It has been considered that the urethral obstruction influence the function and the nerve innervation of the bladder. In this study, the changes in the bladder function and the nerve growth factor (NGF) synthesized in the bladder were systematically analyzed both during partial urethral obstruction and after its relief in the rat.
The maximum contraction pressure was temporally decreased and then increased 1.5 times of the normal level 6 week after the obstruction. NGF in the bladder. measured by ELISA method, was rapidly increased 5 times of the normal level 1 day after the obstruction. It gradually decreased 2 weeks after the obstruction but did not recover to the normal level. The maximum contraction pressure and the bladder NGF recoverd to the normal level after the removal of 1 to 6 weeks obstruction.
These results suggest that partial urethral obstruction reversibly increases the contractility and the NGF synthesis of the bladder.

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(Background) Systematic biopsy has been commonly used for detection of prostate cancer. Nevertheless, as this examination occasionally gives patients severe complications it is necessary to give careful consideration for application of this examination. Thus, we analyzed retrospectively 145 cases who underwent transrectal ultrasonography (TRUS) guided systematic biopsy to evaluate the application of systematic biopsy, correlating with the findings of digital rectal examination (DRE), prostate specific antigen (PSA), the findings of transrectal ultrasonography (TRUS) and the results of biopsies.
(Methods) Between May, 1995 and May, 1997, 143 patients who were suspected to have prostate cancer with either of PSA and DRE, and 2 patients who received visual laser ablation of prostate (VLAP), underwent TRUS guided systematic biopsy of prostate. We evaluated diagnostic efficacy of PSA, DRE, TRUS, prostate-volume-specific PSA, and PSA density (PSAD).
(Results) Sensitivity, specificity and positive predictive value (P. P. V.) are 78.4%, 62.8% and 53.5% for DRE, 100.0%, 4.4% and 41.8% for PSA, 88.2%, 60.0% and 52.9% for TRUS, 87.8%, 72.1% and 64.2% for prostate-volume-specific PSA, 100.0%, 30.6% and 45.4% for PSAD, respectively. Ten of 69 patients (14.5%) whose PSA levels were 4.0 to 10.0ng/ml were diagnosed as cancer, and positive for both or either of DRE and TRUS. Twenty-seven who were negative for both of DRE and TRUS were not diagnosed as prostate cancer. Using the combination of prostate-volume-specific PSA, DRE and TRUS, we could eliminate 29 non-cancer men (21.5%) whose PSA level was greater than 4.0ng/ml from systematic biopsy.
(Conclusion) On the diagnosis of prostate cancer, the combination of prostate-volume-specific PSA, DRE and TRUS is very useful to exclude unnecessary systematic biopsy, if an urologist could be used to and trained for DRE and TRITS.

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(Background) The acute scrotum in children frequently presents a diagnostic dilemma. The objective of this study is to review the experience of patients with acute scrotum in children.
(Methods) From April 1986 until March 1998, we encountered 40 cases of acute scrotum in children less than 15 years old diagnosed by surgical exploration.
(Results) Final diagnoses consisted of 14 patients with torsion of the spermatic cord (35%), 22 patients with torsion of the testicular appendage (55%), 3 patients with acute epididymitis (7.5%), and patient with a strangulated hernia (2.5%). Of 22 patients with torsion of the testicular appendage, which were the most frequent cause of acute scrotum, 20 had torsion of the testicular appendix and 2 had torsion of the epididymal appendix. The age distribution of the patients with torsion of the spermatic cord was biphasic, with the highest frequencies occurring in patients 2 years old and 14 years old. In contrast, the age distribution of patients with torsion of appendage showed a single peak incidence at 9 years of age. Those with epididymitis were younger than 2 years old. Of 14 cases of torsion of the spermatic cord, orchiectomy was performed in 6 cases (42.9%) because of testicular necrosis.
(Conclusion) Although surgical exploration is no longer necessary for all patients with torsion of the appendage, this review revealed that patients complaining of severe or persistent pain usually require surgery to diagnose and treat the problem.

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(Purpose) To evaluate the treatment of grade 3 superficial (stage pTa and pT 1) transitional cell carcinoma (T. C. C.) of the urinary bladder, retrospective analysis was performed with special reference to tumor prognostic factors.
(Materials and Methods) From July 1971 to September 1995, 51 cases with grade 3 superficial T. C. C. of the urinary bladder were treated. The survival rates and prognotic factors of these patient were analyzed.
(Results) Five year survival rate of grade 3, superficial tumors was 92.3% and showed significantly better prognosis compared to patients with pT 2 and pT 3 tumors of grade 3 (p<0.001). As a initial treatments, transurethral resection (TUR) was conducted in 45 patients (88%). Intravesical recurrence was observed in 20 of 45 patients (44%) and 12 of 20 patients (60%) were recurred within 1 year. Non-recurrent rates of the patients treated with TUR were 69.6% at 1 year, 58.8% at 3 year, 49.7% at 5 year, respectively. No significant differences were noted regarding factors of tumor size, figures and a number of tumor. Of the 51 patients, 10 (19.6%) progressed beyond stage T 2 and 6 died with the disease. Survuval rates at 10 years follow up in patients with non-papillary and papillary tumor were 57.1% and 97.8%, respectively.
(Conclusion) These results suggested that TUR should be performed as a initial treatment for the patients with grade 3 superficial T. C. C. of the urinary bladder. However, non-papillary tumors should be considered of more intensive treatment like as radical cystectomy, adjuvant chemotherapy or irradiation.

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(Background) Estimation of urinary oxalate is one of important tools for the diagnosis and treatment of urolithiasis. And more precise, simple and inexpensive method is desirable. In the present study, we evaluated three methods which were clinically well-used.
(Methods) From October 1996 to June 1997, 146 acidified urine samples were collected for 24 hours from 144 urolithiasis patients. We determined the urinary oxalates by three methods; the colorimetric method, the enzymic method and the ion chromatography (IC method). And we evaluated the correlations of these methods.
(Results) Correlation coefficients in the urine oxalate concentration were, 0.86 with the colorimetric method and the IC method, 0.91 with the enzymic method and the IC method, 0.90 with the colorimetric method and the enzymic method. The coefficients in the 24 hours-urinary excretion of oxalate (0.76, 0.87, 082) were lower than those in the urine oxalate concentration. The correlation coefficients with the colorimetric method and the IC method were, 0.58 in hyperoxaluric group, 0.34 in normooxaluric group. The coefficients with the enzymic method and the IC method, 0.93 in hyperoxaluric group, 0.71 in normooxaluric group.
(Conclusion) The colorimetric method is least expensive, but is less useful. The enzymic method is less expensive, and is as useful as the IC method.

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(Background) The detrusor contraction involves an atropine resistant, nonadrenergic noncholinergic (NANC), component Since adenosine triphosphate (ATP) has been proposed as a NANC transmitter, the role of ATP-receptors in the lower urinary tract was examined.
(Materials and Methods) The isovolumetric bladder contractions and the urethral pressure were monitored after intra-arterial administration of ATP analogues and other drugs in 52 female S-D rats under intraperitoneal urethane anesthesia.
(Results) αβmetATP induced a rapid, phasic increase of the maximal bladder pressure immediately after the drug administration, which was followed by a decrease during the P 2 X-purinoceptor desensitization period, but it did not affect the resting bladder pressure. RB-2 did not affect both the maximal bladder pressure and the resting bladder pressure. As for the urethral functions, αβmetATP induced a decrease of the resting urethral pressure during the P 2 X-purinoceptors desensitization period, while RB-2 induced a increase of the resting urethral pressure in contrast. ATP, αβpmetATP and RB-2 did not changed the maximal urethral relaxation.
(Conclusion) The results will indicate that ATP produces detrusor contractions through the P 2 X-purinoceptor. Although ATP dose not affect urethral relaxation during voiding phase, it controls the urethral tone during collecting phase by both the excitation of P 2 X-purinoceptor and the inhibition of P 2 Y-purinoceptor.

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A 71-year-old man who had been treated conservatively for advanced prostate cancer with hormonal therapy presented with complaint of left flank pain. Intravenous urography demonstrated obstruction caused by a left upper ureteral calculus and leakage of contrast medium outside the renal pelvis and calyces. Left percutaneous nephrostomy was performed, and subsequent nephrostography showed extravasation into a parapelvic renal sinus cyst previously recognized on follow-up computed tomography (CT). The left ureteral calculus was treated with extracorporeal shock wave lithotripsy (ESWL), after which obstruction and extravasation disappeared. One month later, abdominal CT demonstrated no left renal nor ureteral calculi, as well as a reduction in the left renal sinus cyst.
Urinary extravasation sometimes occurs as a complication of acute urinary obstruction. However, extravasation into a cyst is very rare. We have found only one case reported in the literature, so far.

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A rare case of bilateral synchronous multilocular epididymal cysts is reported. A fifty-six year old man visited to our hospital with a chief complaint of swelling of bilateral intrascrotal contents. Ultrasonographic findings demonstrated multilocular lesions of the bilateral intrascrotal contents. Preoperative diagnosis was bilateral multilocular hydrocele testes. Operative procedure revealed bilateral cysts originating from the head, body and tail of the epididymis without the cysts of the tunica vaginalis. Operative sight was bilateral synchronous multilocular epididymal cysts, and bilateral epididymal cystectomy were performed. The specimen size was right diameter 12×6cm and left its 8×5.5cm. The puncture of the cystic fluid revealed many spermatozoa in both sides.
The acquired cysts of the epididymis generally are the result of tubular obstruction with dilation of tubules adjacent to the obstruction. The dilated tubules are filled variably with viable and degenerating spermatozoa. The cysts originate most commonly from the head of the epididymis, and are unilateral, unilocular or multilocular and are usually within 1cm in diameter. In our case, bilateral synchronous epididymal cysts originating from not only the head, but also the body and the tail is a rare case.

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