(Purpose) We evaluated the utility of free-to total PSA (F/T PSA) ratio, PSA density (PSAD) and PSA density of the transition zone (PSATZ) in diagnosis of prostate cancer with intermediate PSA level (4.1-10ng/ml).
(Patients and Methods) Between January 2000 and December 2003, systematic prostate biopsies were performed on 178 patients with intermediate PSA level. The clinical values of F/T PSA ratio, PSAD and PSATZ for the detection of prostate cancer were compared by using receiver operating characteristic (ROC) curves.
(Results) Overall, 57 of the 178 (32%) patients had prostate carcinoma. The ROC curve analysis showed PSAD and PSATZ were superior to F/T PSA ratio in patients with intermediate PSA level. In patients with total prostate volume greater than 30cm³, the area under the ROC curve for F/T PSA ratio was greater than that for PSAD and PSATZ.
(Conclusions) PSAD and PSATZ were more powerful predictors of prostate cancer than F/T PSA ratio in patients with intermediate PSA level. While F/T PSA ratio was effective for diagnosis of prostate cancer in prostate volume greater than 30cm³.

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(Purpose) To determine pretreatment parameters which predict improvements following varicocele repaire in semen quality.
(Materials and Methods) We retrospectively evaluated a total of 139 infertile patients who underwent varicocelectomy from February 1995 to March 2000. A logistic regression analysis was performed to identify parameters associated with improvements in semen quality. Parameters evaluated included varicocele grade, age, testicular volume, serum testosterone, liteinizing hormone (LH), follicle-stimulating hormone (FSH), preoperative sperm density and sperm motility.
(Results) Of 139 patients 71 (51.0%) improved sperm concentration and 59 (42.4%) improved sperm motility postoperatively. Overall, median sperm density significantly increased from 10×10⁶/ml preoperatively to 30×10⁶/ml postoperatively. Sperm motility also significantly increased 33% to 45%. In logistic regression analysis, varicocele grade (odds ratio [OR]=5.7; 95% confidential interval [CI]: 1.9-17), FSH level ([OR]=0.76; [CI]: 0.60-0.96) and sperm motility ([OR]=1.03; [CI]: 1.0-1.1) were independent predictive factors for improvement in sperm concentration.
(Conclusion) Varicocelectomy improves sperm concentration and motility. Our data suggest that patients with grade 3 varicocele, low serum FSH level and high sperm motility are more likely to benefit from varicocele repair in sperm concentration.

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(Purpose) We examined whether there would be any inhibitive effect to the crystal formation in ethylene glycol treated rat kidney by angiotensin II type I receptor blocker (candesartan).
(Methods) We divided 10-weeks-old male Sprague-Dawley rats into 4 groups. In these groups, rats were given tap water (group A), 1.0% ethylene glycol (group B), 1.0% ethylene glycol and 20μg/ml candesartan (group C), 20μg/ml candesartan (group D) for 4 weeks. Immunohistochemical studies of a renal tissue was performed by ED1 antibody and the osteopontin antibody, the transcription of renin, angiotensin converting enzyme, angiotensin II and osteopontin mRNA in whole kidney was determined using real time PCR and malondialdehyde level was measured. Renal tissue was evaluated using H. E. stain for counting the calcium deposit in the renal tubules. Calcium concentrations in whole kidney were measured with an atomic absorption spectrophotometer.
(Results) Although there is no significant difference urinary oxalate and calcium levels compared with group B and C, group C showed fewer the numbers of calcium deposit in the tubules and decreased the amount of calcium contained in the whole kidney, ED1 positive cells, osteopontine mRNA expression and malondialdehyde level.
(Conclusion) These results suggest that candesartan inhibited superfluously induced osteopontin in the whole kidney by ethylene glycol and crystal formation was also related decreased.

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(Purpose) We compared general and disease specific health related quality of life (QOL) after surgery and radiotherapy for prostate cancer.
(Materials and Methods) We performed a retrospective survey of patients treated between 1992 and 2001. General and disease specific health related QOL were assessed by the SF-36 and the University of California-Los Angels Prostate Cancer Index (UCLA PCI). We mailed questionnaires of QOL survey and obtained from 143 and 73 men who treated surgery and radiotherapy. The median ages of surgery and radiation group were 70.9 and 79.2 years old, and the median periods after treatment were 2.7 and 2.0 years, respectively.
(Results) Physical function, role physical, social functioning and mental health were higher score in surgery group than radiation group, however, general health perceptions was higher in radiation group among SF-36. Surgery group had worse urinary function and better sexual function compared with radiation group. Multi-variable analysis showed that scores of social functioning, mental health and sexual function were most influenced by each modality, the scores of physical function, role physical, urinary function and sexual bother were most influenced by age, and the score of general health perceptions and body pain was most influenced by the existence of recurrence.
(Consideration) This cross-sectional survey cleared the differences of QOL after surgery and radiotherapy, and the influences of each modality. However, because of difference in background of each group, longitudinal investigation will need to aid patients in the decision making process.

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We studied two cases of primary, hepatocellular carcinoma (HCC) that occurred following hormone therapy (estrogen therapy in one case and total androgen blockade therapy in another) for stage D2 prostate cancer. Prostate cancer is considered to be hormone-dependent, and androgens appear to be important hormonal factors. However, hepatocellular carcinoma has been shown to have both estrogen and androgen receptors, suggesting that this may be dependent on estrogen or androgen. Reported here are two unique cases of hepatocellular carcinoma in patients with prostate cancer; the pathogenesis of HCC in these patients was suspected to be related to diethylstilbestrol (DES) therapy and antiandrogen therapy for their prostate cancer.

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A 61-year-old man consulted our hospital complaining of high prostate specific antigen (PSA) value and difficulty to urinate. Prostate biopsy had been performed at another hospital, but did not reveal cancer. PSA was 18.5ng/ml. Transrectal ultrasound-guided prostate biopsy was performed, but cancer was not detected. Later, PSA rose rapidly, and findings suggesting bone metastasis at right pubic bone and left sacro-ilial joint were found on computed tomography (CT), bone scintigraphy and magnetic resonance imaging (MRI). A repeat prostate biopsy was performed, but cancer was not detected from the prostate. On right pubic bone biopsy, poorly to moderately differentiated adenocarcinoma was detected. PSA immunohistochemical staining was positive, and the diagnosis was bone metastasis from prostate cancer. After endocrine therapy was started, PSA declined and bone metastasis disappeared on bone scintigraphy.

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Two cases of intractable overactive bladder which were treated by intradetrusor botulinum-A toxin (BTX-A) are presented.
Case 1: A 53-year-old woman suffered from adhesive arachinoiditis. She had severe detrusor hyperreflexia and urge urinary incontinence despite a high dose of anticholinergic medication. Under cystoscopic control, a total of 300 units of BTX-A were injected into the detrusor muscle at 30 sites (10 units per ml per site), sparing the trigone area using a 27G flexible injection needle. This procedure was done under both caudal anesthesia with 10ml 1% lidocaine and bladder mucosa anesthesia by instilling 40ml 2% lidocaine. At a 12-week followup she was completely continent.
Case 2: A 63-year-old man with intractable detrusor overactivity of idiopathic origin was treated using the above technique. Urge urinary incontinence decreased 4 weeks after the BTX-A injections. However, postvoid residual urine volume was increased, and intermittent self-catheterization was needed.
Intradetrusor BTX-A dramatically increases the bladder capacity and decreases the frequency of urge urinary incontinence. However, this treatment caused urinary retention in Case 2. We believe that the dosage amount of BTX-A should be changed case by case.

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We report a case of a patient with a fistula between left ureter and abdominal aorta. The patient was a 84-year-old male who had undergone total cystectomy with a single stoma cutaneous ureterostomy for the treatment of transitional cell carcinoma of the bladder. His postoperative course was complicated by stenosis of the stomal orifices, which was treated with two silicone tubes.
Twelve years after the operation, massive arterial bleeding occurred from the cutaneous ureterostomy, which was caused by left ureteral-abdominal aortic aneurysm fistula due to prolonged ureteral stenting. Graft replacement for abdominal aortic aneurysm and percutaneous left nephrostomy were performed, but he died 3 months following the operation due to multiple organ failure.
Ureteroarterial fistula after the urinary diversion can occur in association with prolonged ureteral stenting, radiation therapy, and vascular pathology. Identification of a fistula is often difficult and requires the physician to be highly alert and vigilant.

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