Experience of Extracorporeal Shock Wave Lithotripsy with Electroconductive Lithotriptor (ECL, EDAP- Sonolith Praktis) in 703 Patients with Urinary Calculi / 대한비뇨기과학회지

PURPOSE: We analyzed the therapeutic results of 703 cases of urinary calculi treated using an EDAP-Sonolith Praktis, an electroconductive lithotriptor (ECL). MATERIALS AND METHODS: Between January 2000 and June 2004, 703 patients meeting the study inclusion criteria were treated with an EDAP-Sonolith Praktis. The site and size of the stones, session, auxiliary procedure, success rate, causes of failure, complication, efficiency quotient (EQ) and retreatment were analyzed. RESULTS: The records of 703 patients, in whom urinary calculi were treated by extracorporeal shock wave lithotripsy, using an EDAP-Sonolith Praktis, were retrospectively reviewed. The success rates were 99.3, 92.5, 66.7 and 12.5% for stone sizes or=30mm, respectively, with an overall success rate of 95.3%. The EQ, mean number of session and retreatment rate were 0.71, 1.7 and 30.6%, respectively. As auxiliary procedures, double-J stenting, ureteroscopic stone removal and open surgery were performed in 6, 15 and 1, respectively. The complications were gross hematuria, flank pain, steinstrasse, nausea and fever, which were successfully controlled by conservative treatment. CONCLUSIONS: EDAP-Sonolith Praktis, an ECL, is an efficient and safe outpatient procedure for initial urinary calculi treatment.

Changes of Causative Organisms and Antimicrobial Sensitivity of Urinary Tract Infection between 1979 and 2001 / 대한비뇨기과학회지

PURPOSE: We studied the changes in the antibiotic sensitivity to the causative organisms of urinary tract infection, between 1979 and 2001, in order to provide useful information on the choice of adequate drugs in the treatment of urinary tract infection (UTI). MATERIALS AND METHODS: We retrospectively analysed 1,370 uropathogens, and their antimicrobial sensitivities, in 647 patients admitted to, or visiting our hospital, between January 1979 and December 2001, that had more than 105cfu/ml in urine culture. RESULTS: The incidence of UTI increased with age, and was highest in the 6th decades (21.0%). Mixed infections increased from 6.1%, in 1979, to 18.4%, by 2001. The common pathogens were E. coli (37.8%), enterococcus (15.0%), Pseudomonas (10.1%) and Klebsiella (9.1%). E. coli was the most important uropathogen during the stated time period. However, the incidence of Gram positive organisms increased from 14.2%, in 1979, to 26.0%, by 2001. In the Gram negative stained uropathogens, the antibiotic sensitivity was changed: ampicillin (11.8 to 14.6%), cephalothin (40.6 to 46.3%) and amikacin (80.5 to 74.8%). For E. coli, trimethoprim/Sulfamethoxazole (TMP/SMX) and ampicillin showed decreased sensitivities of 37.3 and 18.5%, respectively. However, sulbactam/cefoperazone, cefepime and imipenem showed high sensitivities of 96.1, 97.5 and 100%, respectively. CONCLUSIONS: Prior to receiving the bacteriological report, the use of TMP/SMX and ampicillin, as the first choices of treatment for UTI, should be reconsidered. Our results implied that amikacin, which showed the best effects, and was cheaper than fluoroquinolones, can be used as an alternative to these drugs as a primary empirical antibiotic for UTI.

Effects of acetaldehyde on responses of rabbit corpus cavernosal smooth muscle

Ethanol has various effects on male sexual activity under the influence of direct and indirect, in acute and chronic alcohol ingestion. However, whether acetaldehyde, a principal metabolite of ethanol, may affect penile erection directly has still not been elucidated. This present study was, therefore, designed to clarify the pharmacologic effects of the acetaldehyde on corpus cavernosal smooth muscle. Corpus cavernosal strips were prepared from rabbit penises. Isometric tension changes of rabbit corpus cavernosal strips to various drugs and electrical field stimulation (EFS) in an organ chamber were recorded with a pressure transducer after active muscle tone had been induced by phenylephrine (10(-5) mol/L). At the concentrations employed, acetaldehyde had no effect on the pH of the bathing medium. Acetaldehyde in each concentration did not significantly affect resting tone of the smooth muscle during 30 min incubation. Acetaldehyde suppressed contractility induced by phenylephrine and KCI at 10(-4) mol/L, and relaxation induced by EFS and bethanechol at 10(-3) mol/L and 10(-4) mol/L respectively, but acetaldehyde enhanced relaxation induced by ATP at high acetaldehyde level. Sodium nitroprusside-induced relaxation was not affected at any employed acetaldehyde concentration. This suggests that increasing the acetaldehyde level may contribute to male erectile dysfunction mainly by the inhibition of nitric oxide formation.

Effects of acetaldehyde on responses of rabbit corpus cavernosal smooth muscle

Ethanol has various effects on male sexual activity under the influence of direct and indirect, in acute and chronic alcohol ingestion. However, whether acetaldehyde, a principal metabolite of ethanol, may affect penile erection directly has still not been elucidated. This present study was, therefore, designed to clarify the pharmacologic effects of the acetaldehyde on corpus cavernosal smooth muscle. Corpus cavernosal strips were prepared from rabbit penises. Isometric tension changes of rabbit corpus cavernosal strips to various drugs and electrical field stimulation (EFS) in an organ chamber were recorded with a pressure transducer after active muscle tone had been induced by phenylephrine (10(-5) mol/L). At the concentrations employed, acetaldehyde had no effect on the pH of the bathing medium. Acetaldehyde in each concentration did not significantly affect resting tone of the smooth muscle during 30 min incubation. Acetaldehyde suppressed contractility induced by phenylephrine and KCI at 10(-4) mol/L, and relaxation induced by EFS and bethanechol at 10(-3) mol/L and 10(-4) mol/L respectively, but acetaldehyde enhanced relaxation induced by ATP at high acetaldehyde level. Sodium nitroprusside-induced relaxation was not affected at any employed acetaldehyde concentration. This suggests that increasing the acetaldehyde level may contribute to male erectile dysfunction mainly by the inhibition of nitric oxide formation.

The Role K+ channel and the Effect of K+ channel Opener in the Relaxation of Vaginal Smooth Muscle / 대한비뇨기과학회지

No abstract available.

Results of Anterior Vaginal Wall Sling Operation for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To review the short-term result of Raz`s anterior vaginal wall sling as a treatment for intrinsic sphincter deficiency(ISD) and urethral hypermobility. MATERIALS AND METHODS: Twenty-three women who had intrinsic sphincter deficiency and urethral hypermobility were treated by AVL which employed an island of in situ anterior vaginal wall as a sling to support the bladder neck and mid-urethra. RESULTS: After a mean follow-up of 4.7(3-6)months, urinary incontinence was disappeared completely after the AVL. Complications included urinary retention in 6 patients, residual urine sensation in 5 patients which improved after intermittent catheterization. The other complication was low abdominal pain in 5 patients. CONCLUSIONS: It is suggested that AVL was effective treatment of ISD and urethral hypermobility with simple technique, low morbidity and high cure rate.

Comparative Studies of KATP Channel Openers in Penile Erection: Minoxidil, Diazoxide and Pinacidil / 대한비뇨기과학회지

PURPOSE: Currently available K+-channel openers are exclusively KATP channel openers. Among the KATP channel openers, minoxidil and diazoxide have been already used as antihypertensive agents clinically but their erectogenic activities have not been demonstrated. We performed this study to identify the effects of intracavernosal minoxidil and diazoxide on feline penile erection and also to compare that of pinacidil, relatively well-demonstrated K+-channel opener. MATERIALS AND METHODS: Using a feline model, the magnitude of penile erection caused by pinacidil was compared with that caused by minoxidil and diazoxide. With control erectile responses of intracavernosal PGE1 and papaverine, synergistic effects of erectogenic agents with KATP channel openers were also investigated in twenty-eight male cats in vivo. RESULTS: Intracavernosal injection of pinacidil increased intracavernosal pressure (ICP) in a dose-dependent fashion but minoxidil and diazoxide did not affect ICP significantly. Furthermore, pinacidil (10-5M/ml) enhanced the increase of ICP by PGE1 or papaverine but minoxidil and diazoxide did not. Noteworthy, pinacidil induced cavernous relaxation to the following erectogenic agents even in refractory cases to higher concentration (10-1M/ml) of erectogenic agent alone (n=7, p<0.01). CONCLUSIONS: These result suggests that minoxidil and diazoxide, which have been used as antihypertensive agents clinically, do not affect intracavernosal pressure. Among the KATP channel openers, pinacidil seems to be promising in producing penile erection as an alternate component of previous intracavernous injection. Also, pinacidil may be useful clinically because of the potential therapeutic effects as an intracavernosal agents in combination with PGE1 or papaverine.

Incidence of Detrusor Underactivity in Men with Prostatism Older than 50 years / 대한비뇨기과학회지

PURPOSE: It has been well known that 70-80% of men with prostatism actually manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU) or other abnormalities. Accordingly, the treatment of BPH by the results of symptom score, or uroflow may be partly incorrect. It is also well known that the pressure-flow study is the gold-standard to define the presence and degree of BOO. Therefore, we investigated pressure-flow study to identify non-obstructed, underactive detrusor function among the patients presented with prostatism. MATERIALS AND METHODS: This study included 96 patients older than 50 years (mean 69.6+/-5.8) with prostatism. All patients were assessed by history taking, symptom score, digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided into irritative and obstructive symptom groups according to their chief complaints. Urodynamic parameters between those two groups were analyzed and compared. RESULTS: Of the total 96 patients, detrusor instability was noted in 45(47%) at the filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed detrusor instability(62%); Of the 43 patients mainly presented with obstructive symptoms, only 12(28%) showed detrusor instability. Statistically significant correlation was found between irritative symptoms and detrusor instability as well as obstructed symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43 patients mainly presented with obstructive symptoms, BOO and DU was found in 23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms, BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant differences between irritative and obstructive symptom group as well as BOO and DU group in the clinical parameters as determined by symptom score, prostate size, and uroflowmetry. CONCLUSIONS: In this study, significant proportion(37%) of the whole patient population was classified as detrusor underactivity as diagnosed by urodynamics to which treatment for BPH may not be as effective as for those manifested with BOO. It is suggested that pressure-flow study is to be considered to patients with prostatism who didn`t show any symptomatic improvement despite the treatment for BPH.

Adenovirus-mediated Suicide Gene Therapy for Experimental Prostate Cancers with in Vivo Tumor Transduction Using the Herpes Simplex Virus Thymidine Kinase Gene/Acyclovir System / 대한비뇨기과학회지

PURPOSE: The goal of this in vivo study is to determine the feasibility and efficacy of suicide gene therapy using adenovirus-mediated herpes simplex virus thymidine kinase (HSV-TK) and the prodrug acyclovir (ACV) system in animal model of human prostate cancer. MATERIALS AND METHODS: We used a replication-defective adenoviral vector containing the beta-galactosidase gene (Ad-CMV-beta-gal) as a control and Adenovirus-Cytomegalovirus-Thymidine Kinase (Ad-CMV-TK) as the therapeutic vector under the trascriptional control of the CMV promoter. Transduction efficiency was assessed in vitro by infection of LNCaP and PC-3 human prostate cancer cells with Ad-CMV-beta-gal utilizing X-gal staining. TK activity in LNCaP and PC-3 cells infected with Ad-CMV-TK was determined by measuring the TK-mediated [3H]-Ganciclovir (GCV) phosphorylation. Sensitivity of LNCaP and PC-3 cells to Ad-CMV-TK in vitro was determined after infection of therapeutic vector with or without ACV. Subcutaneous tumors were established in athymic nude(nu/nu) mice with PC-3 cells, and Ad-CMV-TK/ACV sucide gene therapeutic system-induced inhibition of tumor growth in vivo was determined in separate and controlled experiments. RESULTS: The mean TK activity was significantly higher in Ad-CMV-TK-infected LNCaP and PC-3 cells than in cells infected with Ad-CMV-beta-gal that was used as a control(P<0.05). The growth of human prostate cancer cells with Ad-CMV-TK was significantly inhibited by the addition of GCV in vitro(p<0.05). In vivo experiments using PC-3 human prostate cancer animal model demonstrated that tumor volume and growth at the conclusion of experiment was significantly attenuated in the suicide toxic gene therapy (Ad-CMV-TK / ACV) group compared with Ad-CMV-TK, ACV and no treatment control groups(p<0.05). CONCLUSIONS: Adenovirus-mediated suicide gene therapy using HSV-TK / ACV system provides an effective therapy in an experimental human prostate cancer animal model by significantly inhibiting tumor growth.

Correlation Among Symptom Score, Peak Urine Flow, Prostate Volume and Obstructive Parameters as analyzed in Pressure-Flow Studies for the Patients wth Benign Prostate Hyperplasia in Whom TURP will be Contemplated

No abstract available.

Development of Osteoporosis after Hormonal Treatment for Prostate Cancer Patient / 대한비뇨기과학회지

PURPOSE: Combined androgen blockade(CAB) is often used in the management of advanced adenocarcinoma of the prostate. Recent case reports indicated that hypogonadism from CAB therapy is associated with osteoporosis and related fracture. The effect of CAB on bone mineral density(BMD) has not been adequately studied in men with prostate cancer. In this study, the possibility, frequency and severity of osteoporosis following CAB in prostate cancer patient was investigated. MATERIALS AND METHODS: A total of 19 men with advanced prostate cancer receiving CAB were evaluated for the presence of osteoporosis defined as bone mass 2.5 standard deviation below peak bone mass of young normal men(T-score). The BMB of the femoral neck and lumbar spine were measured. The BMD was then compared to the age-matched control value and reported as the Z-score. BMD measurements were compared to duration of CAB and Gleason score. RESULTS: Osteoporosis occurred in 10 of 15 patients in lumbar spine, and 4 of 18 patients in femoral neck. Osteoporosis was unrelated to the type of the CAB(orchiectomy, or LHRH-agonist). CAB caused a decrease in mean BMD of lumbar spine and femoral neck. There is a negative linear relation between mean BMD and duration of CAB(lumber spine; R2=0.059, Y=-2.368-0.016X, p>0.05, femoral neck; R2=0.089, Y=-1.923-0.020x, p>0.05). There is a statistically significant negative linear relationship between Gleason score and mean T-score of femoral neck(lumbar spine; R2=0.391, Y=-0.08-0.371X, p<0.05, femoral neck; R2=0.517, Y=0.855-0.450x, p<0.005). CONCLUSIONS: Our study provide evidence for acceleration of osteoporosis among men whose prostate cancers were treated with CAB. This study indicates a need for bone mineral density determination at the onset of CAB and at periodic intervals there after to begin appropriate therapy, undefined at this point, for prevention of osteoporosis and its complications aggravated by this therapy.

The Role of Prostanoids in vivo Feline Penile Erection / 대한비뇨기과학회지

PURPOSE: The widespread use of intracorporeal prostaglandin E1 (PGE 1) injection for the treatment of erectile dysfunction has focused interest on the physiological functions of prostanoids with the mechanism of action. We investigated in vivo feline penile erectile and contractile responses to prostanoids. MATERIALS AND METHODS: Under the general anesthesia, 26 mature male cats were conditioned normoxia and hypoventilated hypoxia with ventilator in room air(PH: 7.14+/- 0.47, PO2: 25.52+/-5.89mmHg, PCO2: 74.27+/-10.86mmHg). Vasoactive substances were infused via internal pudendal artery and the changes of intracavernous pressure to vasoactive substances were monitored with physiograph under normoxia and hypoxia with acidosis. RESULTS: Under normoxia, PGE1 induced dose-dependent cavernous relaxation and PGE1 was more potent than papaverine but less than acetylcholine. PGE1- induced cavernous relaxation was blocked by the K+-channel blockers, tetraethylammonium(TEA) and 4-aminopyridine, in dose-dependent manner but was completely reversed by the K+-channel opener, pinacidil. Calcium ionophore, ionomycin(10-3M/0.2ml) prevented the cavernous relaxation by PGE1 under hypoxia(n=6, p<0.01). PGI2 showed minimal cavernous relaxation with tumescence. Thromboxane A2(TXA2) attenuated the acetylcholine-induced relaxation CONCLUSIONS: This study showed that PGE2 relax feline cavernous smooth muscle. But the mechanism of PGE2 on feline cavernosum should be elucidated by the receptor binding study. These results suggest that PGE2 induced smooth muscle relaxation by the opening of Maxi-K+ (Kca) channel and subsequent hyperpolarization. It would be followed by a reduced opening of voltage-dependent Ca2+-channel and subsequent decrease of intracellular Ca2+concentration.

A Giant Mullerian Duct Cyst in Pelvic Cavity / 대한비뇨기과학회지

A Case of Mullerian duct cyst as a large pelvic mass encountered in 25-year-old man is introduced. The treatment, pathological and radiological appearence are discussed, and also the embryology and history of this entity are reviewed.

Two Cases of Retroperitoneal Lymph Node Dissection for the Treatment of Yolk Sac Tumor of Testis / 대한비뇨기과학회지

Germ cell tumors in children are rare but the predominent pathologic type is the yolk sac carcinoma. And there are no specific guidelines for the treatment of the young child with a testis tumor of the yolk sac or endodermal sinus type. Initial treatment of radical orchiectomy is not in question. However, because of its presumed less virulent character, especially in children less 2 years old, confusion remains As to adjunctive treatment for yolk sac carcinoma. Although chemotherapy is so effective its toxicity cannot be minimized. Therefore, adjunctive chemotherapy should be reserved for those patients who have lymphatic spread. Young children with yolk sac tumors are not immune to metastatic disease and, regardless of age, should be treated with retroperitoneal Iymphadenectomy for staging and appropriate treatment regimens. Herein we report two cases of yolk sac carcinomas in children treated with adjunctive chemotherapy and nerve sparing retroperitoneal lymphadenectomy.

Interleukin-4 Receptor Expression on Human Renal Cell Carcinoma Cell Lines by a Reverse Transcription-Polymerase Chain Reaction / 대한비뇨기과학회지

Recently interleukin-4 (IL-4) has been suggested to be a promising therapeutic agent for the malignant tumors of both murine and human origin. The effect of IL-4 is mediated by IL-4 receptor (IL-4R), which has been shown to be expressed in many normal and tumor cell lines. We herein tested two cell lines of human renal cell carcinoma (RCC), Caki-1 and CURC-II, for the expression of IL-1R gene. On the reverse transcription-polymerase chain reaction study, both cell lines expressed IL-4R mRNA. The present study suggests that it would be worthwhile to investigate the anti-tumor effect of IL-4 on Caki-l and CIJRC-II, which may help to develop new therapeutic strategies for RCC using IL-4.

Malignant inverted papilloma of the urinary bladder: the histopathological aspect of malignant potential of inverted papilloma

To investigate the histopathological characteristics of inverted papillomas of the urinary bladder, including the possibility of malignant transformation, we studied the indicators of cellular proliferation activity in 7 inverted papillomas of the bladder including two cases of malignant inverted papilloma of the bladder. PCNA expression rates in two cases of malignant inverted papilloma were higher than in benign inverted papillomas. Mean numbers of AgNORs per nucleus in malignant inverted papillomas were much more than in benign inverted papillomas. The c-erbB-2 oncoprotein was expressed only in malignant inverted papillomas. These results suggest that PCNA expression rate, mean number of AgNORs per nucleus and c-erB-2 oncoprotein expression may be merited as good indicators to detect the inverted papilloma with more proliferative and aggressive lesions, and with the potential of malignant transformation.

A Case of Verrucous Carcinoma of Scrotum / 대한비뇨기과학회지

The variant of squamous carcinoma of the scrotum known as verrucous carcinoma is very rare, but has a distinct clinical and pathological condition which has a significantly better prognosis than the more common infiltrative type. We report one case of verrucous carcinoma of the scrotum that was treated by wide local excision with placing the bilateral testes subcutaneously in the thigh and a split-thickness skin graft to cover the scrotum. And we tried to detect human Papillomavirus (HPV) type 6, 11, 16 and 18 with DNA in situ hybridization method.

The Changes of Histopathology, Proliferation Activity, and Nuclear DNA Content N-butyl-N-(4-hydroxybuty1) Nitrosamine(BBN) Induced Bladder Cancer in Rats / 대한비뇨기과학회지

To evaluate the process of tumor progression in chemical carcinogenesis of the bladder cancer. 0.05% BBN was administered to female Wistar rats for 12 weeks. The rats were divided into six groups and sacrificed every or every two weeks from the 12th to the 20th weeks. Cellular touch imprints of urinary bladder for DNA content analysis by image analyzer and mean AgNORs count per nucleus were performed immediately after sacrifice. Thereafter, the urinary bladder was embedded in paraffin for histopathological examination.On histopathological findings, simple hyperplasia was found in all cases after 12 weeks therapy of BBN. Atypical hyperplasia of the bladder, indicative of a precancerous state, was found in 88.9% of the 12 weeks group, 83.3% of the 13 weeks and in all cases after 14 weeks therapy of the BBN. Bladder cancer was found in 33.3% of the 13 weeks, 55.6% of the 14 weeks, and 100% of the above 16 weeks therapy group. The nuclear DNA content of 21 cases of atypical hyperplasia was diploid in 19 cases(91.5%) and aneuploid in 2 cases(9.5%). DNA aneuploidy was found in 18 cases(66.7%) among the 27 cases of the cancer group. Mean AgNORs count per nucleus and proliferation index by flowcytometry were higher in atypical hyperplasia and cancer group than these of simple hyperplasia and control group, but those differences according to histologic type were not statistically significant. And there was statistically significant correlation between proliferation index and mean AgNORs count per nucleus(r=0.57, p<0.05). These data suggest that the change of nuclear DNA content might occur during the early phase of the carcinogenesis in BBN-induced bladder cancer of rats.

Pharmacophysiological Change of Rabbit Corpus Cavernosum under Hypoxia / 대한비뇨기과학회지

Local contributing factors in penile erection are trabecular smooth muscle, endothelium, trabecular fibroelastic components, tunica albuginea and local neuro-control. There are three neuroeffector systems in local neuro-control for penile erection. One is adrenergic system causing contraction and the others are cholinergic and noncholinergic nonadrenergic system causing relaxation of corpus cavernosum under normoxia. The effect of these systems under hypoxic condition however is not fully understood. The aims of this study were to detect the pharmacophysiological changes of corporal smooth muscle about 3 local neuroeffector systems under hypoxia in the rabbit and to apply the results of study to the management of the priapism. The strips of rabbit corporal tissues were studied for isometric tension measurement under normoxia, hypoxia and cooling condition in the organ chambers. Influence of NL- monomethyl-L-arginine (L-NMMA) and L-arginine to acetylcholine under normoxia and effects of phenylephrine, norepinephrine, acetylcholine, VIP, endothelin 1, papaverine and KCI on the rabbit corpus cavernosal tissue were monitored under normoxia and hypoxia and changes under cooling condition were observed. Relaxing effect of acetylcholine under normoxia was suppressed with L-NMMA and this suppression was reversed with L-arginine. Relaxation with acetylcholine and contraction with endothelin 1 were suppressed under hypoxic condition. Contracting effect of norepinephrine and phenylephrine was stronger under hypoxia or cooling condition than normoxia or 37 degrees C condition respectively. Relaxing effect of VIP and papaverine on corpus cavernosa was similar under normoxia or hypoxia. These results suggest that endothelium-dependent relaxation by cholinergic and noncholinergic nonadrenergic system and endothelium-dependent contraction by endothelin 1 are suppressed under hypoxic condition. VIP related noncholinergic nonadrenergic relaxation and direct relaxation effect of papaverine to corporal smooth muscle are preserved under hypoxia. Application of adrenergics and local irrigation with cold saline would be effective in the management of priapism.

Nuclear Expression of Mutant p53 protein in Transitinal Cell Carcinoma of the Bladder Detected by Immunohistochemistry: The Correlative Study with Proliferating Cell Nuclear Antigen Expression, Nucleolar Organizer Regions per Nucleus and Flow cytometric P / 대한비뇨기과학회지

We examined the nuclear overexpression of p53 protein by immunohistochemical analysis of the deparaffinized tumor tissue specimens from 45 patients with transitional cell carcinoma of the bladder. The data were then correlated with conventional prognostic variables such as histologic tumor grade, stage and DNA ploidy. In addition, we related the expression of the 53 protein to indicators of cellular proliferative activity, including proliferating cell nuclear antigen(PCNA), mean number of silver-binding nucleoar organizer regions(AgNORs) per nucleus, flow cytometric S-phase fraction(SPF) and proliferation index(PI). Survivals of the patients according to mutant p53 protein expression, stratified by histologic tumor grade and stage were analyzed.None of the urothelial cells from normal bladder specimens showed nuclear expression of mutant p53 protein. Mutant p53 protein expression was not associated with histologic tumor grade, stage, flow cytometric SPF and PI, but there was an association between mutant p53 protein expression and flow cytometric DNA ploidy with marginal statistical significance(p=0.0892) There was statistically significant difference of mutant p53 protein expression between low and high AgNORs counts per nucleus(p=0.0108), but here was no significant correlation between mutant p53 protein expression and PCNA expression rate. Using Kaplan-Meier analysis, we could not identify the statistically significant difference of survivorship between patients with and without mutant p53 expression. These results suggest that immunohistochemical analysis of bladder cancer specimens could be a good method of screening for the presence of mutant p53 protein, and mutant p53 protein expression may be an indicator of bladder cancer with more proliferative and/or aggressive activity, but it may not be an clinically useful prognostic factor in patients with bladder TCC.