(Objectives) Using a portable three dimensional ultrasound scanning device (The Bladder Scan ™BVI6100, Diagnostic Ultrasound Corporation), we examined measured values of bladder volume, especially focusing on volume lower than 100ml. (Materials and Methods) A total of 100 patients (male: 66, female: 34) were enrolled in the study. We made a comparison study between the measured value (the average of three measurements of bladder urine volume after a trial in male and female modes) using BVI6100, and the actual measured value of the sample obtained by urethral catheterization in each patient. We examined the factors which could increase the error rate. We also introduced the effective techniques to reduce measurement errors. (Results) The actual measured values in all patients correlated well with the average value of three measurements after a trial in a male mode of the BVI6100. The correlation coefficient was 0.887, the error rate was -4.6±24.5%, and the average coefficient of variation was 15.2. It was observed that the measurement result using the BVI6100 is influenced by patient side factors (extracted edges between bladder wall and urine, thickened bladder wall, irregular bladder wall, flattened rate of bladder, mistaking prostate for bladder in male, mistaking bladder for uterus in a female mode, etc.) or examiner side factors (angle between BVI and abdominal wall, compatibility between abdominal wall and ultrasound probe, controlling deflection while using probe, etc). (Conclusions) When appropriate patients are chosen and proper measurement is performed, BVI6100 provides significantly higher accuracy in determining bladder volume, compared with existing abdominal ultrasound methods. BVI6100 is a convenient and extremely effective device also for the measurement of bladder urine over 100ml.
(Purpose) The level of serum free testosterone (Se free T) is thought to affect personal emotion and behavior. On the other hand, salivary testosterone (Sa-T) exists mainly in an unbound state and its measurement is noninvasive and repeatable. The aim of this study was to evaluate whether Sa-T can be measured in a clinical setting using a simple enzyme immunoassay kit, and to evaluate whether the level of Sa-T obtained by a simple procedure can be used as a substitute for the level of Se free T by comparing the values obtained with those of Se free T. (Patients and Methods) Seventy-six volunteers from among patients who visited our outpatient clinic. They were 74 male and 2 female patients between the ages of 28 and 90 (mean 67.2±12.7 years, median 70 years). Sixteen of 74 male patients were treated with hormone therapy for prostate cancer. All of 76 patients were scheduled for blood examinations because of urological diseases, and gave full informed consent to participate in this study. Saliva and serum samples were collected between 06.00 and 11.00h. Sa-T, Se free T and the concentration of transferine in saliva was measured with a Salivary Testosterone Enzyme Immunoassay Kit, a Coat-A-Count Free Testosterone and a Blood Contamination Enzyme Immunoassay Kit, respectively. The average of duplicate values was used. Bioavailable testosterone (BT) was assayed by Liquid Chromatography-Mass Spectrometry/Mass Spectrometry. Average intraassay coefficient of variations of all assays were within 15%. (Results) Eleven out of 76 salivary samples were disqualified as unsuitable because of possible blood contamination or falling outside the range of the assay sensitivity. The ranges of Sa-T, Se free T and the transferrin concentration in saliva were 32 to 360pg/ml (n=65, mean 176.8±96.6pg/ml, median 168.0pg/ml), 0.15 to 21.0pg/ml (n=76, mean 6.6±4.2pg/ml, median 7.0pg/ml), and 0.08 to 6.0mg/dl (n=76, mean 0.66±0.89pg/ml median 0.42mg/dl), respectively. In 10 participants randomized chosen out of all, there was significantly correlation between Se free T and BT (r=0.964, p<0.01). There was significant correlation between Se free T and Sa-T (n=65, r=0.592, p<0.01) and estimated Se free T value can be calculated based on the Sa-T level. (Conclusion) Though disqualified samples accounted for 14.5% of the total number of saliva samples, Sa-T can be used as a substitute parameter for biologically active testosterone.
(Purpose) The analgetic efficacy of intraurethral instillation of anesthetic jelly in rigid cystoscopic examination for men is not clearly confirmed. This study evaluated the usefulness of intraurethral instillation of anesthetic jelly by questionnaires regarding the pain and uncomfortable feelings during and after the cystoscopic examination. (Materials and methods) A total of 62 men were enrolled in the study. Sixteen patients had not received cystoscopy previously (first cases), and 46 had prior experiences of cystoscopy more than twice (repeat cases). These patients were sequentially divided into two groups; one group (jellygroup) received intraurethral instillation of oxybuprocaine hydrochroride jelly (Benoxil® jelly) prior to cystoscopic examination, and the other group (no-jelly-group) did not receive the jelly instillation. Pain during the jelly instillation to examination, and uncomfortable feelings at micturition after the examination was evaluated by questionnaires. (Results) Instillation of the jelly itself caused considerable pain, which almost similar to that of scope insertion. There was no significant difference in pain score between jelly-group and no-jelly-group during the insertion of the scope to examination. The miction pain after examination was significantly severer in the jelly-group than in the no-jelly-group in repeat cases. In addition, 75% of repeat cases felt better comfortableness when jelly was not instilled, and 96% of repeat cases did not want jelly instillation for their future examination. (Conclusions) Intraurethral instillation of anesthetic jelly had no efficacy for reducing the pain during cystoscopy. Instillation of the jelly itself caused considerable pain, and it made pain and uncomfortable feelings after the examination worse. These results suggested that the instillation of anesthetic jelly before rigid cystoscopy in men might not be useful enough for reducing the uncomfortable feeling during the examination.
(Objective) To assess the significance and current status of the benign prostatic hyperplasia (BPH) impact index (BII) in the evaluation of subjective symptoms of impaired urination in so-called QOL disease, BPH. (Patients and Methods) Over the past 2 year-period, in 159 patients with the diagnosis of BPH were asked to reply to each of the international prostate symptom score (I-PSS), QOL index and BII questionnaires. The subjective symptom scores (a total of 246 points) were evaluated from the viewpoint of clinical statistics in the search for any these and to find which questions cover the BII, most. (Results) 1) Statistically significant but moderate correlations were observed among I-PSS total score, QOL index and BII. The correlations among Qmax, BII and QOL were very weak. 2) Out of the 11 domains in both IPSS and BII, 2 questions of BII (“bothersomeness caused by urinary problems” and “degree of worry about well-being”) and 4 questions of IPSS (“residual sense, ” “pollakisuria, ” “weak urinary stream” and “nocturia”) were shared as QOL indices. Patient satisfaction was affected also by the questions in the BII. 3) Of the 7 BPH symptoms assessed in IPSS, 4 symptoms (“residual sense, ” “pollakisuria, ” “weak urinary stream” and “nocturia”) affected the QOL index, and 4 symptoms (“urgency on micturition, ” “residual sense, ” “nocturia” and “strain at urination”) affected BII. 4) Of the 7 symptoms assessed by IPSS, different symptoms affected each of the 4 BIT questions. (Conclusion) It is needed to assess BPH symptoms not only by the IPSS and QOL index but also based on BII to provide the detailed therapeutic instructions and thorough patients consultation.
(Purpose) Hippocrates was a famous physician of Kos in ancient Greece (c. 460 B. C.). His works later were described in the Hippocratic Collection, in which I studied references to urinary stones. (Materials and Methods) I collected mentions of urinary stones from the Hippocratic Collection (Roeb, Otsuki, and Kon editions) to compared descriptions of urinary stones between the Kos and Knidos schools. (Results) Urinary stones were mentioned in 24 passages of the collection: 12 (50%) referred to pathogenesis of urinary stones; 6 (25%) to symptoms; 4 (17%) to treatment, and 2 (8%) to other aspects. Symptoms of urinary stones included hematuria, colic, painful urination, difficult urination, and passing a urinary stone. Bladder stones were mentioned in 15 passages (63%), renal stones in 4 (17%), and both bladder and renal stones in 2 (8%). Although no site was mentioned directly in 7 passages (29%), these appeared most likely to refer to bladder stones. Descriptions by Kos, Knidos, and unspecified schools accounted for 15 (63%), 4 (17%), and 5 (21%) of mentions of urinary stones. Descriptions of bladder stones by the Kos school were relatively numerous, while most of the few renal stones were described by the Knidos school. Treatments for urinary stone included medication, presumably to aid in passing the stone or to relieve pain; warm soaks or applications to treat pain; and incision over the kidney, when the affected area showed swelling with elevation. (Conclusions) Urinary stones were mentioned in the Hippocratic Collection more frequently by the Kos school. No description of cystolitotomy included. The Oath of Hippocrates proscribed use of the knife to treat urinary stones, however, incision over the kidney (presumably nephrolithotomy) was mentioned in “Internal Affection” by the Knidos school.
A 67-year-old male presented to our clinic with gross hematuria. Cystoscopic examination revealed a broad-based tumor of 2.5cm in diameter on the lateral side of the right ureteral orifice. Under the clinical diagnosis of TCC G2>G3, T3bN0M0, radical cystectomy with orthotopic bladder substitution was performed. Pathological diagnosis was TCC G3 with sarcomatoid carcinoma, pT2pR0pL1 pV1pN0. Adjuvant chemotherapy was not performed because of his transient poor conditions. Lung metastasis was observed 6 months postoperatively. Despite of M-VAC therapy and radiation therapy, additional metastases to brain and liver were observed. One month later, partial ileectomy specimen for occlusive ileum revealed the same histologic findings, TCC G3 with sarcomatoid carcinoma. He died 9 months postoperatively. To our knowledge, this is the first case of sarcomatoid carcinoma of the bladder with metastasis to small intestine, although 6 cases of transitional cell carcinoma of the bladder with metastasis to small intestine has been reported in Japan.
We report a case of primary malignant lymphoma of the prostate. A 76-year-old man was refer to our clinic with a chief complaint of dysuria. Based on a benign prostatic hypertrophy, transurethral resection of the prostate was performed. Histological findings showed diffuse, large cell type malignant lymphoma. His clinical stage was 1A prostate (+) according to the Ann Abor classification. The combination chemotherapy with THP-COP was performed for 3 courses, followed by irradiation at 30Gy. His prostate has showed no recurrence for 10 month after treatment. Primary malignant lymphoma of the prostate is rare. About 30 cases have been reported in the japanese literature. Preoperative diagnosis of malignant lymphoma of the prostate is difficult. All cases have been diagnosed after prostatic surgery or biopsy.
A 65 year-old man visited the outpatient clinic of internal medicine complaining of fever and upper abdominal pain. Bilateral adrenal tumors were detected by CT scan and ultrasonography without any hormonal abnormalities. The diagnosis was bilateral primary non-functioning adrenal tumors because there was no tumor except adrenals with the detailed examinations. Then we are informed about the patient and he was transferred for the surgery. Cortisol was administrated because adrenal insufficiency was observed before surgery. Right adrenalectomy was performed after the recovery of patient status with cortisol. The pathological diagnosis was malignant lymphoma (diffuse large, B cell type). The patient was getting worse and dead 15 days after the surgery.
A 78-year-old woman was presented with bleeding in the region of the genitalia. The tumor arose from the urinary meatus and biopsy was performed. The pathological examination revealed sarcomatoid carcinoma which was composed of squamous cell carcinoma and spindle cell sarcoma. She underwent urethrectomy and suprapubic cystostomy. She is alive at 26-month follow-up, after local radiation therapy of 50Gy to the recurrence sites.