(Background) Pontine micuturition center and storage center are controlled by upper brain. Pharmacological and molecular biological data indicate the distribution of muscarinic receptor subtypes in rat brain, however, the effect of central muscarinic cholinergic mechanisms on the bladder activity has not been evaluated. We investigated the diversity of effect of each subtype in rat brain.
(Methods) The muscarinic agents such as muscarine (non-specific agonist), atropine (nonspecific antagonist), pirenzepine (M1 receptor antagonist), AF-DX116 (M2 receptor antagonist) and 4-DAMP (M3 receptor antagonist) were administrated with intracerebroventricular injection (I. C. V. group) or intravenous injection (I. V. group). The drug effects on rhythmic bladder contraction were investigated.
(Results) In I. C. V, group, the bladder contraction pressure were reduced by atropine, pirenzepine and 4-DAMP. The contraction time were shortened by pirenzepine and 4-DAMP but extended by AF-DX116. The contraction frequency was decreased by AF-DX116. Whereas AF-DX116 in I. V. group reduced the contraction pressure but did not cause any changes of the contraction time and the frequency. Other agents in I. V. group had same tendency with those of I. C. V. group except for intensity.
(Conclusion) That is to say AF-DX116 in I. C. V, group facilitate both micuturition center and storage center. In other words, these data indicate M2 receptor in rat brain inhibits both micurition and storage center. In addition, the effect of AF-DX116 in brain suggests that the development of new drug which proceed to central neuron system might provide a new treatment of neurogenic bladder.

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(Objective) We have the impression that the degree of obstruction was stronger in the patients with a middle lobe of hyperplastic nodule than in those without such a lobe in patients with benign proststic hyperplasia. In the present study, we compared the data from a pressure-flow study (PFS) and a presence of a middle lobe.
(Materials and Methods) A transurethral resection for benign prostatic hyperplasia was performed in 2, 439 patients, 798 underwent PFS. The PFS findings and the presence of a middle lobe were compared with the following parameters, namely, the bladder detrusor function, the degree of obstruction, the post-voided residual volume, the maximum flow rate, the prostate volume and the resected volume.
(Results) In the pressure-flow study, the rate of the normal bladder detrusor function was higher in the patients with a middle lobe than in those without such a lobe (71.9 versus 53.3%). The degree of obstruction was also stronger in the patients with a middle lobe than in those without in the patients with a normal bladder detrusor function (89.0 versus 79.4%). Then in the patients with a middle lobe, the quantity of the post-voided residual volume was greater, however, the maximum flow rate was lower.
(Conclusion) Most patients with a middle lobe demonstrate an improved voiding ability after underwent a transurethral resection.

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(Purpose) To assess the effect of high concentration of sodium and potassium ion on the motilities of human sperm following the preservation in electrolyte-free solution.
(Patient) Semen samples were obtained from patients attending our infertility clinic. The motilities of their sperm were more than 40%.
(Method) Ejaculated sperm were washed by using the electrolyte-free Percoll gradient and then preserved in electrolyte-free solution at 4 degrees C for a week. The preserved sperm was incubated and analyzed after the addition of electrolyte solutions under acid or alkaline condition. The sperm were continuously preserved for a day at room temperature and analyzed.
(Result) The sperm was by the addition of 35-135mM Na⁺ or 5-135mM K⁺ in acid solutions. Under the alkaline conditions, sperm were reactivated without Na⁺ or K⁺. However, the addition of 135mM Na⁺ or K⁺ significantly decreased in sperm motilities. The some sperm in the solution containing low concentration of Na⁺ or K⁺ ions maintained their motilities for a day at room temperature. However, all sperm lost their motilities in the 135mM Na⁺ or K⁺ solutions.
(Conclusion) The high concentration of Na⁺ or K⁺ ions had detrimental effects on motilities of sperm following the preservation in electrolyte-free solution.

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(Purpose) In this study, we examined risk factors for duration of incontinence after radical prostatectomy at our hospital.
(Materials and Methods) From April 1988 to March 2000, 45 patients with prostate cancer underwent retropubic radical prostatectomy at our hospital. Thirty-eight of 45 patients could be followed up. The patients' age, height, weight, body mass index (BMI), preoperative prostatic specific antigen level, clinical stage, nerve-sparing surgery or none, operation time, bleeding volume, resected prostate weight, cancer positive or negative at surgical margins, postoperative stage, radiation therapy or none, anti-androgen therapy or none, duration of postoperative incontinence, and follow-up period were examined.
(Results) All patients had postoperative stress incontinence, and no one had urge incontinence. Medians of duration of postoperative incontinence and follow-up period were 5.5 and 12 months, respectively. When the patients were divided into 2 groups by the value of each parameter, postoperative anti-androgen therapy (χ² test, p=0.0429) and high BMI (≥25.0kg/m², p=0.0206) were related to the long duration (≥5.5 months) of postoperative incontinence.
(Conclusion) These results suggest that common factors are involved in the etiology of prolonged incontinence after radical prostatectomy and genuine stress incontinence in women. Therefore, both body weight control and pelvic floor muscle exercise might be also important for the treatment of incontinence after radical prostatectomy.

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(Purpose) We reviewed the clinical data of male urethritis diagnosed as sexually transmitted disease with the aim of revealing its clinical features.
(Patients and Methods) In a total number of 414 males diagnosed as having acute urethritis transmitted by sexual activities between January and December in 2000, clinical data were collected and analyzed. In addition, questionnaire concerning the awareness of pharyngeal infection was obtained.
(Results) Their ages ranged from 16 to 60 years with a mean of 31 years. The source of infection was a commercial sexual worker (CSW) in 288 (69.6%) out of 414 cases. In 241 cases in whom an infection route was determined, 199 cases (82.6%) were considered to have an infection through oral sex. Microbiological examinations isolated Neisseria gonorrhea alone in 206 (49.8%), Chlamydia tracomatis alone in 47 (11.3%) and both in 46 (11.1%) cases. In our study, 57.5% and 20.8% of Neisseria gonorrhea strains were resistant to penicillin and new quinolones, respectively. Based on questionnaire, 174 (57.8%) out of 301 cases were not aware of possible infection from the pharynx through oral sex.
(Conclusion) The remarkable prevalence of gonococcal urethritis might be in part due to the lacking of awareness of infection through oral sex and sexual activities without a condom. Instruction on the prevention as well as the actual situation of urethritis is needed for general population with a broad age spectrum. The appropriate use of antimicrobial agents with sufficient susceptibility and less inductivity of drug-resistance is also of clinical importance.

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(Purpose) In this study, we studied the immune response against to human renal cell carcinoma and its antigenisity.
(Methods) Mixed lymphocyte tumor culture test was performed using tumor cells as stimulator cells, peripheral blood lymphocytes from tumor patient (autologous) or healthy volunteer (allogeneic) as responder cells, and tumor cells or peripheral blood lymphocytes from tumor patient as target cells. The cytotoxic activity of mixed lymphocyte tumor culture test was assayed by ⁵¹Cr-relase test, and cell surface antigens presented on tumor cells or peripheral blood lymphocytes were assayed by antibody block test.
(Results) The cytotoxic activity against to tumor cells was induced from allogeneic peripheral blood lymphocytes by mixed lymphocyte tumor culture test. Its cytotoxic activity was inhibited by anti-CD8 antibody treatment of peripheral blood lymphocytes and anti-HLA class II antibody treatment of tumor cells. Furthermore, allogeneic peripheral blood lymphocytes induced to tumor cells did not damage peripheral blood lymphocyte of the tumor patient derivation.
(Conclusion) Renal cell carcinoma may express tumor specific antigen restricted to HLA class II antigens that could be recognized by allogeneic CD8 positive T lymphocytes.

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(Objective) Because of recent increases in health care costs, cost containment has become a important issue in medical practice. We evaluated the effect on cost and clinical outcome with the implementation of clinical care pathway for transurethral resection of the prostate (TURP) patients.
(Materials & Methods) Our series consists of 69 consecutive patients treated with TURP between June 1, 1999 and March 31, 2000. The patients were divided into two groups at random. Thirty-two patients were treated on the clinical pathway (pathway group) and 37 patients were not placed on the clinical pathway program (non-pathway group). Total hospital charges, average length of stay and clinical outcomes were compared in two groups.
(Results) The average of total hospital charges (insurance points) and average length of stay were 48, 424.2 point, and 12.7 days for the pathway group, and 55, 365.5 point, and 14.7 days for nonpathway group respectively. Postoperative complications and rehospitalization did not differ between two groups.
(Discussion) With the implementation of the clinical care pathway, average hospital charges and length of stay were reduced. The clinical pathway program is considerd to be a good tool for health care cost management.
This methotology can be applied to all patients. However, when we make the clinical pathway program, we take into account the individuality of each patients.

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(Back ground) We carried out a retrospective study comparing radical prostatectomy plus adjuvant hormone therapy with radical prostatectomy plus surveillance in patients with positive surgical margins to evaluate whether adjuvant hormone therapy is beneficial for disease free survival.
(Patients and methods) Sixty-five patients with positive surgical margins after radical prostatectomy were included in this study. Twenty-six patients received adjuvant hormone therapy. Thirty-nine patients underwent surveillance with salvage hormone therapy at PSA failure. None of these 65 received androgen deprivation prior to surgery. Treatment outcomes were measured in terms of progression free survival.
(Results) Five year clinical progression free survival rates for the patients with positive surgical margins in the adjuvant therapy group and surveillance group were 85.9% and 80.0% respectively (p=0.85). Clinical progression free survival between the groups was not statistically different in terms of seminal vesicle involvement and tumor grade. The difference of clinical progression free survival between the two groups approached statistical significance in poorly differentiated tumor (p=0.08).
(Conclusions) We conclude that adjuvant hormone therapy is not beneficial in terms of progression free survival in patients with positive surgical margins. Nevertheless, adjuvant hormone therapy could be beneficial in patients with poorly differentiated prostate cancer.

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(Purpose) We evaluated the results of extracorporeal shock wave lithotrppsy (ESWL) in a large number of cases with upper urinary tract calculi, and reported the strategy how to improve the efficacy and safety of ESWL.
(Patients and Method) Eight hundred fifteen patients with renal calculi and 1, 204 patients with ureteral calculi were treated using a piezoelectric ultrasound-guided lithotriptor, Toshiba ESL-500A. Auxiliary measures were needed in 51 cases (2.5%) and 1, 968 cases (97.5%) were treated by in situ procedures. ESWL was performed with the optimal positioning of the patient and under the continuous monitoring by ultrasound system. The visibility of stones was improved by removal of abdominal gas and administration of diuretic agent to dilate the ureter. Cases with urinary tract infection were medicated by antibiotics and the obstruction of the urinary tract was cleared away as soon as possible.
(Results) Including the cases with residual fragments less than 4mm, the success rates at one month after the treatment were 97.7% and 98.7% for the renal and ureteral calculi, respectively. The mean numbers of sessions were 1.49 for renal calculi and 1.16 for ureteral calculi. Multiple sessions were required in 24.2% of renal calculi and 12.0% of ureteral calculi. No serious complication has been observed except for three cases, which were sepsis after ESWL, anuria in a solitary kidney, and pyonephrosis caused by Steinstrasse with urinary infection, respectively.
(Conclusion) ESWL using ESL-500A is an efficient treatment of upper urinary tract calculi which has higher pulverization rate and fewer complications in the adequate procedure.

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Laser treatment is considered to be effective in treating carcinoma in situ of the penis. We, however, report a case with carcinoma in situ of the penis which developed invasive carcinoma and inguinal lymphnode metastases only 6 months after the laser treatment.
A 74-year-old man with pseudophimosis presented with redness of the glans penis. A physical examination revealed thick erythema, 12 millimeters in diameter, around the external urethral meatus. Histologically, biopsy revealed squamous cell carcinoma in situ. No metastasis was suspected by physical examination and imaging studies. Although the lesion appeared to slightly extend into the urethra, it was primarily treated with the CO₂ laser. Six months after the treatment, however, local recurrence was confirmed by the touch smear cytology, resulting in the partial amputation of the penis. The histopathological examination revealed subepithelial and marked lymphatic invasion of the tumor and positive margin in the urethral stump (squamous cell carcinoma in situ). Further, since bilateral superficial inguinal lymphnode swelling appeared, total amputation of the penis with perineal urethrotomy and pelvic/inguinal lymphnode dissection was performed subsequently. The metastases to bilateral inguinal lymphnodes were confirmed histologically. The patient received adjuvant chemothrapy and has been alive and well without evidence of disease 40 months after the initial treatment.

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Two patients with refractory Peyronie's disease were treated by tunica vaginalis testis autografting following surgical excision of indurated tunica albuginea of the corpora cavernosa. One patient could achieve relief of pain and a straight erection of the penis 3 months after surgery. Another patient could not obtain a satisfactory erection during the follow-up of 6 months, but could have sexual intercourse after 7 months. A tunica vaginalis testis autograft might be an ideal substitute for tunica albuginea because it has several advantages: it causes no rejection at the recipient site; it is flexible enough to accommodate to expansion; there is no development of sebaceous glands and hair follicles that may occur in the use of a dermal graft; and it is easy to obtain.

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Liposarcoma is one of the most common primary retroperitoneal neoplasms, and the perinephric region is a frequent location for them. Liposarcomas show a variety of radiographic features in terms of histological types and tumor sizes, so the specific diagnosis of liposarcoma is often difficult. We present a unique case of perinephric dedifferentiated liposarcoma mimicking cystic renal tumor.
A 71-year-old man presented himself at our hospital with a palpable mass in his upper right abdomen. Abdominal computerized tomography (CT) revealed a well-defined cystic mass at the lower pole of the right kidney that contained heterogeneous solid components and small foci of fat. There were no signs of lymphadenopathy or tumor thrombus in the renal vein. Metastatic evaluation by chest x-ray and bone scan was negative. The probable diagnosis was cystic renal cell carcinoma or atypical angiomyolipoma. Because we could not exclude the possibility of cystic malignancy, a right radical nephrectomy was performed.
Grossly, the tumor was predominantly encapsulated by a unilocular fibrous capsule and was filled with bloody fluid and debris. The anterior portion of the tumor was composed of various-sized soft and rubberly masses covered with necrotic tissue. The histological diagnosis was dedifferentiated liposarcoma arising in the perinephric retroperitoneum with extensive necrosis, and the cyst wall was composed of a necrotic tumor with a well differentiated liposarcoma and a fibrous capsule. Although the tumor widely covered the right kidney, there was no microscopic invasion of the kidney. No signs of tumor recurrence were noted six months after the operation.

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We report an unusual case of a 3-year-old girl with multiple nephrogenic adenomas in the urinary bladder following previous surgical intervention. When she was 6-month-old, right vesicoureteralreflux (VUR) and left marked hydronephrosis with ectopic urethral opening were found. The left renal pelvis and ureter were incompletely duplicated with a short common segment. Bilateral ureterocystoneostomy and closure of ectopic opening of the left ureter were performed. Left ureteral orifice resulted in double barreled pattern. Postoperative voiding-cystourethrography revealed VUR in the ureter belonging to the lower part of the left kidney. At the age of 3 year, cystoscopic examination revealed multiple papillary lesions in the urinary bladder. These lesions were resected transurethrally and the pathologic diagnosis was nephrogenic adenoma. The patient is the 27th case of nephrogenic adenoma of bladder reported in the Japanese literature.

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A 28 year-old woman presented right upper abdominal pain. She had been pointed out her masculinization and amenorrhea.
CT scan and magnetic resonance imaging showed right adrenal tumor. In the endocrinological study, the serum cortisol and testosterone was elevated. Transabdominal right adrenalectomy and nephrectomy was carried out and histopathological diagonosis was adrenocortical carcinoma. The masculine symptom had disappeared after the operation and she has been without recurrence for five years.

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