(Purpose) We report on our experience with the Memotherm stent implanted in high-risk patients who had an indwelling catheter.
(Patients and Methods) Seventeen patients (mean age 80.6 years, range 55 to 93) who had an indwelling catheter were treated by placement of the Memotherm stent. The mean duration time of indwelling catheter were 12.7 months (range 1 to 60). The methods of implantation was used the special delivery system and treatment can be done with the patient under local anesthesia with non-steroidal anti-inflammatory drug. To assess the efficacy of the treatment we measured urinary peak flow rate (ml/sec), residual urine volume (ml) and residual urine rate (residual urine volume/total urine volume: %). Subjective symptoms were evaluated using the International Prostate Symptom Score (I-PSS). The mean follow-up time was 3.3 months (range 1 week to 8 months).
(Results) There were no severe medical problems associated with stent placement. Sixteen patients were able to void immediately after insertion of the stent. The remaining 1 required an indwelling catheter to 2 months, however, eventually able to void. Only 7 of the 17 patients can be evaluation for urinary flow and residual urine, nevertheless the mean urinary peak flow rate showed 9.7ml/sec, the mean residual urine volume was 77.4ml, and the mean residual urine rate was 27.5%. Also, average I-PSS showed 13.4 in these patients.
(Conclusions) As a results of this study, the Memotherm stent is good conservative therapy for high-risk urinary retention patients.

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(Purpose) This study was undertaken to determine the most appropriate type of operation for the improvement of the radical cure rate and QOL of patients with urachal cancer. We assessed the association between the stage, type of operation, and prognosis of cases we experienced and those reported in Japan.
(Patients and Method) The subjects included 15 cases of urachal cancer we have experienced in the past 14 years. While clarifying the clinical patterns of these cases, the association between stage, type of operation, and prognosis was studied. Of the cases of urachal cancer reported in Japan in the recent 20 years, 75 cases in which the stage, type of operation, and prognosis were documented were selected, and the association between the stage and outcome in each type of operation was studied.
(Results) In regard to stage, all the cases were rated as more than IIIA.
As for prognosis, 9 cases (60%) are alive without cancer at the present time with a mean survival time of 7 years. Of the above patients, 3 underwent cystectomy and 6 underwent en bloc segmental resection (herein after referred to en bloc). Recurrence or cancer death was experienced in 5 patients, 2 of which were classified as stage IIIA and 3 as IIID. Of these patients, one underwent en bloc, 3 partial resection of the bladder, and one underwent exploratory laparotomy.
As far as our study of the cases reported in Japan is concerned, the prognosis of the cases having undergone only partial resection of the bladder was poor, while of the cases having undergone en bloc or total cystectomy 88-100% were alive without cancer for more than 2 years if their stage was classified as IIIA or below. On the other hand, prognosis was very poor whatever the type of operation in the cases whose cancer was stage IIIC or above.
(Conclusions) It appears that the en bloc is most appropriate as the type of operation for the cases of urachal cancer and that the application of total cystectomy is limited to some cases. In performing the en bloc, an extensive resection of the peritoneum, resection of the posterior sheath of the rectus muscle of the abdomen, and dissection of the intrapelvic lymph nodes in addition to the conventional types of operation should be carried out positively.

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(Background and purpose) We conducted a questionnaire survey concerning the prevalence and preference with regard to various types of surgical treatment for benign prostatic hypertrophy (BPH), in order to gather preliminary data that may be helpful for standardizing the surgical treatment of BPH.
(Method) A questionnaire survey was mailed to institutes in which a council member of the Japanese Endourology and ESWL Society was present. The questions dealt with the type and volume of surgical treatment experienced previously, and the treatments which had been performed in each institute during 2000. Preferences concerning cost effectiveness, safety, degree of invasion, efficacy, overall usefulness, and the possibility of prevalence from now on at general hospitals were also asked with regard to each surgical treatment.
(Results) Of the 155 institutes to which the questionnaire was sent, 70 responded (45% response rate). TUVP (transurethral vaporization of the prostate by thick-loop) was second to TURP (transurethral resection of the prostate) both regarding the volume of the surgical treatment that had been experienced previously, and the volume that had been performed during 2000. TURP was recognized as the most preferred treatment with regard to both cost effectiveness and overall usefulness, while TURF (transurethral radiofrequency thermotherapy) was preferred both for safety and reduced invasiveness, and open surgery for efficacy. Minimal invasive surgical treatment, such as TUVP, followed by ILCP (interstitial laser coagulation of the prostate) and TUMT (transurethral microwave thermotherapy) was recognized as the most preferable treatment for dealing with the prevalence from now on at general hospitals.
(Conclusion) Each minimal invasive surgical treatment was recognized as being safer and less invasive, but less effective and less useful compared to TURP. Among these surgical treatments, TUVP by thick-loop was recognized as being second choice to TURP with regard to efficacy and overall usefulness. As a matter of course, it would seem to be essential to evaluate long-term efficacy in addition to both safety and invasiveness when trying to standardize the surgical treatment for BPH.

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(Background) As Bayoumi, et al pointed out in their article (J. Natl. Cancer Inst. 2000, vol 92, p 1731), it is evident that treatment of prostate cancer with Luteinizing Hormone Releasing Hormone (LHRH) analogue costs more than treatment by bilateral orchiectomy. However, patients with metastatic prostate cancer are usually treated with LHRH analogue. Does this mean that urologist choose higher cost and less Quality-Adjusted Life Year (QALY) treatment? Therefore, we urologists should re-analyze their conclusion whether the treatment with LHRH analogue is really strictly dominated (high cost and low effect).
(Material and Method) We performed a cost-utility analysis using the Markov model based on a formal meta-analysis and literature review, using the same assumptions as Bayoumi, et al, from the perspective of insurer. The base case was assumed to be a 65-year-old man with symptomatic metastatic prostate cancer. The model used time horizon of 10 years. Five androgen ablation therapies were evaluated as first-line therapy: diethylstilbestrol diphosphate (DES), orchiectomy, orchiectomy+nonsteroidal antiandrogen (NSAA), LHRH analogue and LHRH analogue+NSAA. Outcome measures were QALY, lifetime costs and incremental cost-effectiveness ratios.
(Results) While DES was the least expensive therapy with the lowest QALY, LHRH analogue monotherapy was the second most expensive therapy with the longest QALY. Incremental cost-effectiveness ratios relative to DES of LHRH (\4, 288, 295/QALY) was cheaper than that of orchiectomy when quality of life (QOL) weight of orchiectomy was assumed to be 0.94 relative to that of LHRH analogue. Contrarily, LHRH analogue+NSAA is excluded with strict dominance and Orchiectomy+NSAA is excluded with extended dominance.
(Conclusion) Although LHRH analogue costs higher than orchiectomy, LHRH analogue can offer longer QALY than orchiectomy. Cost/QALY of LHRH analogue relative to DES is \4, 288, 295/QALY, which we considered to represent a good value. Choice of therapy depends on the patient's preference.

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(Purpose) we report our experience in 10 years of sperm cryopreservation to reveal the present state of the cryopreservation project.
(Materials and Methods) 42 germ cell tumor, 110 non-germ cell tumor and 2 non-malignant disease patients who visited our clinic for semen cryopreservation were retrospectively analyzed.
(Results) only 7 (20%) out of 35 unilateral testicular tumor patients who had received no chemotherapy met the WHO criteria for sperm concentration and motility. However, there were no patients with azoospermia. Three testicular tumor patients with previous chemotherapy and 4 retroperitoneal germ cell tumor patients had poor sperm concentrations and motilities.
Twenty (52%) out of 38 non-germ cell tumor patients without previous chemotherapy met the WHO criteria. In contrast, only 9 patients (13%) met the WHO criteria among 72 patients with previous chemotherapy. Twenty-nine patients (40%) with chemotherapy were azoospermia.
Totally, 74 (96%) of 77 tumor patients' semen without chemotherapy and 34 (45%) of 75 with chemotherapy were cryopreserved.
Sperm from a patient with testicular torsion were cryopreserved.
(Conclusion) most cancer patients without previous chemotherapy, regardless of underlying disease, had abundant motile sperm. However, half of the patients who had received chemotherapy did not have suitable sperm for freezing. It is important to inform young cancer patients of the cryopreservation project immediately after the diagnosis is made.

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Prostatic neuroendocrine (NE) carcinoma is a rare situation and the NE differentiation in the prostate adenocarcinoma appears to be characterized as poor prognosis, rapid tumor progression and the androgen-independent state, for which there is currently no successful therapy. We report two cases of NE differentiated prostatic carcinoma, which were diagnosed adenocarcinoma initially and the tumors progressed universally with NE differentiation during androgen suppression therapy.

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Persistent Müllerian duct syndrome is associated with cryptorchidism and transverse testicular ectopia. Such gonads are at an increased risk of malignant transformation. Furthermore, most patients have azoospermia. Here in we report about two brothers with persistent Müllerian duct syndrome. The diagnosis was made during surgical operation for testicular cancer in younger brother. In the other one, persistent Müllerian duct syndrome was diagnosed during examination for infertility.

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A 74-year-old man was referred to our clinic for the work-up of digitally hard and irregularly surfaced prostate and elevated serum prostate-specific antigen (PSA). His serum PSA was elevated to 41ng/ml, but testosterone and LH level were decreased to 23.5ng/dl and 0.5mIU/ml, respectively. He had a history of taking an androgenic medicine containing methyl-testosterone 2 to 3 times a week for 2 year and 6 months. Transrectal sextant prostatic biopsy revealed moderately differentiated adenocarcinoma (Gleason score: 3+4) in 6 of 6 specimens and CT scan of the abdomen showed an enlarged obturator lymph-node (15mm), resulting in the diagnosis of stage D1 (T3aN1M0) prostate cancer. Since serum testosterone level seemed to recover around the normal level after discontinuation of the exogenous androgen, we treated him with combination androgen blockade with LHRH agonist and bicaltamide, although his testosterone level was very low. Indeed, serum PSA decreased to 0.09ng/ml and the right obturator node was markedly reduced by the hormone treatment. After the neoadjuvant therapy of 6 months duration, radical prostatectomy and limited pelvic lymph node dissection was carried out. Histologically, viable cancer cells were not found in any of resected lymph nodes, but they remained in bilateral lobes of the prostate (pT2bN0). The histological effect of the neoadjuvant hormone therapy according to General rule for Clinical and Pathological Studies on Prostate Cancer (3rd ed.) was grade 2. The patient has been well with undetectable PSA and no evidence of clinical failure for more than 12 months, though serum testosterone level recovered to near normal (288ng/dl) 8 months after the cessation of the hormone treatment following the operation. Combination androgen blockade or non-steroidal anti-androgen agent appears to be effective for the treatment of prostatic cancer patients who takes exogenous androgenic medicine, even with a suppressed low serum testosterone level.

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