(Purpose) We reviewed prognosis and bladder recurrence of 31 patients with renal pelvic and ureteral cancer concerning clinicopathological and immunohistochemical factors.
(Methods) The patients consisted of 19 males and 12 females. The median age was 69 years, ranging from 43 to 84 years. Median follow-up period was 79 months. Immunohistochemistry for p53, Ki-67, E-cadherin and β-catenin was performed on sections from tumor tissue.
(Results & conclusions) The overall 5-year cause-specific survival rate was 77.4%. Univariate analysis indicated tumor number, grade, infiltrating pattern, lymphatic involvement to be significant prognostic factors. Moreover, multivariate analysis with Cox's proportional hazard model revealed tumor number and lymphatic involvement to be independent prognostic factors for cause-specific survival rate. The overall 5-year bladder recurrence free rate was 60.9%. Univariate analysis revealed expression of E-cadherin to be a significant factor for bladder recurrence free rate.

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(Objectives) The long-term outcome of transurethral sphincterotomy (sphincterotomy) for the management of male quadriplegic patients with neurogenic bladder was examined.
(Materials and methods) A total of 39 men with at least 5-years follow-up after sphincterotomy at our institute were included in this retrospective analysis. The mean age was 36.2 years (range 15-61). The mean follow-up period was 13.1 years (range 5-27).
(Results) Of the 39 patients, 30 patients (77%) were successfully maintained in reflex voiding with a condom catheter and remaining 9 patients (23%) have received another urinary management, including 4 suprapubic cystostomy, 2 clean intermittent catheterization and 2 clean intermittent catheterization by care giver. The main reason that required another urinary management was the augmentation in autonomic hyperreflexia due to poor urinary drainage. Analysis of the urodynamic parameters revealed that the detrusor overactivity is hard to occur with time and this would be one of the reasons for the change of urinary management. In addition, the preoperative maximum bladder pressure in patients who has changed the urinary management due to the augmentation in AH was significantly lower than that in patients that has been successfully followed up in reflex voiding.
(Conclusions) The long-term outcome of sphincterotomy was relatively good. However detrusor overactivity is hard to occur with time and this would be one of the important points during the postoperative routine follow up.

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(Objective) Fish intake may reduce the risk of prostate cancer. However, the results of previous prospective cohort studies have been inconsistent, and almost all have been undertaken in Western countries, where total fish intake is low. We therefore investigated the association between fish intake and the risk of prostate cancer in a prospective cohort study in Japan.
(Participants and methods) We delivered a self-administered questionnaire including items on dietary intake (40-item food frequency questionnaire [FFQ] ), and various lifestyle habits, between October and December 1994 to all male National Health Insurance (NHI) beneficiaries aged 40-79 years in Japan. Usable questionnaires were returned from 24, 895 (94%) of the participants. We divided the participants into quartiles based on their self-reported fish intake. We used the Cox proportional hazards model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of prostate cancer incidence according to fish intake, after adjustment for potential confounders.
(Results) We identified 95 prostate cancer cases during 7 years of follow-up, to the end of December 2001. An inverse association was observed between fish intake and the risk of prostate cancer. The multivariate HRs (95% CI) of prostate cancer across increasing quartiles of fish intake were 1.00, 0.92 (0.48-1.76), 0.73 (0.42-1.28), and 0.72 (0.40-1.33) (P for trend=0.23). Among participants aged 40-69 years, the multivariate HRs (95% CI) of prostate cancer across increasing quartiles of fish intake were 1.00, 1.26 (0.51-3.11), 0.86 (0.38-1.94), and 1.01( 0.43-2.34) (P for trend =0.83). On the other hand, among participants aged 70 years or older, the corresponding multivariate HRs (95%CI) were 1.00, 0.63 (0.23-1.69), 0.60 (0.27-1.30), and 0.44 (0.18-1.11) (P for trend =0.08).
(Conclusions) The risk of prostate cancer tended todecrease among those aged 70 years or older although it was not significant. The relation was not seen in those aged 40-69 years old.

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(Purpose) Androgen deprivation therapy (ADT) in patients with prostate cancer is associated with bone loss. We investigated the effectiveness of risedronate about a decreasing bone mineral density in patients with prostate cancer on ADT.
(Material and method) A prospective study was conducted in Kitasato University Hospital from April 2004 to October 2006. A total of 69 men with prostate cancer were assigned to receive either oral risedronate or none during ADT (hormone naïve). The treatment group was 58 men and taking 2.5mg risedronate per day. The control group was 11 men. At baseline, we assessed BMD (bone mineral density) by DEXA and urinary NTX, and measured for these changes every 6 months.
(Result) At baseline, each BMDs had no significant difference at the lumber and total hip. At the first 6-month stage, the change in BMD percentage between the 2 groups was statistically significantly different at lumber (p=0.002) and total hip (p=0.038). At the 12-month stage, the change in the BMD percentage between the 2 groups was statistically significantly different at the lumber (p=0.038). And each difference made out that the risedronate group was preserving BMD. In urinary NTX, bone turn over was statistically significantly decreased with the risedronate group compared with the control group at the 12-month stage (p=0.017).
(Conclusion) We assure the beginning of bone loss at an early date (6 months) with ADT. Daily oral risedronate in patients with receiving ADT reduces bone mineral loss and maintain BMD.

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A 24-year-old man experienced gross haematuria and dysuria several times a year from the age of 19, presenting to this Department for the first time at age 21, when he was given standard antibiotic treatment for acute cystitis. Although urinary symptoms persisted, he failed to attend for follow-up. He attended another clinic at the age of 24 with increased urinary frequency. Transrectal ultrasonography revealed thickening of the bladder wall, concavity of the right bladder neck, and nodular changes extending from the left bladder neck to the left bladder wall, so he was referred to this department for further investigation.
Mycobacterium tuberculosis was detected in the urine by the referring doctor, so the diagnosis was made of bladder tuberculosis (TB). We treated him with rifampicin (RFP), isoniazid (INH) and pyrazinamide (PZA) triple therapy for 2 months, followed by RFP and INH dual therapy for 4 months. His urinary frequency improved markedly after one month, and his bladder capacity was 420ml after 4 months of treatment. After 2 and half year follow-up he remains well without any signs of relapse. To our knowledge, this is only the ninth case of teenage onset of urinary tract TB in Japan since 1995. As specified in Clause 22 of the Enforcement Regulations of the Tuberculosis Control Law, chemotherapy and surgical treatment of TB, the mainstays of treatment, should be administered in accordance with the ‘Standards for the Treatment of Tuberculosis’, issued by the Japanese Minister of Health and revised in 2004. The level of recognition of the ‘Standards for the Treatment of Tuberculosis’ is low, however. Although the incidence of TB of the urinary tract has dropped dramatically, as urologists we must be aware that treatment of this condition must be given in accordance with the Standards.

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A 56-year-old male was admitted for induration of ventral side of the penile shaft. Computed tomography showed a large urethral calculus in the distal urethra. About 50 years previously, he had undergone multi-staged urethroplasty for hypospadias. He had also suffered from recurrent urethral calculi managed by urethrolithotomy 5 and 2 years before the admission. Urethrolithotomy revealed hair-bearing urethral calculus. Instillation of depilating agent containing thioglycolate into the neourethra for preventing hair regrowth was ineffective. Transurethral laser hair removal of neourethra was subsequently performed. All the neourethral follicles were ablated with GaAlAs diode laser (wave length 810nm; at a power of 15W for 2 seconds) through a side-firing laser fiber. Another three operations were performed for a few regrown hairs at a power of 20-30W. Convalescence was uneventful. The patient is free of hair regrowth except for a hair at five months of follow-up.

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A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20×12×11cm tumor. The serum CA19-9 level elevated to 4, 400U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.

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We report an unusual case of bilateral ureteral polyps causing intermittent hydronephrosis, which developed extensively in the upper part of ureters. The patient was an 8-year-old male. He had several episodes of gross hematuria with right flank pain.
Ultrasonography of the kidney showed mild bilateral hydronephrosis, while this finding was markedly aggravated in association with the onset of pain. Intravenous pyelogram and retrograde pyelogram revealed multiple filling defects in both upper parts of ureters.
Since the diseased part of the ureter was wide (about 7cm in length), a segmental resection of the right ureter with mobilization of the right kidney was performed, followed by end-to-end ureteral anastomosis. The pathological diagnosis was fibroepithelial polyps. Regarding the disease of contralateral ureter, no surgical treatment was performed because he had no clinical symptoms.
Six years after the surgery, he again developed gross hematuria with left flank pain. Marked dilatation of the left renal pelvis was shown by ultrasonography, which suggested left intermittent hydronephrosis caused by ureteral polyps. He underwent a partial ureterectomy with mobilization of the left kidney for the left ureteral disease. No recurrence of polyps has been observed in the urinary tract since this surgery.

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Calcifying fibrous (pseudo) tumour (CFP) is an uncommon and distinct pathological entity, which is usually occurring in the soft tissue of the extremities, trunk, axilla, pleura, mediastinum and peritoneum. We report a case of CFP of the adrenal gland. A 29-years-old previously healthy woman complained the left lumbago. A solid mass was found on computed tomography on the left adrenal gland. There were no abnormalities in physical examination and laboratory studies. Only urinary noradrenalines and dopamines levels were slightly high. Laparoscopic left adrenalectomy was performed. Pathological findings of the left adrenal tumor showed dense hyalinized fibrous tissue containing bland spindle-shaped cells, calcifications, and lymphoplasmacytic infiltrate. Our case seems to be the first case of CFP to be published in the Japanese literature.

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