[Evaluation of utility index of quality of life (QOL) in prostate cancer patients: comparison of QOL utility index EuroQol-5D (EQ-5D) and visual analogue scale (VAS) with health-related QOL questionnaires SF-36 and EPIC].

PURPOSE: For the management of patients with localized prostate cancer, a number of therapeutic options are available. To compare the therapeutic modalities, it is important and necessary to evaluate economical aspects based on cost-effectiveness analysis. In addition, the survival time adjusted by quality of life (QOL), quality adjusted life year (QALY), is more reliable than the crude survival time. Thus, the usefulness of the commonly used QOL utility indexes, EuroQol-5D (EQ-5D) and visual analogue scale (VAS, 0-100 points), was investigated in prostate cancer patients. PATIENTS AND METHODS: A total of 81 patients with prostate cancer were included. The patients were asked to answer the four sets of questionnaires (EQ-5D, VAS, SF-36 and EPIC). The QOL utility indexes (EQ-5D and VAS) were evaluated in relation to the general and prostate cancer-specific QOL questionnaires (SF-36 and EPIC, respectively). RESULTS: The results of EQ-5D and VAS were significantly correlated to all domains of the general QOL questionnaire (SF-36). On the contrary, no remarkable relationship of EQ-5D and VAS was observed with any domain (urinary, bowel, sexual or hormonal) of the prostate cancer-specific QOL questionnaire (EPIC). There was significant and close correlation between the actual values of VAS and the estimates of VAS calculated from SF-36 data (R = 0.53, p < 0.0001). CONCLUSIONS: The QOL utility indexes (EQ-5D and VAS) are pertinent to evaluation of QOL utility index in prostate cancer patients and can be utilized for cost-utility analysis. It is suggested that the accumulated data of SF-36 could be used by conversion to QOL utility index.

A case of fibrous pseudotumor originating from tunica vaginalis testis.

A 32-year-old man presented with a complaint of painless palpable mass of the left scrotal content. Based on the preoperative diagnosis of scrotal or spermatic cordal benign tumor, local excision was performed. The histological diagnosis was scrotal fibrous pseudotumor. In Japan, only 35 cases of fibrous pseudotumor of the scrotum have been reported including our case. Orchiectomy was performed in 15 cases. Fibrous pseudotumor is a benign fibroproliferative lesion with dense hyalinization and sometimes focal calcification. It may be induced by previous intrascrotal inflammatory events such as epididymitis, an infected hydrocele, prior surgery or trauma. Although a relatively rare disease, a fibrous pseudotumor should be considered in the differential diagnosis of testicular and testicular tunica tumors. Our case was of a benign pseudotumor and orchiectomy could have been avoided.

Association of absence of intestinal oxalate degrading bacteria with urinary calcium oxalate stone formation.

AIM: Urinary concentration of oxalate is considered an important factor in the formation of renal stones. Dietary oxalate is a major contributor to urinary oxalate excretion in most individuals. Furthermore, oxalate degrading bacteria have been isolated from human feces. We investigated the significance of oxalate degrading bacteria for urinary oxalate excretion and urinary stone formation. METHODS: Twenty-two known calcium oxalate stone-forming patients (stone formers) and 34 healthy volunteers (non-stone formers) were included in the study. Stool specimens were inoculated into pepton yeast glucose (PYG) medium supplemented with oxalate under anaerobic condition at 37 C for one week. After the incubation period, each colony was checked for the loss of oxalate from the culture medium. A 24-h urine sample was collected in 43 individuals and analyzed for oxalate excretion. RESULTS: Twenty-eight of 34 (82%) healthy volunteers and 10 of 22 (45%) calcium oxalate stone formers were colonized with oxalate degrading bacteria. Calcium oxalate stone formers were more frequently free of oxalate degrading bacteria (P < 0.01). Urinary excretion of oxalate in those with oxalate degrading bacteria was significantly less than in those without oxalate degrading bacteria (P < 0.05). Hyperoxaluria (> 40 mg/day) was found in four of 27 individuals (15%) with oxalate degrading bacteria compared to seven of 16 (44%) without oxalate degrading bacteria (P < 0.05), suggesting an association between the absence of oxalate degrading bacteria and the presence of hyperoxaluria. CONCLUSION: The absence of oxalate degrading bacteria in the gut could promote the absorption of oxalate, thereby increasing the level of urinary oxalate excretion. The absence of oxalate degrading bacteria from the gut appears to be a risk factor for the presence of absorptive hyperoxaluria and an increased likelihood of urolithiasis.

Annual changes of the incidence and clinical characteristics of magnesium ammonium phosphate urinary stones.

BACKGROUND: Magnesium ammonium phosphate (MAP) urinary stones account for the majority of staghorn stones and frequently cause a non-functioning kidney. In the present study, we examined the annual changes of the number and clinical characteristics of MAP stones. METHODS: The annual incidence of MAP stones was investigated in 2619 patients with urinary stones in whom composition of the stone was analysed at Chiba University Hospital between 1964 and 1999. In addition, the annual number of patients with MAP stones was examined at Funabashi Clinic. In a total of 644 patients with MAP stones, age and sex of the patients, location and size of the MAP stones, urinary cultures and etiological factors were analysed. RESULTS: The number of MAP stones in the lower urinary tract was relatively constant. In contrast, MAP stones in the upper urinary tract had dramatically decreased since 1989, resulting in an increase in the rate of MAP stones in the lower urinary tract. Age distribution of the MAP stone patients ranged from 10 years to > 80 years, with the majority aged 30-60 years. The proportion of larger MAP stones in the upper urinary tract increased. There was no significant difference in prevalence of urine cultures. Among etiological factors for MAP stones, difficulty on urination tended to be common in recent years. CONCLUSION: The number of MAP stones, especially in upper urinary tract, has been decreasing during the last decade. At present, treatment of urinary tract obstruction seems important for the management of MAP stones in lower urinary tract.

Usefulness of diagnostic imaging in primary hyperparathyroidism.

BACKGROUND: In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. METHODS: We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and 99mTc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. RESULTS: The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. CONCLUSION: In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy.

Distinct patterns of chromosomal losses in clinically synchronous and asynchronous bilateral renal cell carcinoma.

PURPOSE: Bilateral renal cell carcinoma has been reported to occur in 1% to 4% of patients with renal cancer. However, whether bilateral renal cell carcinoma involves metastatic lesions of the contralateral kidney or develops as simultaneous primary tumors remains unclear to date. Thus, we investigated chromosomal losses and von Hippel-Lindau (VHL) gene abnormalities in bilateral tumors from patients with nonfamilial bilateral renal cell carcinoma. MATERIALS AND METHODS: Genomic DNA was exacted from 2 tumors in 8 patients each with nonfamilial bilateral renal cell carcinoma, including clinically asynchronous and synchronous disease in 5 and 3, respectively. The DNA was then subjected to microsatellite analysis on 13 chromosomal loci. In addition, polymerase chain reaction-single nucleotide specific conformation polymorphism analysis and direct sequencing of 3 exons of the VHL gene were performed. RESULTS: All 5 asynchronous cases showed loss of the same allele in bilateral tumors, indicating a common clonal origin. In contrast, 2 of the 3 synchronous cases showed different patterns of chromosomal loss in the right and left renal tumors, suggesting bilateral primary origins. The other synchronous case with loss of the same allele in each tumor involved right stage T3b and left stage T1a neoplasms. No VHL gene mutations were detected in any case. CONCLUSIONS: Except for a small number of cases synchronous and asynchronous bilateral renal cell carcinoma may represent the simultaneous appearance of separate primary tumors and metastatic progression from the contralateral kidney, respectively.