bladder. Resection of the tumor with partial cystectomy was performed on February, 1998. Histopathological examination showed that the tumor composed of angiomyxoma infiltrating into the urinary bladder. The patient is alive without recurrence of aggressive angiomyxoma 12 months after surgery. To our knowledge, this is the first report in the Japanese literature of aggressive angiomyxoma involving the urinary bladder. Awareness of this uncommon neoplasma is important in the diagnosis of pelvic tumor to prevent an extencsive surgery.

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