(Introduction and objective)
The goal of this study was to evaluate the efficiency of the PlasmaKinetic (PK) system^® by comparing the preoperative and postoperative results in patients with benign prostate hyperplasia (BPH) treated in this hospital.
(Methods)
From June 2004 to November 2006, the PK system^® was utilized for 46 cases of TUR-P in this Hospital. The patients International prostate symptom score (IPSS), QOL score, uroflowmetry, measurement of residual urine amount and ultrasonography were compared before and after the surgery (first month, third month and first year). In addition, the operation times, urethral catheterization times, preoperative and postoperative hemoglobin and serum sodium values of the patients were compared before and after the operations.
(Results)
At 1 and 3 months and 1 year, the IPSS decreased from 28.2±7.4 to 6.1±5.9, 2.7±3.5 and 6.6±5.3, respectively. The QOL score, decreased from 5.4±1.0 to 0.9±1.2, 0.6±0.9 and 1.3±1.1, respectively. The maximum urinary flow increased from 3.7±4.0ml/s to 19.5±9.6, 17.9±7.3 and 18.7±9.9ml/s, respectively. The post void residual urine decreased from 104.8±83.6ml to 19.4±25.0, 11.1±24.7 and 17.9±28.5ml, respectively.
(Conclusions)
Acceptable outcomes with normal recovery from TUR-P were obtained using the PK system^®.

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(Purpose)
To evaluate bladder preservation protocol by radical TUR-Bt and subsequent concurrent chemoradiotherapy in muscle invasive bladder cancer.
(Patients and methods)
Twenty-six patients with muscle invasive bladder cancer (T2-T4N0M0) were treated with concurrent chemoradiotherapy after transurethral resection of the tumor as much as possible beyond muscle layers. Chemotherapy was consisted of systemic administration of methoterexete (30mg/m² day 1 and day 22) and intraarterial infusion of cisplatin (70mg/m², day 2 and day 23). The response was evaluated by TUR, urine cytology, CT and/or MRI 4 to 6 weeks after the treatment.
(Results)
Among 24 evaluable cases, pathological complete response was achieved in 13 cases (50%) and residual tumors were noted in 11 cases (pT1 in 9 and pT2 in 2). During follow-up period up to 69.8 months, Invasive recurrence was observed in 2 cases, superficial recurrence was noted in 5 patients and distant metastasis without evidence of local recurrence was noted in 4 cases. Overall bladder preservation rate was 92%.
(Conclusions)
The bladder preservation by radical TUR-Bt and chmeradiotherapy is a safe and effective treatment option for muscle invasive bladder cancer.

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(Purpose) Although urinary complications of Crohn's disease are relatively rare, they often present diagnostic and therapeutic dilemmas. However, there is no established strategy for treating urinary complications of Crohn's disease. In the present clinical study, we describe the frequency of urinary complications of Crohn's disease, and discuss various approaches to their diagnosis and treatment.
(Patients and methods) The subjects were 1, 551 patients who underwent medical treatment for Crohn's disease between January 1994 and May 2002 at Social Insurance Central General Hospital. The subjects were retrospectively evaluated.
(Results) Urinary complications occuered in 75 of the 1, 551 patients (4.8%): urolitiasis in 60 patients, urinary fistula in 14 patients, and urachal abscess (Enterourachocutaneous fitulas) in 1 patient. A total of 41 of the 75 patients with urinary complications (55%) consulted a practicing urologist: 26 patients with urolithiasis, 14 patients with urinary fistula and 1 patient with urachal abscess. 26 patients with urolithiasis received medical treatment: 20 patients underwent conservative therapy, 4 patients underwent ESWL, and 2 patients underwent TUL. In all 26 of those cases, the treatment was successful. Twelve of the 14 patients with urinary fistulas (86%) underwent resection of the inflamed intestine combined with reconstruction of the urinary tract. The 1 patient with urachal abscess underwent resection of the urachus and the inflamed intestine, and partial cystectomy.
(Conclusion) All patients with urolithiasis should be treated the same way, whether or not they have Crohn's disease. In patients with Crohn's disease complicated by urinary fistula, surgery should be performed after preoperative medical therapy, as it improves the quality of life of such patients more rapidly than other approaches and may help avoid intestinal resection.

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(Purpose) Staging for prostate cancer often includes computed tomography (CT) and bone scan in Japan. We examined the criteria of avoiding unnecessary CT and bone scan for the prostate cancer patients at Matsusaka Chuo General Hospital.
(Subjects and methods) 211 patients were newly diagnosed at our institution between 1998 September and 2004 April. We reviewed data from 208 patients who had a staging CT and bone scan. The data was analysed using Gleason score, clinical T-stage and serum prostatic specific antigen (PSA) level.
(Results) CT detected lymphadenopathy in 19 patients (9.1%), Bone scan detected bone metastasis in 31 patients (14.9%). However there was no lymphadenopathy detected by CT in the patients with 20ng/ml or less. In the analysis using PSA and Gleason score, there was no bone metastasis detected by bone scan in the patients with PSA level of 20ng/ml or less and Gleason sum 7 or less. In the analysis using PSA and clinical local stage there was no bone metastasis detected by bone scan in the patients with PSA level of 20ng/ml or less and localized lesion (cT1-2).
(Conclusion) In a new proatate cancer patient CT and bone scan can be avoidable by PSA level of 20ng/ml or less and cT1-2 or less and Gleason sum 7 or less.

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(Purpose) We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot.
(Materials and methods) We analyzed data from 761 patients registered in “a multi-institutional study of TURP clinical pathway” sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed.
(Results) The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe. (4.4% VS 12.9%, p<0.001) There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection.
(Conclusions) Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.

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A 72-year-old man with genital ulcerative tumor was introduced to our hospital in December 1997. The pathological examination revealed well differentiated squamous cell carcinoma. A diagnosis by computed tomography and magnetic resonance imaging indicated that a locally advanced penile carcinoma had infiltrated the urethra, prostate, pubic bone and there was also bilateral inguinal lymphoadenopathy. Linac irradiation (40Gy/4 weeks) combined with once-a-week administration of THP-ADM were indicated. One month after the combination therapy, the tumor size had become small enough to allow curative surgical treatment. Pathological examination revealed no positive margin. For eight years since this radical treatment, the patient has been healthy with no local recurrence and no distant metastatic lesion.

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A 55 year-old man complained dysuria and visited to our hospital. Physical examination showed firm large mass occupying whole abdomen. Computed tomography (CT) demonstrated a huge retroperitoneal tumor which compressed intestine, liver, kidney, and urinary bladder. We performed extirpation of the tumor (8.6kg, largest diameter 60cm) which was composed of myxoid stromal region associated with cystic pattern. Histological examination revealed that the epithelium of the cystic region was positive for prostate specific antigen (PSA) immunostaining. The tumor was diagnosed phyllodes tumor of the prostate (prostatic stromal proliferation of uncertain malignancy, PSTUMP). Serum PSA was declined 3.9ng/ml to 0.9ng/ml; however, magnetic resonance imaging (MRI) demonstrated a residual (recurrent?) tumor in the pelvis one month after the operation. We carried out total prostatectomy and residual tumor resection.
Phyllodes tumor of the prostate is histologically characterized with biphasic pattern of hyperplastic epithelial cysts and variably cellular spindle stroma. The tumor is considered to have malignant potential and several histological factors including cellularity, atypia, etc. are utilized to assess it. However diagnostic criteria and subsequent treatment modalities are not established thus far. Previous reports showed efficacy of total surgical removal rather than partial resection and that we performed radical extirpation of the entire tumor. Close follow up is needed against this frequently recurrent disease.

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We reported a case of laparoscopic heminephroureterectomy for ureter cancer in a horseshoe kidney. A 59-year-old woman presented with frequency and diagnosed as left lower ureter cancer with a horseshoekidney. We performed transperitoneal laparoscopic nephroureterectomy. Feeding vessels were four arteries and two veins. Isthmus of the horseshoe kidney was divided using LCS and hemostasis was made using monopolar shears. Operating time was 300 minutes. Total Blood loss was 400ml. Laparoscopic pyeloplasty or ishmusectomy to benign disease of the horseshoe kidney is often reported, but that of heminephrectomy to malignancy is seldom reported. Laparoscopic Heminephectomy for a horseshoe kidney is difficult surgery for aberrant vessels and isthmus, so it tends to be avoided for safety. But if anatomical consideration about aberrant vessels etc is well done and we operate carfully, so we will be able to do it for safety and small invasive opration.

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Herein, we report two cases of female urethral cancer. Case 1 presented with acute urinary retention and case 2 presented with a painful perineal mass. Magnetic resonance imaging (MRI) revealed a urethral tumor in both cases. Histopathological examination of transperineal biopsy specimens from both patients suggested clear cell adenocarcinoma in case 1 and squamous cell carcinoma in case 2. Both cases underwent total urethrectomy with partial resection of the vaginal wall and cystostomy urinary diversion. With reference to case 1, obturator lymph node metastases were observed during surgery, and treatment comprised combined radiotherapy to 60Gy and chemotherapy with 5-fluorouracil and cisplatin following surgery. However, metastases appeared in the lung 6 months after initial treatment and she died 20 months after surgery. For case 2, tumor marker failure was observed 5 months after surgery. The same combined treatment was performed and a complete response was obtained. At 19 months after surgery, the patient showed no evidence of recurrence.

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A 64 year-old female visited our outpatient clinic with left dull flank pain. The ultrasonography and CT scans showed the large solid mass in 12cm in maximum diameter, containing large area of fatty element, in the left retroperitoneal space. Under the diagnosis of retroperitoneum liposarcoma, the mass and left kidney was completely removed. Pathological examination revealed the dedifferentiated liposarcoma which contained the distinct two patterns of well differentiated lipoma and dedifferentiated fibrotic sarcomatoid tissue.

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