(Purpose) To determine the prevalence of testicular microlithiasis (TM) in the contralateral testis of patients with unilateral testicular tumor, and evaluate the association of TM with carcinoma in situ (CIS) (Materials and Methods) In a period of 12 years, ultrasonography was performed in 41 patients with unilateral testicular tumor. TM was defined as multiple small hyperechogenic foci. Only images of the tumor-free testis were reviewed. In addition, archived biopsy specimens of the contralateral testicle were reviewed after immunostaining for placental alkaline phosphatase (PLAP) as a marker for CIS. (Results) TM was diagnosed in 11(26.8%) patients. Of them, microliths were pathologically confirmed in only 2. Prevalence of CIS was higher in patients with TM (2 of 11 patients) than in those without TM (0 of 30 patients, p=0.017) (Conclusion) TM was associated with testicular tumor. TM in the contralateral testis of patients with unilateral testicular tumor may increase the risk of CIS.
(Aims of study) Examining the clinical efficacy on the interferential low frequency therapy for elderly overactive bladder (OAB) patients with urinary incontinence prospectively, for whom anticholinergics were not effective. (Study design, materials and methods) Subjects are 80 patients over 65 years with urinary incontinence, who are clinically diagnosed with OAB. For over three months, they were administered anticholinergics (20mg/day propiverine hydrochloride), but in an interview after the administration period they responded that their QOL indexes were 4 (mostly dissatisfied) or over. After the anticholinergics had been washed out for over one week, the patients were provided with interferential low frequency therapy (IF) alone for three months using the Uromaster® (made by Nihon Medix Co.). Before and after IF, the following items were examined. 1) Frequency of IF treatment required to show optimal effects subjectively, 2) Average incontinence frequency in a week, 3) PAD test for 60 minutes, 4) Frequency and voided volume in the daytime and nighttime, 5) Fluid intake volume, 6) IPSS, QOL index, 7) UFM (voiding time, voided volume, Qmax, Qave), 8) PVR (postvoid residual urine), 9) Specific gravity of urine, 10) Average hours spent outside per day, 11) Average radius of action per day, ADL scale, 12) Blood pressure and pulse in the standing position, 13) Values of clinical examination, 14) Adverse events of IF., 15) Plasma osmotic pressure, 16) BNP (Brain natriuretic peptide). During the trial, no behavioral advice, including fluid intake advice, was provided to the patients. Before starting this study, all patients signed an informed consent agreement. (Results) 1) After a median of eight treatments of IF, the patients showed significant improvements subjectively and this effect continued. Improvement was observed in the following items. All these values showed [The mean value before IF]→[The mean value after IF for three months], and statistically significant differences were identified between before and after IF in all these values (p<0.0001 except nighttime voiding frequency [p=0.0004]). 2) Incontinence frequency; 13.3→3.6times/week, 3) PAD test; 17.5→3.1gr., 4) daytime voiding frequency; 8.3→7.0 times, nighttime voiding frequency; 1.8→1.4 times, 6) IPSS; 12.1→6.3, QOL index; 5.2→2.4, 7) Voided volume; 170.2→254.2ml, Qmax; 18.1→25.7ml/sec, Qave; 8.9→12.1ml/sec, 10) Average hours spent outside; 1.5→3.0hrs., 11) Average radius of action; 400→1, 200m, ADL scale; 8.0→3.4, 12) Blood pressure in the standing position; 132.9/79.7→127.1/74.7mmHg., 15) Plasma osmotic pressure; 295.1→297.8mOsm/l, 16) BNP; 41.3→19.2pg/ml. Other items including clinical examination and pulse did not change much, while the adverse events of IF were not recognized. (Interpretation of results) The results indicate the possibility that IF has safe and better effects than anticholinergics on the elderly OAB patients with urinary incontinence. It is clear that the OAB can significantly impair the QOL and reduce the ADL. By improving the urgent incontinence, the QOL will be improved and the physical activity may increase.
(Summary) Clinical guideline for decontamination of endoscopes in urological field has not been provided, although endoscopic examination should be done in aseptic circumstance. (Material and method) From decontamination processes, following 3 points were selected for verification: 1) Volume of residual water in flexible scope after rinsing, estimated by weight change. 2) Concentration of eluted disinfectant from flexible scope after standard rinsing procedure for gastrointestinal endoscope. 3) Observation of possible damage of telescope, caused by repeat autoclaving. (Results) Wet condition of flexible scope could be suspected in 60 hours in room temperature. Eluted disinfectants were detected, but in harmless level. Repeated autoclaving merely caused minor damage, which does not interfere clinical use. (Conclusion) We obtained a couple of evidences with cautions in decontamination processes for endoscopes. Urgent requirement of standardization in this field should be discussed widely.
(Objective) In addition to overactive bladder (OAB) and sleep disorders (disturbance of additional sleep induction), nocturnal polyuria has been reported as an etiology of nocturia in elderly people. To investigate the influence of heart function on nocturnal polyuria in elderly people, we examined the association with nocturnal polyuria using brain natoriuretic peptide (BNP), which are useful for evaluating the prognosis of heart failure. (Patients and methods) The patients were 128 patients (92 males, 36 females) who were treated for nocturia in Kohsei general hospital and other relative hospital between October 2002 and September 2005. We measured BNP levels at physical examination. Simultaneously, the patients were instructed to write a frequency volume chart (FVC) for 4 days. 24-hour urine volume, Daytime urine volume, nocturnal (sleep) urine volume, nocturnal polyuria index (NPi) were calculated from FVC. The association was examined. However, α1-blockers or anticholinergic agents that had been prescribed to treat urination disorders were continuously administered. (Results) Overall, the mean BNP level was high, 46.3±39.6pg/ml. The mean 24-hour urine volume was 1, 555±458ml. The mean daytime urine volume was 935±322ml. The mean nocturnal urine volume was 624±251ml. The mean nocturnal urine volume rate was high, 40.1±10.5%. However, there was a close association between BNP and the 24-hour urine volume (p=0.0215), the daytime urine volume (p=0.0004), the NPi (p=0.0003). The daytime urine volume decreased with the BNP level. The NPi increased with the BNP level. Patients were divided into 2 groups, a group with a BNP level less than 50pg/ml and a group with a BNP level of 50pg/ml or more. In the group with a BNP level less than 50pg/ml, the nocturnal urine volume rate was 38.14±10.07%. In the group with a BNP level of 50pg/ml or more, the rate was significantly higher (43.97±10.48%, p<0.0029). (Conclusions) These results suggest that many elderly patients latently have mild heart failure, and that relative nocturnal polyuria reduces cardiac load. Therefore, in patients with a high BNP level, administration of antidiuretic hormone to decrease nocturnal urine volume is risky. Administration of diuretics during the afternoon or evening may be safer.
(Objectives) We investigated whether preoperative parameters predict pathological stage at radical prostatectomy for patients with clinically localized prostatic cancer. (Materials and methods) We studied a total of 160 men with clinically localized prostatic cancer (less than or equal to clinical T2) who underwent radical rertropubic prostatectomy at Wakayama Medical University. Clinical Ts patients are not included in this study. Preoperative parameters include patient age, Body Mass Index, preoperative serum PSA value, biopsy Gleason score, clinical stage, the percent of positive biopsy cores (%PosBx) and the percent of positive biopsy cores on the dominant side (%DomPosBx). Univariate and multivariate analysis were performed to examine the prognostic significance of these preoperative parameters. Significant independent factors were combined to create a table to predict pathologically organ confined disease. (Results) Univariate analysis showed preoperative serum PSA value (p<0.001), biopsy Gleason score (p=0.001), clinical stage (p=0.026), %PosBx (p=0.002) and %DomPosBx (p=0.003) were significantly related to the pathological stage. On multivariate analysis, serum PSA value (p<0.01), biopsy Gleason score (p<0.05) and %DomPosBx (p<0.05) were significant independent predictors of pathological stage. (Conclusion) We provide two model combinations using preoperative clinical factors, one is a combination of serum PSA and biopsy Gleason score and the other is a combination of serum PSA and %DomPosBx, which define a new preoperative model for predicting pathological organ confined prostatic cancer. These combinations are useful and provide important information for urologists to determine the appropriate treatment strategy for clinically localized prostatic cancer.
We report a case of small cell carcinoma in a diverticulum of the bladder. A 64-year-old Japanese man visited our hospital with the chief complaint of urinary retention. Cystoscopy revealed a papillary tumor arising in a diverticulum on the right lateral wall of the bladder. Partial cystectomy was performed under the diagnosis of bladder cancer in the diverticulum. The histopathological diagnosis was a combination of small cell carcinoma and urothelial carcinoma, of which the former was dominant. It is often difficult to detect tumors in the bladder diverticula and its early penetration is not rare because of the thin wall. Therefore, the prognosis of the bladder cancer in the diverticulum is believed to be generally poor. On the other hand, small cell carcinoma originating in the urinary bladder is also characterized by its extreme rareness and poor prognosis. To our knowledge, this is the second case report of the small cell carcinoma arising in a diverticulum of the urinary bladder in the Japanese literature.
A 49-year-old female visited to our department with complaints of gross hematuria and micturition pain. Cystoscopic examination revealed a 5-cm diameter solid broad-based tumor located at the front wall of the bladder. Histologically, the tumor was composed of grade 2 urothelial carcinoma (UC) element and sarcomatous spindle cell element. Immunohistochemical examination demonstrated that both UC and spindle cells were positive for cytokeratin. In addition, spindle cells did not stain for S-100 protein or smooth muscle actin. We diagnosed the tumor as sarcomatoid carcinoma and performed total cystectomy and ileal conduit without chemotherapy and radiation. The patient has remained without any evidence of recurrence for 14 months after operation. Sarcomatoid carcinoma of the bladder has aggressive malignant potential and poor prognosis. An appropriate adjuvant therapy for Sarcomatoid carcinoma with metastasis has not been established. Total cystectomy is recommended as soon as possible after pathological diagnosis in the same manner as conventional high grade UC.
A 71-year old male visited our hospital with a chief complaint of pollakisuria. The needle biopsies of the prostate were performed with PSA 8.0ng/ml, and he was diagnosed as moderately differentiated adenocarcinoma. Imaging techniques revealed a right complete duplicated upper urinary system with an ectopic ureter draining to the prostatic urethra. He received radical prostatectomy with concomitant anastomosis of ureter to ureter. There is no evidence of hydronephrosis or tumor recurrence 11 months after operation. This is, to our knowledge, the second case report describing the association of radical prostatectomy and ectopic ureter.