[Pseudosarcomatous myofibroblastic proliferation of the bladder-case report].

A 66-year-old man with a history of sporadic von Recklinghausen' s disease was treated for pseudosarcomatous myofibroblastic proliferation in the bladder. The patient had a history of repetitive recurrence of bladder carcinoma requiring transurethral resection (TUR) 4 times and 1 course of intravesical BCG instillation. Three months after the fourth TUR, an intravesical solid mass 4 cm in diameter was detected. Suspicion of recurrent bladder carcinoma led to a fifth TUR procedure. Pathological findings showed submucosal growth of myofibroblasts with myxoidal stroma and we made a diagnosis of Pseudosarcomatous myofibroblastic proliferation. The patient was well with no evidence of recurrence after 1 year.

A study of plasma bicalutamide concentrations in hemodialysis patients.

Bicalutamide is an anti-androgen that is used worldwide to treat prostate cancer (CaP). However, there are no data on blood bicalutamide concentrations in hemodialysis (HD) patients with CaP. Therefore, we investigated the plasma levels of bicalutamide during the peridialysis period in this population. The study group included 5 HD patients with CaP who had been treated with bicalutamide (80 mg/day) for at least 3 months. Blood samples were taken during and between HD sessions and the plasma concentrations of the active R enantiomer (R-bicalutamide) were assessed using an HPLC assay. The plasma R-bicalutamide levels on the non-dialysis day were measured in 2 patients (patients 1 and 2) immediately before dosing and 8 and 24 h after dosing. These levels were 18,730, 19,090 and 19,420 ng/ml (patient 1), and 4,522, 4,581, and 5,296 ng/ml (patient 2), respectively. The mean plasma levels of R-bicalutamide in all 5 subjects just before HD, and 2 and 4 h after the start of HD were 8,726, 9,354 and 10,068 ng/ml, respectively. These results show that bicalutamide does not accumulate and is not diluted in the blood circulation of HD patients when given at the normal dosage used in the general population.

[Dextranomer beads in stabilized non-animal sodium hyaluronate gel (NASHA/Dx gel) for vesicoureteral reflux: multi-center study in Japanease patients].

PURPOSE: To investigate the efficacy and safety of endoscopic treatment with the injectable gel of dextranomer beads in stabilized non-animal sodium hyaluronate (NASHA/Dx gel) administered submucosally close to the proximity of ureteral orifice, we performed the multi-center open study of Japanese patients with vesicoureteral reflux (VUR). We herein report the results of the study. SUBJECTS AND METHODS: Patients aged > or = 1 year with grade II-IV VUR underwent endoscopic injection with NASHA/Dx gel. Post-treatment assessment was done by voiding cystourethrography (VCUG) at 3 and 12 months. Patients with VUR grade II-IV at 3 months underwent re-treatment, with VCUG assessment 3 and 12 months after retreatment. Positive response to treatment was defined as reflux grade 0 or 1. RESULTS: The initial treatment was conducted to 116 ureters in 73 patients. The per-protocol efficacy population included 97 ureters in 71 patients. On a per-ureter basis, the positive response rate at 12 months after the last endoscopic treatment was 69.1%, compared with 62.0% on a per-patient basis. Improvement in reflux grade was shown to be statistically significant at both 3 months post initial treatment and 12 months post last treatment. Positive response rate decreased with increasing baseline reflux grade. There were only two mild adverse events (AEs) and one moderate laboratory fluctuation which were potentially relating to NASHA/Dx gel. CONCLUSIONS: This study has shown that endoscopic injection of NASHA/Dx gel is effective and well tolerated in Japanese patients with VUR. First-line use of this treatment for VUR could potentially be considered for Japan also.

[Two cases of prostatic carcinoma causing a disorder of gastrointestinal transit due to rectal stenosis].

A 64-year-old man, was admitted to the Department of Gastroenterology at another hospital in October, 2005 because of constipation and urinary retention. Endoscopic and computed tomographic (CT) examinations of biopsy specimens obtained from the rectal mucous membrane which appeared to be thickened revealed evidence of proctitis but no evidence of malignancy. The patient was referred to our hospital because of a high prostate specific anyigen (PSA) level (74.17 ng/ml), and hydronephrosis accompanied with hydroureter at the right side. Biopsy specimens taken from a prostatic tumor through a transrectal route showed histological features consistent with anaplastic adenocarcinoma which was positively stained with PSA antibody. We treated the patient with maximium androgen blackade (MAB), resulting in a decrease in plasma PSA level and amelioration of constipation as well. A 77-year-old man, visited a hospital because of constipation and high plasma carcinoembryonic antigen and carbohydrate antigen (CA) 19-9 values in May, 2005, and was diagnosed as having hyperplastic mucous membrane and atypical glands of the rectum by means of a rectal biopsy. Having been referred to our hospital, the patient received a prostate biopsy, specimens of which revealed moderately differentiated adenocarcinoma with negative PSA staining. A pelvic evisceration was performed. The eviscerated samples showed no abnormality in the rectal mucous membrane but cancer with light PSA staining in the prostatic ducts. The hormone therapy was initiated in the patient under the diagnosis of anaplastic cancer in the prostate. Since the therapy for the invasion of prostatic cancer on the rectum differs markedly from that for a primary tumor in the rectum, it is very important to differentiate accurately the one from the other.

Clinical outcome of high-grade non-muscle-invasive bladder cancer: a long-term single center experience.

OBJECTIVES: To report on the long-term clinical outcome of high-grade (G3) non-muscle-invasive bladder cancer (NMIBC) patients treated at a single institution. METHODS: A retrospective analysis of 93 patients with NMIBC treated between January 1991 and September 2005 was performed. Patients were divided into three groups on the basis of treatment they received after transurethral resection (TUR) of the bladder. Forty-seven patients received adjuvant intravesical epirubicine after TUR of the bladder (Group 1). Twenty-four patients received intravesical bacillus Calmette-Guérin (BCG) (Group 2). A radical cystectomy (RC) was performed on twenty-two patients (Group 3). RESULTS: Median follow up was 68.7 months. Overall, thirty patients (33%) experienced tumor recurrence. The survival rates of Group 3 were significantly higher than the 71 patients undergoing conservative therapy (Group 1 and 2). There was no statistically significant difference between Group 1 and 2, but treatment failure in patients treated with epirubicine was significantly higher than in those with BCG. Cases without concomitant carcinoma in situ (CIS) showed statistically significantly higher survival rates than those with concomitant CIS. CONCLUSIONS: RC provides excellent survival rates in patients with high-grade NMIBC. Adjuvant therapy with BCG after a complete TUR of the bladder may be an effective treatment for high-grade NMIBC. If a conservative treatment is preferred to RC, co-existence of a concomitant CIS should be considered with caution.

A case of renal cell carcinoma with intrahepatic vena caval tumor thrombus successfully managed by surgery in a long-term chronic hemodialysis patient with liver cirrhosis.

A 54-year-old man who had been under hemodialysis therapy for 16 years presented with gross hematuria at our department in February 2005. Imaging findings revealed right renal tumor of8.2 cm in diameter. In addition, the tumor extended into inferior vena cava at the level of the hepatic vein. There were no findings of distant metastasis. Right radical nephrectomy and thrombectomy were performed on April 2006. Histopathological analysis showed that the tumor was renal cell carcinoma of clear cell type, grade 2. Postoperative course was uneventful, and the adjuvant therapy with interferon alpha was initiated. He has been free from recurrence for 22 months after surgery.

Effects of direct injection of dehydrated ethanol on PC3 human prostate cancer cells in nude mice: preliminary study.

OBJECTIVES: The effect of direct local injection of dehydrated ethanol on hormone-independent prostatic carcinoma cells (PC3 cells) implanted in nude mice was investigated. METHODS: PC3 tumors were implanted subcutaneously into 30 nude mice. Three weeks later, dehydrated ethanol was injected directly into the tumors. Twenty-three animals received an injection of ethanol at a volume of 40 microL, 80 microL, or 160 microL, and were divided into a low-dose group (n = 11) and a high-dose group (n = 12) on the basis of the ethanol/tumor volume ratio (<30% versus> or =30%). The control group (n = 7) was injected with 40 microL of physiological saline. The tumor volume before treatment was 324.9 +/- 110.9 mm(3) and was assessed as well as 1 day, 4 days, 1 week, 2 weeks, and 3 weeks after injection. Then the changes of tumor volume were compared between the two ethanol groups (low-dose group and high-dose group) and the control group. Histological examination was performed for up to 3 weeks after injection. RESULTS: Assessment of tumor volume showed that the ethanol/tumor volume ratio was 16.1 +/- 5.3% in the low-dose group (n = 5) and 51.8 +/- 20.3% in the high-dose group (n = 6). Tumor growth was significantly inhibited after 1 and 2 weeks in the ethanol groups compared with the control group (n = 3). After 3 weeks, there was a tendency for tumor regrowth in the low-dose group, but growth inhibition was maintained in the high-dose group. Histological examination showed tumor degeneration and necrosis with feeding vessel obstruction in the acute phase. CONCLUSIONS: Local injection of dehydrated ethanol regressed tumors of prostatic carcinoma cells in nude mice, with the degeneration of tumor cells and occlusion of feeding vessels.

[A case of bilharziasis diagnosed 10 years later].

A 31-year-old Japanese man had macroscopic hematuria 5 or 6 years previously. When he was examined at a local hospital, he was pronounced normal. However he still had macroscopic hematuria, so he visited our department. Urine cytodiagnosis was class II. Cystoscopy revealed irregular mucosa at the anterior wall and dome of the bladder. CT and MRI also demonstrated irregular thickness at the anterior wall of the bladder. A diagnosis of bilharziasis was made by histological specimen obtained by TUR-biopsy. The specimen did not show evidence of malignancy. When questioned about overseas travel, he said he had visited Malawi in Africa when he was 20 years old. As international exchange between Japan and other countries is now increasing, we will be examining more patients who have traveled to epidemic areas. In such patients, we should consider the possibility of Schistosomiasis.

Local injection of a sustained-release antiandrogen formulation into a target prostatic site: an experimental study.

OBJECTIVE: To evaluate the efficacy of one intraprostatic injection with sustained-release chlormadinone acetate (CMA-SR) in rats. MATERIALS AND METHODS: CMA, a steroidal antiandrogen, was enclosed in microcapsules for sustained-release (CMA-SR). Forty-eight rats were divided into group A (intraprostatic CMA-SR 8 mg/kg, one injection), group B (as A but with 25 mg/kg), group C (intraprostatic, vehicle only) and group D (subcutaneous, s.c., CMA 10 mg/kg once daily for 4 weeks). Prostate weight, body weight and plasma testosterone levels were measured for up to 4 weeks. RESULTS: After a s.c. injection with CMA-SR, residual CMA at the s.c. injection site decreased with time. The injected prostate lobe weighed significantly (P < 0.05) less than the contralateral lobe in groups A and B, and significantly (P < 0.05) less in groups A and B than in group C. Both prostate lobes in group D were significantly (P < 0.05) smaller than in group C (P < 0.05). Plasma testosterone levels were significantly lower in group D than in group C (P < 0.05). CONCLUSIONS: The sustained release of CMA after one intraprostatic injection persistently decreased the weight of the target prostate. This new concept of antiandrogen therapy might therefore be effective in man, with fewer systemic adverse reactions.

[Clinico-pathological investigation of upper urinary tract tumors in patients with normal renal function and in patients with end stage renal disease].

AIMS: To clinically investigate upper urinary tract tumors in end stage renal disease (ESRD) patients. PATIENTS AND METHODS: Between 1988 and 2003, a study was made of 153 patients who underwent surgical treatment for upper urinary tract tumors in the Department of Urology, Tokyo Women's Medical University. Of these, 10 had ESRD while 143 had normal renal function. Comparisons were made of the following variables between the two groups: patient's background, clinical findings, surgical procedures, pathological findings, prognosis, depth of tumor cell invasion, tumor grades, postoperative survival rates, cancer-specific survival rates, and complications. RESULTS: Ten ESRD patients with upper urinary tract tumors were comprised of 5 males and 5 females with a median age of 59 (40-71) years and an average hemodialysis period of 71 (0-279) months. Macroscopic hematuria appeared in seven cases (70%) at the onset, and tumors occurred at the renal pelvis in nine cases (90%). As to the T stage, seven cases (70%) were pT2 or more and all 10 cases (100%) exhibited grade 2 or higher in ESRD patients, yielding no significant differences with the cases of normal renal function. In addition, there was no significant difference in both groups with respect to postoperative survival rates and cancer-specific survival rates in cases with curative resection. CONCLUSION: Although upper urinary tract tumors had been considered to exhibit higher grades and stages of malignancy in ESRD cases than in those with normal renal function, the present results showed that the clinico-pathological features are similar in both patients groups. Given that there was no significant difference in postoperative survival rates and cancer-specific survival rates, radical surgery should be also indicated, if possible, for the ESRD patients with upper urinary tract tumors as well as the patients with normal renal function.

Stability of the BK polyomavirus genome in renal-transplant patients without nephropathy.

To clarify the stability of the BK polyomavirus (BKPyV) genome in renal transplant (RT) recipients, three to five complete BKPyV genomes from each of six RT recipients with surviving renal allografts were molecularly cloned. The complete sequences of these clones were determined and compared in each patient. No nucleotide difference was detected among clones in two patients, and a few nucleotide variations were found among those in four patients. In each of these patients a parental sequence (usually the major sequence), from which variant sequences (usually minor sequences) with nucleotide substitutions would have been generated, were identified. A comparison between the parental and variant sequences in each patient identified a single nucleotide substitution in each variant sequence. From these findings, it was concluded that the genome of BKPyV is stable in RT recipients without nephropathy, with only minor nucleotide substitutions in the coding region.

Retroperitoneoscopic adrenalectomy: lateral versus posterior approach.

PURPOSE: We used a lateral or posterior approach to perform retroperitoneoscopic adrenalectomy for adrenal tumors and compared the results to determine which approach is more advantageous. PATIENTS AND METHODS: We removed 42 adrenal tumors from 42 patients by retroperitoneoscopic surgery. We used the posterior approach in 17 cases and the lateral approach in 25 cases. We compared the operating time, complications, and surgical advantages for the two approaches. RESULTS: The mean operating time was significantly shorter with the lateral approach, 141 +/- 64 minutes v 225 +/- 88 minutes for the posterior approach (P = 0.0019), which we believe reflects the technical advantages of the lateral approach. Complications included one case of pneumothorax and an instance of pulmonary edema in a patient with chronic renal failure using the lateral approach and one occurrence each of pneumothorax and bleeding using the posterior approach. Retroperitoneoscopic adrenalectomy could not be performed in 1 of 25 cases (4.0%) using the lateral approach and in 3 of 17 cases (17.6%) using the posterior approach. CONCLUSION: Our series suggests that the lateral approach is preferable to the posterior approach for retroperitoneoscopic adrenalectomy.

Subtypes of BK virus prevalent in Japan and variation in their transcriptional control region.

BK polyomavirus (BKV) is ubiquitous in the human population, infecting children without obvious symptoms, and persisting in the kidney in a latent state. In immunosuppressed patients, BKV is reactivated and excreted in urine. BKV isolates have been classified into four subtypes (I-IV) using either serological or genotyping methods. To elucidate the subtypes of BKV prevalent in Japan, the 287 bp typing region in the viral genome was PCR-amplified from urine samples of 45 renal transplant (RT) and 31 bone-marrow transplant (BMT) recipients. The amplified fragments were subjected to a phylogenetic or RFLP analysis to determine the subtypes of BKV isolates in urine samples. Subtypes I, II, III and IV were detected, respectively, in 70-80, 0, 2-3 and 10-20 % of the BKV-positive patients in both patient groups. This pattern of distribution was virtually identical to patterns previously demonstrated in England, Tanzania and the United States, suggesting that BKV subtypes are distributed similarly in various human populations. Furthermore, transcriptional control regions (TCRs) were PCR-amplified from the urine samples of 25 RT and 20 BMT recipients, and their nucleotide sequences were determined. The basic TCR structure (the so-called archetype configuration) was observed in most isolates belonging to subtypes I, III and IV (subtype II isolates were not available), albeit with several nucleotide substitutions and a few single-nucleotide deletions (or insertions). Only three TCRs carried extensive sequence rearrangements. Thus, it was concluded that the archetypal configuration of the BKV TCR has been conserved during the evolution of BKV.

Transurethral ethanol injection therapy for prostatic hyperplasia: 3-year results.

PURPOSE: We assessed the medium-term (3-year) efficacy of transurethral ethanol injection therapy of the prostate (EIP) for benign prostatic hyperplasia. MATERIALS AND METHODS: A total of 34 patients were followed for a median of 4.3 years after EIP. Mean age was 68.1 years and mean baseline prostate volume was 49.3 ml. With the patient under combined sacral and urethral anesthesia, dehydrated ethanol was injected into the prostate with endoscopic guidance. A urethral catheter was inserted postoperatively. RESULTS: Mean total ethanol dose was 6.4 ml and a catheter was required for a mean of 7.6 days postoperatively. Mean International Prostate Symptom Score was 21.8 points before EIP (in 34 patients), and decreased to 13.1 points after 3 years (in 17, p <0.01). Mean quality of life index decreased from 5.0 points before EIP to 2.8 points after 3 years (p <0.001). Mean peak urine flow rate was 8.3 ml per second before EIP and increased to 12.7 ml per second after 3 years (p <0.01). Mean residual urine volume decreased from 93 ml before EIP to 28 ml after 3 years (p <0.01). Mean prostate volume decreased from 49.3 ml before EIP to 45.7 ml after 1 year (p <0.001), but increased to 51.4 ml after 3 years. No major complications were experienced. By 3 years after surgery 59.0% of patients had not required further treatment. CONCLUSIONS: Transurethral EIP caused minimal complications while maintaining improvement of the prostate symptom score and an increased peak urine flow after 3 years.

[The clinical efficacy of Bladder Chek NMP22 in urothelial cancer].

The purpose of this study is to investigate the clinical efficacy of a quick test for NMP22 (Nuclear Matrix Protein 22), Bladder Chek NMP22, as a screening test for urothelial cancers. The subjects include 51 cases(43 cases with pathologically confirmed bladder cancer, and 8 cases with upper urothelial cancer). Bladder Chek NMP22 revealed false positive in the urine with more than 1 x 10(5)/microliter of erythrocytes and 1 x 10(3)/microliter of white blood cells. Thus, showing that Bladder Chek NMP22 was not relatively affected by the contaminated erythrocytes and white blood cells, compared with other conventional methods to detect urinary malignant disease. In 51 cases diagnosed of having pathologically urothelial cancers, the sensitivity of Bladder Chek NMP22 was 56.8%. Bladder Chek NMP22 demonstrated more excellent sensitivity than the other methods. The positivity of Grade3 patients was 68.4%, 68.4% and 63.2% by Bladder Chek NMP22, NMP22 ELISA and urinary cytology. In contrast, the positivity rate for the patients with Grade1 stage was 58.3%, 33.3% and 8.3%. There is no significance of positivity rate between each examination in patients with high grade cancer. However Bladder Chek NMP22 demonstrated the higher positivity in patients with low grade cancer. Bladder Chek NMP22 test could be an easy and confidential method to detect urothelial cancers, especially with low grade, as a screening examination.