(Purpose) To investigate the effect of patient age on the stone-free rate (SFR) in patients with urinary stones treated by extracorporeal shock wave lithotripsy (ESWL).
(Patients and method) 138 patients with renal calculi and 463 patients with ureteral calculi were treated using the Siemens Lithostar Multiline. Multiple logistic regression was used to investigate the effect of age and other possible predicting factors, i. e., gender, location, size, side, grade of hydronephrosis, symptom at onset and history of urolithiasis, on the SFR at 3 months after treatment.
(Results) The overall SFR was 77.2%. The SFRs of aged<=39, 40-49, 50-59, 60-69 and 70=<years were 87.4%, 84.4%, 75.0%, 71.1% and 66.3%, respectively. The elder patients complained less frequency of pain at onset and showed more frequency of hydronephrosis. Multiple logistic regression analysis revealed that patient age (younger) as well as stone location (middle and distal ureter), size (small), hydronephrosis (mild or less) and symptom (painful) at onset were a independent (better) prognostic factors determining stone clearance after ESWL of upper urinary tract stones.
(Conclusion) The SFR of elder patients showed lower than that of younger ones, however, the former less needed analgesia for ESWL session than the latter. ESWL is convenient, relatively useful for elder patients.

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(Objective) Severe urinary tract infection may lead to sepsis in some cases. In these cases, treatment must not only include drainage of the source of infection, but also management of systemic inflammatory response syndrome (SIRS). Blood purification therapy focused on endotoxin adsorption is thought to be a useful treatment method for this purpose. Herein, we clinically investigated the cases in which this treatment method was applied.
(Subjects and methods) A total of 22 patients underwent endotoxin adsorption therapy following diagnosis of sepsis at the department of urology, Hokkaido Social Welfare Association Furano Hospital during the last six years. Of these patients, six patients whose primary disease was urinary tract infection were included in the study.
(Results) Patients comprised four men and two women with either pyelonephritis (n=5; complicated by prostatitis in one patient) or pyonephrosis (n=1). Primary diseases included urolithiasis (n=4), vesicoureteral reflex (n=1), and ureteric stenosis (n=1). Urinary tract drainage included ureteral stent (n=4), nephrostomy (n=1), and cystostomy (n=1), with concomitant use of continuous hemodiafiltration in one patient. Serum endotoxin levels were 3.2pg/ml on average, and returned to normal following endotoxin adsorption therapy in all patients. A total of four strains of Escherichia coli and one strain of Klebsiella pneumoniae were identified as pathogenic bacteria.
(Conclusion) Hemodynamics was markedly stabilized following endotoxin adsorption therapy, and all patients survived. These findings indicate that endotoxin adsorption therapy should be actively considered as a treatment method for patients with sepsis secondary to urinary tract infection.

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(Objective) Clinicopathogical features and prognosis of patients with renal cell carcinoma (RCC) concomitant with adrenal involvement (metastasis or invasion) were evaluated in a single institute.
(Methods) In 380 patients with RCC who underwent radical nephrectomy 18 patients had adrenal involvement (13 ipsilateral adrenal involvement). Clinicopathological factors were compared between patients with ipsilateral adrnal involvement and control patients. Cause-spesific survival was calculated by Kaplan-Meier Method.
(Results) Patients with ipsilateral adrenal involvement had significantly higher percentage of tumor>5.5cm, upper pole tumor, pathological stage (pT) 3≤, lymph node metastasis, distant metastasis outside ipsilateral adrenal gland, histological grade 3 and microvascular invasion than control patients (p<0.05). Therefore, large tumor (especially 5.5 cm<), upper pole tumor, clinical T3 (especially patients with tumor thrombus), lymph node metastasis and distant metastasis were candidates for risk factors of ipsilateral adrenal involvement. 76.9% of ipsilateral adrenal metastasis could be diagnosed by computed tomography (CT). Thus, preoperative adrenal finding by CT is very important to determine the indication of ipsilateral adrenalectomy. All 3 patients with small ipsilateral adrenal metastasis that could not be detected preoperative CT died within one and half year postoperatively. Patients with solitary adrenal metastasis appeared to have better prognosis compared to those with both adrenal and other metastases. In 4 patients who survived more than 2 years after the presentation of adrenal metastasis, 3 patients had solitary adrenal metastasis and underwent adrenalectomy.
(Conclusion) From the results in a single institute, radiological finding of adrenal grand, tumor size, tumor location, T stage, lymph node metastasis and distant metastasis outside ipsilateral adrenal gland are possible important factors to determine the indication of ipsilateral adrenalectomy preoperatively.

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A 75-year-old man was referred to our department with prostate cancer. When our pathologist reviewed the biopsy specimen, he was diagnosed as intraductal urothelial carcinoma. Transurethral random biopsy showed the urothelial carcinoma in the prostate ducts but no cancer in the bladder. He was diagnosed as primary urothelial carcinoma of the prostate ducts (cTis pd cN0 M0), and radical cystoprostatectomy were performed. Histopathological examination showed urothelial carcinoma in situ spread along ducts and ejaculatory ducts and into seminal vesicles but there was not invasion of prostatic stroma. (pTis pd pN0 M0 Urothelial carcinoma G3 pL0 pV0) He had no adjuvant therapy, he is alive without any evidence of tumor recurrence after surgery.

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A 59-year-old female was referred to our department for a renal mass which was incidentally found during pneumonia treatment. Computed tomography and magnetic resonance imaging showed a 1.5-cm enhancing mass in the posterior midportion of the left kidney. Subsequently, an open partial nephrectomy was performed on the diagnosis of renal cell carcinoma. Pathological examinations revealed a hyaline-vascular type of Castleman's disease. Castleman's disease confined to the kidney is exceptionally rare. We present this rare case and review the literature concerning this unusual disorder.

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A 68-year old female underwent laparoscopic vaginal hysterectomy for uterine wall perforation, following the removal of an intrauterine contraceptive device (IUD). The patient entered our hospital complaining of persistent genital bleeding, lower abdominal pain and urinary incontinence. She was diagnosed with a vesicovaginal fistula. The diameter of the fistula was over 3cm and extended from the trigone to the internal urethral orifice, complicating the right distal ureteral obstruction. Therefore, curative surgery required a subtotal cystectomy and substitution cystoplasty due to severe urothelial changes, hydronephrosis and poor bladder compliance. An ileal neobladder (modified Studer's method) was successfully created and the postopertive course was uneventful. Although minor urinary incontinence persists, she can void through the urethra which has improved her quality of life.

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