(Purpose) Primary symptoms were reviewed retrospectively in patients with prostate cancer diagnosed in our hospital with the aim of promoting early detection. (Materials and Methods) The subjects included 301 cases with prostate cancer diagnosed histologically in Nagoya Urology Hospital from August, 1988 to December, 2001. The mean age was 72.7 years, and the median PSA was 20.0ng/ml. Primary symptoms were classified according to the General Rule for Clinical and Pathological Studies on Prostate Cancer (The 3rd Edition). (Results) Out of 301 cases, 274 (91%) visited our hospital with clinical symptoms. Of them, 272 had primary urological symptoms. In these 272 cases, 250 (92%) and 19 (7%) had lower urinary tract symptoms (LUTS) and macroscopic or microscopic hematuria, respectively. The majority of patients (82%) referred from other urologists had already undergone PSA measurement, compared to 50% in those referred from physicians other than urologists (p<0.0005). (Conclusion) The present data revealed that LUTS were important primary symptoms for the detection of prostate cancer, particularly in an area like Nagoya where the mass screening for prostate cancer is still unavailable. In terms of the early detection of prostate cancer, PSA has to be measured in patients with LUTS even when they visit physicians who are not urologists.
(Purpose) Lower pole renal stones are well known to exhibit a poor stone clearance rate following extracorporeal shock wave lithotripsy (ESWL). In the present study, we analyzed several anatomical factors as predictors of lower pole stone clearance that may be used to indicate the usefulness and the universality of ESWL in such patients with two different lithotriptors. (Patients and Methods) 93 patients with a unilateral single lower pole stone of 2cm, or less underwent ESWL using Piezolith 2500 or Medstone STS, were included in the study. An IVP was used to determine the lower infundibulopelvic angle, the caliceal pelvic height, the lower infundibular length, the lower infundibular diameter, the lower infundibular length-to-diameter ratio and the number of lower pole minor calyces. Stone-free status was assessed by a plain film with or without renal ultrasound. (Results) The stone clearance rate at the Piezolith 2500 group was 53.1% (34 of 64 patients), while was 51.7% (15 of 29 patients) at the Medstone STS group. In all cases, the overall stone clearance rate was 52.7% (49 of 93 patients). Age, laterality of the stone burden within the kidney and stone size were not different between the stone-free and residual stone groups. Multivariate logistic analysis revealed that length-to-diameter ratio was the most independent predictors of successful stone clearance at each group. The patients exhibited length-to-diameter ratio less than 7 achieved high stone clearance rates, greater than 72%. In contrast, the stone clearance rate was less than one third when length-to-diameter ratio was 7 or greater. Besides length-to-diameter ratio was strong prognostic factor in patients with stones 1cm. or less and 1 to 2cm at each group. (Conclusion) From this study, it is apparent that successful ESWL is highly sensitive to the anatomy of the lower pole of the kidney. Especially, the lower infundibular length-to-diameter ratio is potentially useful and a universal predictor regardless of the kind of lithotriptors at least in patients with a lower pole radiopaque stone 2cm. or less treated with ESWL.
(Objective) There are few clinical investigations on the hot flushes that develop during endocrine therapy for prostate cancer in Japan, although there are many reports in the Western countries. Therefore, we evaluated the incidence of hot flushes and the association between hot flushes and clinical characteristics of prostate cancer patients receiving endocrine therapy. (Patients and methods) Sixty-eight prostate cancer patients receiving endocrine therapy LH-RH analog (group LH-RHA); 22 patients, LH-RHA+non-steroidal antiandrogen (group LH-RHA+NSAA); 20 patients, LH-RHA+steroidal antiandrogen (group LH-RHA+SAA); 8 patients, LH-RHA+estramustine phosphate (group LH-RHA+EP); 1 patient, bilateral orchiectomy (group O); 5 patients, O+non-steroidal antiandrogen (group O+NSAA); 11 patients, and O+steroidal antiandrogen (group O+SAA); 1 patient were evaluated by a fixed questionnaire. The incidence of the hot flush, the association between hot flushes and the clinical factors, as well as the therapy of hot flushes including SAA and Kampo therapy were analyzed. (Results) The overall incidence of hot flushes was 37% (36% in group LH-RHA, 45% in group LH-RHA+NSAA, 13% in group LH-RHA+SAA, 0% in group LH-RHA+EP, 20% in group O, 45% in group O+NSAA, 100% in group O+SAA). No significant association between the hot flushes and the clinical factors of the patients was observed. On the other hand, in 3 of 4 patients treated by SAA, hot flushes improved after 4 weeks. In 2 of 3 patients treated by Kampo, hot flushes improved after 4 weeks. (Conclusion) Hot flushes are the major side effect of endocrine therapy for Japanese prostate cancer patients. SAA and Kampo are thought to be effective for treatment of hot flushes.
A 70-year-old man presented with complaints of difficult urination, perineal pain and lassitude. An enlarged, hard and nodular prostate was palpable on digital rectal examination. Needle biopsy of the prostate was performed, which revealed diffuse large B-cell non-Hodgkin' s lymphoma by immunohistochemical studies. Right internal and external iliac nodes were swollen on computed to-mographic scan (CT) of the pelvis. No abnormal finding was seen on abdominal CT, upper gastrointestinal fiberscopy and bone marrow histology. Therefore, the disease was classified into the clinical stage II according to Ann Arbor's criteria. The patient achieved complete response (CR) to five cycles of combination chemotherapy, CHOP, and survives more than two years without recurrence. Primary malignant lymphoma of the prostate is a rare prostatic malignancy. Only 22 Japanese cases with primary prostatic lymphoma have been reported to our knowledge. In 23 cases including ours the majority of the patients were older than 60 years, and their histopathology was mostly diffuse lymphoma, which belongs to intermediate grade of non-Hodjkin's lymphoma according to the Working Formulation's Classification. Nineteen out of 23 cases (83%) were divided into localized stage i. e. stage I or II. In these reports, three of five cases treated with either radical prostatectomy or radiotherapy alone resulted in death or progressive disease. On the other hand, 11 out of 16 cases (69%) who received chemotherapy alone or with other therapy obtained CR. Primary lymphoma of prostate has previously been considered to have a poor prognosis. Our results, however, suggest that patients with this malignancy respond well to combined chemotherapy, and could possibly be cured when the disease is confined to the localized stage.
We report a case of extracorporeal shock wave lithotripsy (SWL) for ureteral stone in patient with implanted cardiac pacemaker. A 68-year-old woman was admitted to our hospital for left back pain due to left single ureteral stone (13×7mm) in 2002. A permanent cardiac pacemaker has been implanted for sick sinus syndrome in 1997. After evaluation for cardiac function and pacemaker function by a cardiologist and a pacemaker technician, SWL (MFL 5000, Dornier) was performed without changing pacemaker mode (DDD mode). Shock waves were incorrectly exposed a few time triggered by arterial pacing amplitude, but no cardiovascular event or malfunction of the pacemaker was occurred during or after SWL. The ureteral stone was successfully fragmented with 2, 400 shock waves (24kV) and the fragments were delivered immediately.
We report a case of bilateral synchronous testicular torsion in a newborn. A male neonate was referred one day after birth because his left testis was firm and enlarged. We found that the scrotum was firm bilaterally and suspected it to be bilateral testicular tumor. Surgical exploration which was performed at 2 days after birth revealed testicular torsion on both sides. Left orchiectomy, right detorsion biopsy and orchiopexy were performed. Histopathological examination confirmed hemorrhagic necrosis of bilateral testes.
A 43-year-old woman with mental retardation, epilepsy, and urinary stone disease had a right renal tumor. Acne-like anthema around the nose and dental pits of the nine teeth were typical signs of tuberous sclerosis (TSC), and the biopsy finding of the facial anthema was consistant with TSC. The pathological diagnosis of laparoscopic nephrectomy was renal cell carcinoma in the hemorrhagic cyst. The TSC-related renal cell carcinoma tends to develop bilaterally in younger individuals compared with the sporadic RCC. This case is the 27th case of TSC-related RCC in Japan.
In spite of the progress of digital camera technology, photography of the endoscopic picture, with a digital still camera, has not spread in the urologic setting. We attempted to photograph an endoscopic picture with a consumer-grade digital camera. An attachment was produced by pasting step-up rings for digital cameras on a coupler, or eye piece, for endoscopes. An endoscope lens, attachment, and the digital camera were connected, and the endoscopic picture was photographed. The endoscopic picture taken with the digital still camera was high definition compared to the one with the video camera for endoscopes. The conditions of the digital camera, which can be used, require having mounting threads for filters on the lens. Although a way of sterilizing and waterproofing a camera must first be discovered, a digital still camera enables one to obtain a high-definition image inexpensively, and to store and arrange the picture.