(Purpose) Hippocrates was a famous physician of Kos in ancient Greece (c. 460 B. C.). His works were later described in the Hippocratic Collection, in which I studied disorders of urination.
(Materials and Methods) I collected mentions of disorders of urination in the Hippocratic Collection (Roeb, Otsuki and Kon editions) to compared description of disorders of urination between the Kos and Knidos Schools.
(Results) Disorders of urination were mentioned in 67 parts (sentences or sections): difficult urination in 50, retention of urine in 15 and urinary incontinence in two or three (presumably complicated by difficult urination in one). Στραγγουριη (strangourih) and δυσοριη (dusourih) were counted in 20 and 30 parts, respectively. Στραγγουριη was used in 12 (60%), 5 (25%) and 3 (15%) respective descriptions by Kos, Knidos, and unspecified School, while δυσοριη was used in 13 (43%), 17 (57%), and no descriptions; the correlation was not significant. (chi-squared test, p>0.05). Descriptions of “stoppage of the urine or bladder”, “blockage of the urine”, “inability to pass urine”, and “check” in classic Greek may mean retention of urine, which also is suspected in the case of severe δυσοριη and στραγγονριη. Retention of urine only appeared in descriptions by the Kos School, except for one of origin not specified between the Kos and Knidos Schools. The terms “δυσοριη” and “στραγγουριη” are the origins of the English terms “dysuria” and “strangury”. Dysuria (“dys+urine+ia”) denotes painful or difficult urination, while strangury (“drop+urine”) denotes slow and painful discharge of urine. Δυσουριη and στραγγουριη with severe pain appear in descriptions by the Kos School. However, in classic Greek, these words by no means always meant painful urination, which differed partially from present-day meanings of dysuria and strangury. There were δυσουρια, στραγγουριη, and retention of urine accompanied by severe, slight or no pain. The former degree of pain may have included urinary tract infection and/or prostatitis, with the latter, including prolape of uterus or bladder. Στραγγουριη was a chronic disease of a nonfatal natures, unless complications occurred. “Unconsciously passed a copious discharge of urine” may refer to urinary incontinence, which was seen in one description by Kos and two by Knidos. Two types of urinary incontinence were described, copious and drop urine wise urinary incontinence; the former may represent neurogenic bladder caused by brain dysfunctions, while the latter may represent overflow incontinence. Urethral catheterization and diuretics already were mentioned in the Hippocratic Collection. Bleeding and anodyne were used in treatment of δυσουριη and στραγγουριη.
(Conclusions) Disorders of urination appeared in four categories, namely difficult urination or dysuria; dropwise urine or strangury; urinary retention; and urinary incontinence. Severe disorders of urination appear frequently in descriptions by the Kos School.

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(Objective) The prognosis of prostate cancer has been evaluated by clinical stage or pathological grade. PSA parameters including PSA density and PSA doubling time have not always precisely reflected the prognosis of prostate cancer. The aim of this study was to evaluate PSA parameters and extension of disease (EOD) grade as prognostic factors for relapsed prostate cancer.
(Methods) The relationship between PSA parameters or EOD grade, and survival of 29 stage D patients with relapsed prostate cancer after initial hormone therapy was examined.
(Results) Only EOD grade was an independent prognostic factor, even for cause-specific survival period and survival period after relapse.
(Conclusion) EOD grade was a significant prognostic factor, and in particular, very useful as a prognostic factor for patients with bone metastasis. PSA value was not always associated with tumor volume, and therefore it is not an independent prognostic factor.

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(Purpose) To evaluate the safety and efficacy of a new vessel-sealing device (LigaSure™) for laparoscopic varicocelectomy.
(Matelials and Methods) To evaluate the safty, after elective varicocelectomy, the internal spermatic veins (n=8) were sealed ex vivo with a 5-mm laparoscopic Maryland-style LigaSure (LigaSure™ Lap), and bursting pressures were measured. To evaluate the efficacy, a retrospective review of our clinical experience with LigaSure (n=13) and clip (n=13) in laparoscopic bilatelal varicocelectomy from June 2000 to October 2002 was performed and certain parameters were abstracted, including operative time, estimated blood loss and perioperative complications.
(Result) In the ex vivo study the mean varicocele vessele diameter was 2.5±0.8mm (mean±SD) and bursting pressure was 449±95.2mmHg. Six were burst in normal vessel walls at the average bursting pressure of 442mmHg and two in the occlusions at the average bursting pressure of 508mmHg. The difference was not statistically significant. Reliable vessel sealing was achieved in all the patients. The mean operative time showed significant decrease in the LigaSure group compared with the clip group, 70±20 minutes versus 117±27 minutes (p<0.05). Estimated blood loss was minimal and no perioperative complications occurred in both groups.
(Conclusions) Our study suggests that a vessel-sealing device appears to be a safe and feasible alternative to the clip in laparoscopic varicocelectomy. It offers the advantage of reducing operative time.

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(Objective) Female sexual dysfunction is an unfavorable complication for women after intrapelvic surgery. However, there has not been enough data obtained to analyze the inconvenience to female patients of intra-pelvic surgery. To clarify the categories of female sexual dysfunction after intra-pelvic surgery, we analyzed mailed questionnaires obtained from female patients who had undergone mono-therapy of intra-pelvic surgery.
(Materials and methods) A mailed questionnaire regarding female sexual dysfunction was sent to 174 patients, including 118 that had undergone a hysterectomy (Group A) and 56 ostomates (Group B) and the results were analyzed. These patients had received only intra-pelvic surgery, without radiation or chemotherapy. Of the 56 patients in Group B, 50 with rectal cancer had received a colostomy, and 6 with bladder cancer had received ileal conduits. The content of the questionnaire was as follows: age; with or without a male partner; key person for consultation in regard to sexual dysfunction; importance of sex life. Also, a before and after operation comparison was made regarding sexual frequency, sexual desire, genital response, genital transformation, dyspareunia, genital pain and itching, and orgasm.
(Results) Seventy-eight of 174 (45%) patients returned the questionnaire. Nineteen patients without a male partner and 18 patients with a male partner had no sexual intercourse, very low sexual desire, and did not consider their sex life of importance. Twenty-five patients with a male partner (18 in Group A and 7 in Group B) had no trouble in their sexual activity after the operations. However, the other 16 patients (5 in Group A and 11 in Group B) had unsatisfactory sexual intercourse after their operations because of a decrease in sexual desire, poor genital response, and/or decrease of orgasms. Furthermore, the patients in Group B suffered significantly from sexual trouble compared with the patients in Group A. Especially, all the patients in Group B complained that their stoma prevented satisfactory sexual intercourse.
(Conclusions) Based on this data, we do not need to worry about female sexual dysfunction for patients without a male partner and patients with a partner but who are not sexually active before their operations. More than 60% of patients who had been sexually active before their operations maintained fair sexual activity after intra-pelvic surgery. However, we have to take care of the approximately 40% of patients who suffer from female sexual dysfunction after their operation, especially the ostomate patients.

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We report a case of prostatic cystadenoma. A 81-year-old man visited our hospital with the chief complaint of urinary difficulty. RUG and DIP showed bladder and prostatic urethra deviated to the left side. TRUS, CT and MRI revealed multilocular cyst in the pelvic cavity. Resection of the cystic wall was performed under the diagnosis of pelvic cyst. The cysts were originated from the right side of the prostate and adhered with the bladder severely. The histopathological diagnosis was prostatic cystadenoma.
Fortyfive cases of prostatic cyst in the Japanese literature are reviewed.

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Second cancer after radiotherapy is defined that more than five years have passed from radiotherapy for primary cancer in case of solid and different histological cancer and second cancer exists into or near radiotherapy area. While it has been not frequent that a treatment for urological cancers causes second cancer, there is the possibility that second cancer increases by recent increase of radiotherapy for prostate cancer. We report two cases of second bladder cancer after radiotherapy for prostate cancer. It is important to take second cancer into consideration for long term after the patients are treated with radiotherapy.

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