(Purpose) To examine clinical features of the patients of interstitial cystitis (IC) undergoing hydrodistension at our institution. (Materials and Methods) We retrospectively evaluated 52 IC patients who underwent hydrodistension between July 2002 and December 2004. Transurethral coagulation (TUC) of Hunner's ulcer (HU) was subsequently performed for patients with HU (ulcer type). Descriptive statistics of the patients' characteristics and outcomes were provided and compared between ulcer type and nonulcer type IC patients. (Results) Of the 52 patients, 44 (85%) were female and 8 were male. Mean symptom duration at diagnosis was 59 months (range 2 to 388). Mean patient age was 55 years (range 24 to 78). Of them, 92% reported urinary frequency, 54% bladder or lower abdominal pain and 40% voiding difficulty. The daily voiding frequency was 19 times (range 8 to 52) and mean bladder capacity by voiding log was 100ml (range 33 to 260). The mean of bladder capacity at hydrodistension was 580ml (range 220 to 880). All the patients showed glomerulations during hydrodistension and 75% of them experienced amelioration of their symptoms after hydrodistension. Symptom relief lasted for 1 year for two thirds of the patients. Mean observation period was 15 months (range 2 to 30 months). Of 52 patients, 19 (37%) were ulcer type, who were significantly older at diagnosis (60yrs vs. 52yrs), had smaller maximum bladder capacity of voiding log (140ml vs. 230ml) and bladder capacity at hydrodistension (500ml vs. 620ml). However, ulcer type IC patients responded significantly better to hydrodistension (95% vs. 64%). (Conclusions) IC patients suffered from severe symptoms for a long time without correct diagnosis or proper treatments. Hydrodistension was effective for IC patients, especially for ulcer type, combined with TUC.
(Objective) Cisplatin-based combination chemotherapy has been considered as standard therapy for advanced or metastatic urothelial carcinoma. A recent study has, however, revealed that gemcitabine may have the potential to act synergistically with cisplatin. Therefore, the side effects of gemcitabine plus cisplatin (GC) therapy were compared with those of methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) therapy in patients with advanced or metastatic urothelial carcinoma. (Patients and Methods) Twenty-two patients received GC therapy. Gemcitabine (1, 000mg/m2) was administered on Days 1, 8 and 15 of each 28-day cycle. Cisplatin (70mg/m2) was administered on Day 2 of each cycle. As a control group, 24 patients received MVAC therapy methotrexate at 30mg/m2 on Days 1, 15, 22, vinblastine at 3mg/m2 on Days 2, 15, 22, doxorubicin at 30mg/m2 on Day 2, and cisplatin at 70mg/m2 on Day 2 of each. 28-day cycle. (Results) In the group of patients which received GC therapy, the overall response rates based on independent radiologic reviews of the 20 patients with measurable disease were 55%, with 20% CR and 35% PR. Fewer GC patients as compared with MVAC patients had grade 3/4 anorexia (4.5% vs. 75%, respectively), stomatitis (9.0% vs. 66.7%, respectively), and alopecia (27.3% vs. 100%, respectively). On the other hand, there were no significant differences in the incidence or pattern of hematologic toxicities between the group receiving GC therapy and that receiving MVAC therapy. Fatal neutropenic sepsis occurred in one patient receiving MVAC therapy. (Conclusion) GC therapy is effective for the treatment of advanced or metastatic urothelial carcinoma, with an acceptable clinical safety profile. This study also indicates that GC therapy may be better tolerated and safer than MVAC therapy.
(Purpose) Several studies suggest that extended transrectal prostate biopsy more than 6 core may improve the cancer detection rate. We compared 6 and 12 core biopsies to determine the impact on cancer detection and complication rate. (Patients and Methods) We retrospectively evaluated 150 patients who underwent transrectal ultrasound guided prostate biopsy between January 1999 and December 2003. Patients who were suspected to have prostate cancer on digital rectal examination and/or who had a history of previous prostate biopsy were excluded. Sextant biopsy was performed in 52 patients (6 core group) and 12 core biopsy was performed in 98 patients (12 core group). The cancer detection rate and post-biopsy complication rate were estimated. (Results) There was no significant difference in the overall cancer detection rate between 6 and 12 core groups (17 of 52 men or 32.7% versus 35 of 98 men or 35.7%). In addition, even if calculated the cancer detection rate stratified according to a PSA of 0 to 4.0, 4.1 to 10.0 and greater than 10.0ng/ml, there was no significant difference between both groups. There was also insignificant difference of complication rate between both groups. (Conclusions) The results of our study showed that there was no significant difference in cancer detection and complication rate between both groups.
(Objective) To determine the pathologic risk factors after nephroureterectomy in patients with urothelial carcinoma of the renal pelvis and ureter. (Patients and methods) We investigated the clinicopathological features of 131 patients (94 males and 37 females) with urothelial carcinoma of the renal pelvis and ureter who underwent nephroureterectomy at our department and related facilities from August, 1994 to August, 1997. The mean age of the patients was 68 years, ranging from 24 to 86 years. (Results) The 1-, 3- and 5-year cause-specific survival rates (Kaplan-Meier's method) for all of the patients were 91.8%, 76.7%, and 67.8%, respectively. The significant prognostic factors for survival rates by univariate analysis using the log rank test were tumor stage, infiltration pattern, lymphatic invasion, vessel invasion and lymph node metastasis. On the other hand, multivariate analysis using Cox proportional hazards regression model showed the most influential prognostic factors to be vessel invasion and tumor stage. (Conclusions) From these results, in urothelial carcinoma of the renal pelvis and ureter underwent nephroureterectomy, we suggested that vessel invasion and tumor stage were the independent prognostic factors.
(Purpose) Screening with prostate specific antigen (PSA) to detect prostate cancer was started in Ikeda City Osaka from 2003 as part of the city's health program. We evaluated the first year's result. (Material and Method) Fifty-year-old or elder men living in Ikeda City who wanted to have their serum PSA level (Tandem-R) measured to screen for prostate cancer was entered into the screening program. Men whose PSA levels detected to exceed 4.1ng/ml were told they should visit a urologist for further examinations to detect possible prostate cancer. These examinations included prostate biopsy. The results of further examinations were reported to Ikeda City and evaluated. (Results) The population of fifty-years-old or elder men in Ikeda City was 18, 161. 3, 738 (21.0%) men had their serum PSA levels measured. 367 (9.81%) of the men were told they should undergo further examinations to detect possible prostate cancer. 263 (71.7%) men visited a urologist for further examinations, and prostate biopsy was performed in 138 (52.5%) of them. Among these 138, prostate cancer diagnosed in 91 (65.9%). The positive rate of prostate biopsy was 65.9% (91/138), The detection rate for prostate cancer was therefore 2.43% (91/3, 738). Patient's numbers for each clinical stage were 57 (62.6%) in B, 30 (32.9%) in C, 4 (4.4%) in D. (Conclusion) Prostate cancer was diagnosed in 2.34% of 3, 738 men who had their serum PSA levels measured, and in stage B two thirds had a positive diagnosis. PSA screening to detect prostate cancer as one of the health checks in Ikeda City was useful in detecting early prostate cancer.
A 26-year-old man presented with a swelling of the right scrotal content, lumbago and exertional dyspnea. He underwent high inguinal orchiectomy. Histopathological examination of the specimen revealed yolk sac tumor and mature teratoma. Further evaluation revealed mediastinal and retroperitoneal lymph node metastases (stage IIIA). A single course of BEP (bleomysin, etoposide and cisplatin), two courses of chemotherapy consisting of nedaplatin and irinotecan, and three courses of TIP (paclitaxel, ifosfamide and cisplatin) were delivered. The previous abnormally elevated serum biomarkers (AFP, β-hCG and LDH) returned to normal levels, but the mediastinal and retroperitoneal masses continued to enlarge slowly. The CT-guided biopsy of the mediastinal mass was performed, and histologic study revealed no evidence of malignancy. He underwent excision of the mediastinal masses and retroperitoneal lymph node dissection. Histologic examination of the resected specimens revealed mature teratoma without malignant components. These results were compatible with growing teratoma syndrome. 30 months after the first excision of mediastinal mass, he underwent the second excision of recurrent mediastinal mass in the absence of biomarker elevation. The resected specimens revealed mature teratoma without malignant components. He is alive for 49 months after high inguinal orchiectomy and free of carcinoma.
We report a case of a non-traumatic rupture of varicocele. A 28-year-old man visited our hospital complaining of left scrotal swelling with severe spontaneous pain of sudden onset after straining for defecation. MRI revealed a dilated spermatic cord with scrotal hematoma surrounding the left testis, which leads to the diagnosis of varicocele rupture. Conservative treatment with oral analgesics for a couple of weeks relieved the swelling and pain. Subinguinal microscopic ligation of left spermatic veins was performed 4 months later.
A 32-year-old male consulted a hospital with a complaint of left scrotal swelling. Serum hCGβand LDH levels were elevated and computed tomography demonstrated a suspicious small lymphadenopathy in the paraaortic region. Left inguinal orchiectomy was performed. Histological examination demonstrated seminoma. We diagnosed the disease as clinical stage 2A and the patient received 2 courses of chemotherapy with cisplatin, etoposide and bleomycin. After this therapy, the small lymphadenopathy in the paraaortic region did not decrease in size. We considered this lesion a vessel or connective tissue. Although he achieved clinical complete remission and serum LDH level was normalized, the serum hCGβ level remained low level positive. Urinary hCGβ level after chemotherapy was below the threshold of detectability. We measured the serum from this patient as well as control sera by twoand four-fold dilution with a diluent comprised of mouse serum as a heterophilic antibody-blocking agent. The serum hCGβ level of this patient was obviously decreased; in contrast, control sera were decreased in parallel. The serum hCGβ level of this patient remained low level positive without recurrence for 8 months after chemotherapy. These results strongly suggested that low level of positivity for serum hCGβ in this case was a false positive finding. We consider the measurement of urinary hCGβ and dilution measurement using a heterophilic antibody-blocking agent to be useful methods of distinguishing false positive findings for serum hCGβ.