(Purpose) The 1997 T staging classification for renal cell carcinoma (RCC) defined T1 as tumors measuring up to 7cm in size and T1 is subdivided into T1a and T1b with a 4cm cutoff value in the 2002 TMN classification. We evaluated the validity of these cutoff values by assessing the cancerspecific survival of patients with non-metastatic RCC according to a series of alternative size cutoff values. In addition, we calculated how these size cutoffs affected the disease specific survival rates. (Materials and methods) A database containing the records of 200 patients with RCC who underwent open radical nephrectomy for N0M0 disease between 1985 January and 2004 January was evaluated. Tumors were stratified by cutoff values ranging from 3 to 9cm with the 1cm increments in order to evaluate whether the 7cm cutoff value is appropriate. Next, T1 RCC were stratified by cutoff values ranging from 3 to 6cm with the 1cm increment in order to verify whether the 4cm cutoff is appropriate. Lastly, tumors over 7cm diameter were stratified by cutoff values ranging from 9 to 14cm with the 1cm increments in order to verify whether the present T2-3a categories could be divided according to tumor size. (Results) As for the T1-2 classification, a cutoff value at 7cm or 8cm shared the greatest prognostic power. Although there was no significant difference in T1a/T1b subclassification, a 4cm or 5cm cutoff value resulted in a greatest separation of survival curves for T1a and T1b. As for tumors from 9-14cm in diameter, only a 13cm cutoff value provided a significant difference in survival. (Conclusions) Our results indicate that the present 7cm cutoff value in the TMN system is valid in terms of prognostic value. The 4cm cutoff value may not reflect the survival when total nephrectomy is considered, thus indicating that tumors at 4cm cutoff value may be valid when nephron sparing surgery is considered. The 13cm cutoff value seems to be most appropriate in N0M0 tumors with over 7cm in diameter.
(Purpose) We compared the efficacy, safety and conveniency of previous and present lithotriptors for the treatment of upper urinary tract calculi. (Patients and method) 691 patients with renal calculi and 2, 294 patients with ureteral calculi were treated using a 2nd generation electromagnetic fluoroscopic guided lithotriptor, the Lithostar (L group), and 153 with renal calculi and 486 with ureteral calculi were treated using a 3rd generation lithotriptor, the Lithostar Multiline (M group). The success rates, defined as stone-free or residual fragments that were 4mm or less on three months later, were calculated and compared. (Results) The percentage of outpatient were 85.3% (L) and 95.1% (M). The success rates of the L group for the overall and the ureteral calculi patients were indicated significantly better than the M group (89.6% vs 81.4%, 92.2% vs 82.7%, respectively). Mean number of treatment of the L group (1.62) for the ureteral calculi were significantly less than the M group (1.64). For the renal calculi, no significance of the success rates were observed (L: 81.0% vs M: 77.1%). Mean fluoroscopy time of the M group (2.8min.) were significantly shorter than the L group (3.7mim). Less percentage of pentazocine required in the M group (34.7%) than in the L group (50.8%). (Conclusion) This study shows that the success rate of the Multiline does not exceed the previous machine, however, the Multiline achieved shorter fluoroscopy time and decreased rate of adapting analgesia. The Lithostar Multiline is useful, safe and convenient on an outpatient basis.
(Purpose) In order to assess the validity of radical prostatectomy for the prostate cancer with PSA greater than 20ng/ml, we reviewed the clinicopathological characteristics and prognoses of radical prostatectomy cases with PSA greater than 20ng/ml. (Material and methods) Twenty-one radical prostatectomy cases who had a serum PSA level greater than 20ng/ml were reviewed regarding their clinicopathological characteristics. Stepsectioned specimens were used for pathological evaluation. (Result) The serum PSA level ranged from 21 to 65ng/ml (median: 27ng/ml). As for the clinical stage, there were 8 Tic cases, 5 T2b cases, 5 T2c cases, and 3 T3a cases (2001. TNM classification). According to the tumor location, 10 cases were diagnosed as peripheral zone (PZ) cancer, and 10 cases were diagnosed as transition zone (TZ) cancer. One case had several small cancer foci both in PZ area and TZ area. In 10 PZ cancer cases, 2 cases had lymph node metastasis, and 8 had seminal vesicle invasion. All of 10 PZ cancer cases showed extraprostatic extension, and 7 showed positive surgical margin. On the other hands in 10 TZ cancer cases, no cases had lymph node metastasis and seminal vesicle invasion. Five TZ cancer cases showed extraprostatic extension, and 6 showed positive surgical margin. The findings of digital rectal examination (DRE) and transrectal ultrasonography (TRUS) were positive in all PZ cancer cases, but these findings were unclear in TZ cancer cases. In addition, no significant difference were observed between the PZ cancer cases and the TZ cancer cases regarding age, PSA, prostate volume, PSA density, cancer volume, and Gleason scores. PSA failure was observed in 9 PZ cancer cases, and 2 TZ cancer cases. (Conclusion) Based on our findings, the prognosis of TZ cancer cases was better than that of PZ cancer cases among the radical prostatectomy cases with PSA greater than 20ng/ml. Radical prostatectomy might be one of the effective treatment option for TZ cancer even if the PSA shows greater than 20ng/ml. It seems to be important to detect TZ cancer properly based on DRE and TRUS findings.
(Purpose) We compared the efficacy of naftopidil with that of tamsulosin hydrochloride for 154 symptomatic benign prostatic hyperplasia (BPH) patients who also suffered from over active bladder (OAB) symptoms. (Materials and methods) Naftopidil and tamsulosin hydrochloride were administered for eight weeks. The international prostate symptom score (IPSS), QOL index, maximum flow rate (Qmax), residual urine volume (RUV) and side effect profile were determined before the administration and after eight weeks of treatment. (Results) In the naftopidil group, seven parameters of IPSS and QOL index were improved significantly at the endpoint compared to the baseline. In the tamsulosin group, all parameters except frequency and straining were also improved. Both drugs improved the Qmax at the endpoint, too. The RUV did not change in both groups. Naftopidil was also superior to tamsulosin hydrochloride regarding general treatment outcome by the Japanese clinical guideline of urinary disturbance. (Conclusions) This study demonstrated that naftopidil was clinically efficacious in the treatment of BPH patients with OAB.
(Objectives) Treatment trends and outcomes for prostate cancer in our hospital were reported. (Material and methods) A total of 482 patients with prostate cancer treated in our hospital between January, 1990 and December, 2004. (Results) The age distribution was from 51 to 99 years-old, with the mean age of 72.9 years-old at onset. The number of prostate cancer patients, especially asymptomatic patients with PSA elevation, have increased recently. As for the clinical stage, 92 cases (19.1%), 238 cases (49.4%), 48 cases (10.0%) and 104 cases (21.6%) were stage A, B, C and D, respectively. 425 cases (88.2%) received some form of endocrine therapy. Retropubic prostatectomy or external beam radiation therapy was performed in 77 and 57 cases, respectively all cases. The cause-specific 5-year survival rate of the 482 cases was 79.7%, comprising 100% for stage A1, 96.8% for stage A2, 89.4% for stage B, 79.9% for stage C and 42.9% for stage D. The cause-specific 5-year survival was significantly better in the latter patients (1997-2004) than the former patients (1990-1996) in stage C (p=0.0226), D (p=0.0448). In stage C patients, the retropubic prostatectomy (with endocrine therapy) group, increased in the latter period and showed longer cause-specific 5-year survival than the endocrine therapy group (p=0.0027). In stage D2 patients, chemo-endocrine therapy with VP-16, ADM and CDDP refractory and cause-specific 5-year survival was longer than endocrine therapy alone (p=0.0467, P=0.0381). (Conclusion) Our results suggest that retropubic prostatectomy with endocrine therapy and chemo-endocrine therapy are useful for stage C and D prostate cancer patients, respectively.
A 62 year old man with a spinal injury was referred to our hospital for removal of an impacted scallion that he had inserted into his urethra as a form of self-catheterization. We first attempted unsuccessfully to remove the scallion using a Kocher clamp. We then performed transurethral removal of the foreign body, that turned out to be a scallion 30cm in length. In this paper, we present a case report of self-catheterization using scallions, as well as a history of the urethral catheter.
A 27-year-old female with pulmonary lymphangioleiomyomatosis was referred to us because of the right large renal angiomyolipoma (AML), 10cm in diameter, which was found by abdominal CT during close investigation of her pulmonary disease. About 6 months earlier she had received operation for pneumothorax and the histological examination disclosed pulmonary lymphangioleiomyomatosis (LAM). Clinically she does not have tuberous sclerosis. Partial nephrectomy was performed. The renal tumor arose from the lower part of the kidney with somewhat exophytic growth. She is now followed at outpatient clinic without recurrence of renal AML. Pulmonary LAM often associates with renal AML. Although pulmonary LAM is a progressive disease and has a poor prognosis, because of the risk of the rupture of renal AML, large renal AMLs should be treated. Recently several cases have been reported for whom nephron-sparing surgery was performed. This case is 10th report of LAM, which is associated with AML in Japan.
We present two rare cases with renal cell carcinoma which recurred at urinary bladder. The first case is an 87-year-old female who had been undertaken right nephrectomy 17 years earlier. Through the examination of hypercalcemia, bone metastases and a bladder tumor were found. Transurethral resection of the bladder tumor was performed and histological examination revealed that the tumor was clear cell carcinoma similar to the right renal tumor. The second case is a 67-year-old male who had been undertaken left nephrectomy 4 and half years earlier. In spite of the adjuvant immunotherapy including interferon alpha, gamma and interleukin-2, 16 months later multiple lung metastases appeared. One month before admission he noticed asymptomatic hematuria. Cystoscopy revealed 3 non-papillary pedunculated tumors, which were resected transurethrally. Histologically the tumor was clear cell carcinoma similar to the left renal tumor. In both cases the metastasis was confirmed histologically. As in both cases the recurrent bladder cancers were confined in the mucosa, these metastases were thought to be caused by implantation.
We report a 68-year-old woman who had bilateral renal cell carcinoma (RCC) associated with von Hippel-Lindau (VHL) disease. Surgical resection of a central nervous system hemangioblastoma had been done previously. This time, synchronous bilateral RCCs were found in her kidneys, with metastases to lungs and liver. Right radical nephrectomy was performed to remove the primary tumor in the right kidney. Histopathological examination of the tumor revealed clear cell RCC with a sarcomatoid component. After surgery, transcatheter arterial embolization was performed for the tumor in the left kidney and interferon therapy was commenced. The left renal tumor decreased in size and interferon therapy was effective against the metastatic lung tumors. However, 4 years after resection of the right RCC, the tumor in the left kidney increased progressively in size and partial left nephrectomy was performed. Histopathological examination of the resected tumor also showed clear cell type RCC with a sarcomatoid component. The patient eventually died of her disease at 5 years after resection of the right RCC. RCC associated with VHL is usually of the clear cell type has a relatively good prognosis. Sarcomatoid RCC is rare in VHL patients and, to our knowledge, the present report is the first case of sarcomatoid RCC associated with VHL in the Japanese literature.
We report a case of 63-years-old man with a chief complaint of urinary retention and urethral meatal bleeding due to straddle injury. Urological examination revealed proximal bulbous urethral disruption with 1cm gap, and then cystostomy was placed. Afterwards, urethral disruption was treated by echo guided endoscopic urethroplasty. Transurethral resection of scar tissue was performed twice for postoperative urethral stricture. Postoperative voiding cystourethrography revealed no urethral stricture. The patient voids well without urinary incontinence and erectile dysfunction. Recently, endoscopic urethroplasty, which is easy, minimally invasive, and repeatable in comparison with open urethral reconstruction, has been frequently performed for urethral disruption as endoscopic instruments functionally develop. Echo guided image in the present case is so useful that proximal and distal end of urethral disruption can be shown in same plane, indicating that primary urethral tract can be reconstructed without injury of rectum and urethra.