(Purpose) It gives important information in selecting the appropriate treatment for urolithiasis to confirm the component of urinary calculus. Presently component analysis of the urinary calculus is generally performed by infrared spectroscopy which is employed by companies providing laboratory testing services in Japan.
The infrared spectroscopy determines the molecular components from the absorption spectra in consequence of atomic vibrations. It has the drawback that an accurate crystal structure cannot be analyzed compared with the X-ray diffraction method which analyzes the crystal constituent based on the diffraction of X-rays on crystal lattice.
The components of the urinary calculus including carbonate are carbonate apatite and calcium carbonate such as calcite. Although the latter is reported to be very rare component in human urinary calculus, the results by infrared spectroscopy often show that calcium carbonate is included in calculus. The infrared spectroscopy can confirm the existence of carbonate but cannot determine whether carbonate is originated from carbonate apatite or calcium carbonate.
Thus, it is not clear whether calcium carbonate is included in human urinary calculus component in Japan.
In this study, we examined human urinary calculus including carbonate by use of X-ray structural analysis in order to elucidate the origin of carbonate in human urinary calculus.
(Materials and methods) We examined 17 human calculi which were reported to contain calcium carbonate by infrared spectroscopy performed in the clinical laboratory. Fifteen calculi were obtained from urinary tract, and two were from gall bladder. The stones were analyzed by X-ray powder method after crushed finely.
(Results) The reports from the clinical laboratory showed that all urinary calculi consisted of calcium carbonate and calcium phosphate, while the gallstones consisted of calcium carbonate.
But the components of all urinary calculi were revealed to be carbonate apatite by X-ray diffraction.
The components of gallstones were shown to be calcium carbonate (one calcite and the other aragonite) not only by infrared spectroscopy but by X-ray diffraction.
(Conclusions) It was shown that component analysis of the calculus could be more accurately performed by adding X-ray diffraction method to infrared spectroscopy.
It was shown that calcium carbonate existed in a gallstone. As for the carbonate in human urinary calculi, present study showed that it was not calcium carbonate origin but carbonate apatite origin.

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(Objective) TUR-P for the treatment of BPH is not performed in cases with severe heart disease due to the risk of bleeding and hyponatremia etc. Besides, in cases with severe central nerve disease and dementia, TUR-P is not performed because patients cannot take postoperative rest.
We report the efficacy and the safety of Photoselective Vaporization of the Prostate (PVP) using a high-power 80W KTP (potassiumu-titayl-phosphate) in patients for whom TUR-P cannot be performed.
(Patients and methods) 312 patients underwent PVP in our hospital. Of these 312 patients, 8 patients with severe heart disease (American Society of Anesthesiology score of 3 or greater) and 4 patients with severe dementia (Performance status of 3 or greater) were evaluated. We assessed peak flow rate and post-void residual urine volume preoperatively and at 3 months postoperatively, safety of the procedure, and complication rates. The mean age was 81 years old (range 67 to 94) and the mean prostate volume was 63.8ml (range 19 to 120). Urethral catheter was used in 8 patients because of chronic urinary retention. PVP was performed with GreenLightPV^® and a saline solution was used for irrigation. Upon completion of the procedure an 18Fr Foley catheter was inserted without continuous bladder irrigation and removed next morning, as a rule.
(Result) In all 12 patients, PVP was performed successfully without any intraoperative complications. Mean operating time was 101 minutes (range 28 to 184), mean total laser energy was 336, 853 J (range 74, 396 to 550, 000), and mean irrigation volume was 21 L (range 8 to 36). The hemoglobin value changed from mean 13.1mg/dl preoperatively to 12.2mg/dl postoperatively. Blood transfusions were not required and hyponatremia was not observed. In 1 case, the urethral catheter was removed 3 hours following surgery. In the other cases, the urethral catheter was removed next morning. All patients could urinate after catheter removal and were discharged on the day following operation. Mean peak flow rate increased to 18ml/s and mean post-void residual urine decreased to 46.9ml at 3 months. No postoperative complications (urinary retention, hematuria, urinary tract infection, etc.) were observed.
(Conclusion) PVP is safe and effective in high-risk patients who are not candidates for TUR-P.

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A 66-year-old man was diagnosed as having prostate cancer (T2aN0M0) and neoadjuvant hormone therapy was started from 17 February 1995. During observation, superficial bladder cancer was incidentally found and the first transurethral resection was carried out on 21 June 1995. Radical prostatectomy was performed on 8 May 1996. Thereafter, bladder cancer demonstrated repeated recurrence. At the time of the third recurrence, malignant trasformation was recognized as TCC G3 T2 or more invasive, and radical cystectomy with ileal conduit was performed on 12 May 2004 when the patient was 74 years old. From the perspective of double cancer, the frequency of diagnosing localized prostate cancer with superficial bladder cancer is expected to increase because PSA screening is being increasingly performed recently. Because of the possibility of malignant transformation in patients with superficial bladder cancer, in cases of coincident of cancers, it remains controversial which treatment should be selected for the previously diagnosed prostate cancer. Here, we report the clinical course and discuss this issue to some extent.

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We report 2 rare cases of intrascrotal tumors complicated acute scrotum. Case 1: A 15-year-old adolescent presented to our emergency room with acute right scrotal pain. Testicular torsion was suspected, and surgical exploration was performed. A spermatocele with 180° torsion on its pedicle was observed. The patient was diagnosed with torsion of a spermatocele, and it was excised. Case 2: A 25-year-old man presented with acute left scrotal pain. Testicular torsion was suspected, and manual detorsion relieved the pain effectively. However, scrotal swelling did not subside after detorsion, and surgical exploration was performed. The left testis was stony hard on palpation, and intraoperative ultrasound revealed a mosaic echo pattern. A testicular tumor was highly suspected and left high orchiectomy was performed. Histopathological examination revealed seminoma pT1. Torsion of a testicular tumor was diagnosed. Although these 2 cases are extremely rare, they should be considered for the differential diagnosis of acute scrotum.

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We report two cases of squamous cell carcinoma of upper urinary tract with hypercalcemia. Case 1; a 54 year old female with primary squamous cell carcinoma (SCC) of right ureter showed marked hypercalcemia and leukocytosis. High levels of serum parathyroid hormone-related peptide (PTHrP) and granulocyte colony stimulating factor (G-CSF) were detected. Although chemotherapy of cisplatin and 5-fluorouracil with radiotherapy was effective, thereafter recurrence was occurred in renal pelvis, and the patient died 17 months after the initiation of therapy. Case 2; a 54 year old male of primary SCC of right renal pelvis with local lymphadenopathy and anterior mediastinal metastases showed marked hypercalcemia. High levels of PTHrP were detected. Although the patient was administered UFT with palliative radiotherapy to the anterior mediastinum, he died 2 months after the initiation of therapy. To our knowledge, the case 1 is the third case that of the high levels of serum PTHrP and G-CSF simultaneously in squamous cell carcinoma of upper urinary tract.

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