(Purpose) This study was undertaken to clarify the usefulness and problems involved in the clinical path of transurethral prostatectomy (TUR-P) in hospital.
(Patients and Methods) The subjects consisted of 50 patients, for whom the Department of Urology, Jikei Medical University Hospital introduced its own clinical path and performed TUR-P during a period of 9 months from July 1999 to March 2000. The mean length of hospital stay, rate of postoperative complications, and the medical insurance claims made by these patients were clarified and compared with those of 73 patients before introduction of the clinical path.
(Results) With the introduction of the clinical path, the length of hospital stay decreased by an average of 3.4 days and the total medical insurance claims decreased by an average of 18.5%. The rate of postoperative complications before and after introduction was almost equal.
(Conclusion) Our clinical path for TUR-P was well accepted by both patients and comedicals. However, the present medical treatment system in Japan is not as yet prepared to promote the introduction of this clinical path, and it will take some time before this clinical path is introduced on a full scale.

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(Purpose) Estrogen has been highly evaluated as one of the most potent endocrine agents for the treatment of prostate cancer. Unfortunately, a high risk of cardiovascular complications is a clinically important adverse effect of estrogen therapy, and occasionally the complications are fatal. In recent years a high incidence (55%) of thrombotic events has been reported in patients with congenital protein S (PS) deficiency. The aim of this study is to determine the relationship between cardiovascular complications of estrogen therapy and anticoagulant factor levels in the serum of patients with prostate cancer.
(Materials and Methods) Study 1 employed 99 patients with prostate cancer: 39 were untreated, 25 were treated with LH-RH agonist therapy alone, and 35 were treated with oral diethylstilbestrol diphosphate (DESdP) 300mg per day. We measured the serum levels of anticoagulant factors, parameters antithrombin III (ATIII), protein C (PC), PS, coagulant and fibrinolytic factors in all patients. In study 2, the adverse effects of DESdP therapy on the serum levels of anticoagulant factors were examined in 8 patients with advanced prostate cancer, .
(Results) In study 1, the ATIII and PS levels of the patients treated with estrogen therapy were significantly lower than those in either the untreated patients or the patients treated with an LHRH agonist alone. Especially, both PS antigen (51.5±16.0%) and PS activity (42.9±16.0%) were markedly lower in estrogen-treated patients than in the untreated patients (102±20.8%, 100.6±20.7%, respectively) or the patients treated with an LH-RH agonist alone (97.9±16.8%, 91.5±17.7%, respectively, both p<0.0001). PS was decreased to below the normal lower limit of normal in 82% (24/35) of the patients on estrogen therapy. In study 2, all 8 cases showed a significant decrease in PS after DESdP therapy.
(Conclusions) Our results showed that the PS levels in the oral DESdP group were almost the same as in patients with congenital PS deficiency. We conclude that decreased PS may play a role in the development of cardiovascular complications in prostate cancer patients on estrogen therapy.

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(Purpose) A retrospective investigation of patients presenting with renal pelvic and ureteral cancer was performed. This study focused on the prognostic factors and frequency of subsequent bladder cancer following surgical treatment.
(Materials and Methods) Forty-five patients presenting with transitional cell carcinoma, who had undergone nephroureterectomy at the Department of Urology, Okayama Central Hospital, from March 1990 to November 2000, were reviewed. Various factors were evaluated according to survival and non-bladder cancer occurrence rates. The Kaplan-Meier method was used in the analyses.
(Results) Patients consisted of 33 males and 12 females (mean age was 71.7). Seventeen patients exhibited renal pelvic cancer, 25 cases displayed ureteral cancer and three subjects presented with multiple cancers. Eleven patients had received treatment for precedent or coexistent superficial bladder cancer by transurethral resection. The overall 5-year survival rate was 71.9%. Ten patients died as a result of the disease; in all cases, lymph node or distant metastasis had progressed. Pathological T factor, tumor grade and pN factor demonstrated a significant effect on survival; however, sex, age, tumor localization and incidence of subsequent bladder cancer had no influence on survival. The 5-year non-bladder cancer occurrence rate was 38.8%; additionally, all subsequent bladder cancer was disclosed within three years. Tumor multiplicity exclusively in the upper urinary tract significantly affected occurrence of bladder cancer. T factor and tumor grade revealed no correlation to occurrence.
(Conclusions) Adjuvant chemotherapy for prevention of clinical metastasis should be considered in cases involving pT3 or higher stage, grade 3, or in instances of pathologically confirmed lymph node metastasis. The significant occurrence of subsequent bladder cancer in the case of tumor multiplicity suggested that prophylactic therapy such as intravesical BCG instillation or chemotherapy might be beneficial.

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(Objectives) The influence and the interdependence of pathological and clinical factors on prognostic differences between renal cell carcinoma (RCC) with end-stage renal disease (ESRD) and RCC without ESRD after nephrectomy has remained unclear. We compare the clinicopathological features between RCC with and without ESRD.
(Materials and Methods) From June 1993 to May 2000, 150 RCC patients who underwent nephrectomy were pathologically defined to have pT1 to pT3NXM0. The patients were followed for 1 to 84 months (median 30 months) after the surgery. Total of 16 patients with ESRD and 134 patients without ESRD were studied, and the differences of clinicopathological features between two groups were statistically compared.
(Results) We compare the clinicopathological features between RCC with and without ESRD. Patients' age, tumor size, rate of incidental cancer, pathological T stage, and grade were not significantly different between two groups. The 5-year recurrence-free probability rate was significantly higher in patients without ESRD than in patients with ESRD (log-rank test: p=0.04). The status of ESRD, patients age and pathological T stage were significant predictors of recurrence when analyzed by Cox proportional hazards analysis (p=0.01, p=0.03 and p=0.02, respectively).
(Conclusions) This study demonstrated that the ESRD is an independent prognostic factor in RCC patients after surgery. These results reflect that the patients with ESRD have higher risk of tumor progression. Therefore, early detection of tumors is particularly important in these patients by regular abdominal ultrasound or CT screening.

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(Background) Detrusor instability is one of the most common problems in patients with lower urinary tract obstructive diseases, such as benign prostatic hyperplasia.
Adenosine triphosphate (ATP) has been associated as a neuronal component in the detrusor instability.
(Materials and Methods) Ninety-six female Splague-Dawley rats were studied. Outflow obstructions were created by ligature of the urethra over which a catheter was placed. Changes in the bladder capacity, and an isovolumetric contractile response to pharmacologic antagonists were studied in the obstructed rats for a period of from one day to four weeks.
(Results) The bladder capacity of rats obstructed for four weeks increased significantly. Maximum bladder contraction pressure with the use of atropine medication was inhibited in 60 percent and, 30 percent of in the control group, respectively. The inhibitory effect of the maximum bladder contraction pressure by the pyridoxalphosphate-6-azophenyl-2′, 4′-disulphonate (PPADS) dosage after the atropine dosage was not recognized it in the control group, but the effect was recognized powerfully in the obstructed group.
(Conclusion) In the obstructed bladder rat, strong rise of the bladder contraction by P2X receptor with a lower urinary obstruction was accepted, and that result reflects positively. Therefore, it was guessed that the result was an end of the compensatory mechanism of unstable bladder.

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A case of atresia hymenalis with acute urinary retention under the administration of the antihistamine drug for pollinosis was reported. The patient was an 11 year-old female, who complained with acute urinary retention under the administration of the anti-histamine drug. Ultrasonography and magnetic resonance imaging revealed an expansive urinary bladder and an intravaginal hematoma. Subsequently examination of the external genitalia revealed atresia hymenalis and hematocolpos. The symptoms disappeared completely after a hymenal incision and drainage. To our knowledge, approximately fifty cases of atresia hymenalis have been previously reported in Japan. For the urologists, atresia hymenalis may not be experienced because of the rarely gynecological disease. However, we believe it should be considered as one causative disease in pubescent girls who complaining of difficulty in urination. Subsequently an examination of the external genitalia should be performed.

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A 62-year old man presented with a painless, slowly growing mass of the penis, which had been noted since childhood. A cystic mobile mass about 2.5cm in diameter was found at the ventral aspect of the glans penis. Excision of the mass was performed to confirm the diagnosis. There was no communication with the urethra. The pathological diagnosis was epidermoid cyst of the penis.
Epidermoid cysts of the penis are rare, and many of them arise on the penile raphe, which are thought to be one of the type of rapheal cyst. To our knowledge, this is the 7th case in the Japanese literature.

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