Screening for prostate cancer using prostate-specific antigen testing in Japanese men on hemodialysis.

OBJECTIVES: The objectives of this study were to evaluate the usefulness of serum prostate-specific antigen (PSA) screening in detecting prostate cancer in Japanese men on hemodialysis, and to analyze features of prostate cancer detected in these patients. MATERIALS AND METHODS: This study included 115 male hemodialysis patients aged > 55 years who agreed to the measurement of serum PSA value (group A) and 7529 men aged > 55 years participating in a PSA mass screening test in Kobe City (group B) between April 2005 and March 2006. Prostate biopsy was recommended in men with serum PSA > 4.0 ng/ml in both groups. Seventy-eight patients with normal renal function aged > 55 years diagnosed as having prostate cancer during the same time period as groups A and B were also included as a comparison group (group C). RESULTS: There was no significant difference in the distribution of serum PSA values between groups A and B. Prostate biopsy was performed in 8 and 205 men in groups A and B, respectively, and prostate cancer was detected in 5 and 68 in groups A and B, respectively; that is, there was no significant difference in the rate of positive prostate biopsy between these two groups (group A, 62.5%; group B, 33.2%), while the cancer detection rate in group A (4.3%) was significantly greater than that in group B (0.90%). In addition, there was no evident metastasis in five patients on hemodialysis who were diagnosed as having prostate cancer, and their serum PSA, clinical T stage and biopsy Gleason score were similar to those in group C. However, the percent of positive biopsy cores in these five was significantly greater than that in group C. All five were treated by maximal androgen blockade therapy, and all are currently alive without emergence of hormone-refractory diseases. CONCLUSIONS: These findings indicate that hemodialysis patients may have an increased risk of prostate cancer, and that prostate cancer detected in such patients tends to be relatively advanced. Therefore, it would be recommended for hemodialysis patients to undergo PSA testing to screen for prostate cancer.

Health-related quality of life in patients undergoing lithotripsy for urinary stones.

OBJECTIVES: The objective of this study was to analyze the health-related quality of life (HRQoL) in patients undergoing lithotripsy for urinary stones. MATERIALS AND METHODS: This study comprised 76 patients with urinary stones who were treated by lithotripsy, which included shock wave lithotripsy (SWL), ureteroscopic lithotripsy, percutaneous nephrolithotripsy and ureterolithotomy in 66 patients, 25 patients, six patients and three patients, respectively. During the observation period of this series, 37 patients received additional lithotripsy for recurrent urinary stones. HRQoL was evaluated using the Short Form-36 (SF-36) survey assessing eight aspects associated with general health status. RESULTS: There were no significant differences in any scale scores between the 76 patients with urinary stones and age- and gender-matched Japanese norms. Bodily pain (BP) in 37 patients undergoing lithotripsy twice or more appeared to be significantly lower than that in 39 undergoing lithotripsy only once; however, there were no significant differences in the remaining seven scores according to the number of courses of lithotripsy. Furthermore, 47 patients treated by SWL alone had a significantly higher score for general health perception (GH) than 29 who underwent lithotripsy by methods other than SWL, while there were no significant differences in the remaining seven scores between these two groups. CONCLUSIONS: In general, patients undergoing lithotripsy for urinary stones may have a comparatively favorable HRQoL; however, BP and GH were impaired in patients undergoing lithotripsy twice or more and those treated by invasive modalities, respectively. Considering these findings, it would be important to prevent recurrent stone formation and to develop less invasive procedures to further improve HRQoL in patients undergoing lithotripsy for urinary stones.

Mosaic tetrasomy 9p case with the phenotype mimicking Klinefelter syndrome and hyporesponse of gonadotropin-stimulated testosterone production.

Tetrasomy 9p is a rare clinical syndrome and about 30% of known cases exhibit chromosome mosaicism. The cases with tetrasomy 9p mosaicism have been reported to show the various phenotypes. On the other hand, Klinefelter syndrome is well recognized chromosomal abnormality caused by an additional X chromosome in males (47,XXY), and the characteristic clinical findings include tall stature, immaturity of external genitalia, testicular dysfunction. Here, we report a 10-year-old male with tetrasomy of 9p mosaicism, whose phenotypic feature is mimicking Klinefelter syndrome. He was referred to our hospital for inconspicuous penis. He showed tall height (+2.5 SD). Endocrinological examination revealed the poor testosterone response to human chorionic gonadotropin administration, which indicated the testicular hypofunction, whereas MRI revealed concealed penis as a cause of inconspicuous penis. Because of the phenotype mimicking Klinefelter syndrome, karyotype of his blood lymphocytes was analyzed, and an additional marker chromosome was detected in 6% of the investigated metaphases. Fluorescence in situ hybridization analysis revealed that the marker chromosome was an isochromosome 9p, which resulted in tetrasomy 9p. Chromosome analysis of buccal smear also showed mosaicism for two karyotypes: 5% of cells had the isochromosome of 9p, and the other cells showed normal. This case is the second case with tetrasomy 9p mosaicism mimicking Klinefelter syndrome phenotype in the world. Our case, together with previously reported cases with the same association, indicates the possibility of testicular hypofunction and urogenital anomalies induced by overexpression of some genes on chromosome 9p.

Clinical outcome of ureteroscopic lithotripsy for 2,129 patients with ureteral stones.

The objective of this study was to retrospectively analyze the clinical outcomes of ureteroscopic lithotripsy (USL) performed in patients with ureteral stones, and to investigate the factors associated with therapeutic outcomes. This study included a total of 2,129 patients with ureteral stones who underwent USL between December 1985 and March 2006 in a single institution in Japan. In this series, ultrasonic lithotripsy was primarily performed, and forceps and/or baskets were occasionally used for the removal of stones. Complete removal was defined as total clearance 1 day after the initial USL. The initial stone-free rate following a single treatment with USL was 73.3%. Of 569 patients diagnosed as having fragmentation of residual stones, additional therapy was not performed for 115 with stones likely to pass spontaneously, while the remaining 454 subsequently underwent extracorporeal shock wave lithotripsy. Thereafter, ureterolithotomy or percutaneous nephrolithotripsy was further added in 14. Ureteral perforation occurred in 14 patients, of whom 2 underwent nephrectomy; however, there were no other serious complications that could not be managed by conservative treatment. Whether ureteral stones were completely removed by an initial USL was significantly associated with the history of ureteral stone, severity of clinical symptoms, number of stones, localization of stones and maximal diameter of stones. Furthermore, multivariate analysis identified the severity of clinical symptoms, number of stones, localization of stones and maximal diameter of stones as independent predictors for complete removal of ureteral stones by the initial USL application. These findings suggest that USL could be a safe and effective treatment option for ureteral stones; however, other therapeutic strategies should also be considered in patients with currently identified risk factors associated with treatment failure following a single USL procedure.

A comparison of clinical features between chlamydial and non-chlamydial urethritis in men negative for gonococcal infection who attended a urological outpatient clinic in Japan.

OBJECTIVES: The objective of this study was to investigate the clinical features of non-gonococcal urethritis in men who attended a urological outpatient clinic in Japan. MATERIALS AND METHODS: This study included a total of 194 patients diagnosed as having non-gonococcal urethritis and subsequently judged as cured following antibiotic therapy between January 2001 and June 2005. Clinical data were analyzed after dividing these patients into two groups as follows: 96 patients with chlamydial urethritis (CU) and 98 with non-chlamydial urethritis (NCU). RESULTS: The incubation period in the CU group was significantly longer than that in the NCU group (P = 0.0020). The incidence of severity of symptoms in the NCU group was significantly greater than that in the CU group (P = 0.022), and the interval between the appearance of the initial symptom and consulting the clinic was significantly shorter in the NCU group than in the CU group (P = 0.0015). The proportion of commercial sex workers (CSWs) as the causative partner in the NCU group was significantly greater that in the CU group (P < 0.001), and the incidence of oral sex as the causative mode of sexual interaction was significantly more frequent in the NCU group than that in the CU group (P = 0.021). The duration of antibiotic therapy until cured was significantly longer in the CU group than in the NCU group (P = 0.0051). Furthermore, multivariate analysis showed that whether the infection involved CU or NCU was independently associated with the treatment interval irrespective of other factors examined (P = 0.041). CONCLUSIONS: These findings suggest that the clinical characteristics of CU and NCU clearly differ and that CU tends to require a longer time to cure than NCU; therefore, among patients with non-gonococcal urethritis, it would be particularly important to effectively control the spread of CU.

Detection of micrometastases in pelvic lymph nodes in patients undergoing radical cystectomy for locally invasive bladder cancer by real-time reverse transcriptase-PCR for cytokeratin 19 and uroplakin II.

PURPOSE: The objective of this study was to clarify the significance of micrometastases in pelvic lymph nodes in patients who underwent radical cystectomy for bladder cancer. EXPERIMENTAL DESIGN: We included 40 patients with locally invasive bladder cancer who underwent radical cystectomy and pelvic lymphadenectomy. Expression of cytokeratin 19 (CK19), uroplakin II (UP II), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in 760 lymph nodes were assessed by a fully quantitative real-time reverse transcription-PCR (RT-PCR) assay. The quantification value of CK19 or UP II mRNA was described as each value relative to GAPDH mRNA. In this study, we regarded specimen in which either CK19 or UP II mRNA was positive as "presence of micrometastasis." RESULTS: Routine pathologic examinations detected tumor cells in 29 lymph nodes from six patients. Real-time RT-PCR identified positive expression of CK19 and UP II mRNAs in 49 lymph nodes from 10 patients and 98 lymph nodes from 16 patients, respectively. Of 633 lymph nodes from 34 patients with no pathologic evidence of nodal involvement, 13 nodes from five patients and 58 nodes from 10 patients were diagnosed as positive for CK19 and UP II mRNAs expression, respectively, by real-time RT-PCR. Presence of micrometastases was significantly associated with other conventional prognostic variables, including pathologic stage and microvascular invasion. Disease recurrence was occurred in eight patients, among whom four patients were negative for lymph node metastasis by routine pathologic examination and diagnosed as having micrometastasis by real-time RT-PCR assay. Furthermore, cause-specific survival rate in patients without micrometastasis was significantly higher than that in those with micrometastasis, irrespective of the presence of pathologic-positive nodes. CONCLUSIONS: Approximately 30% of locally invasive bladder cancer shed cancer cells to pelvic lymph nodes, and disease recurrence after radical cystectomy could be explained, at least in part, by micrometastases in pelvic lymph nodes.