[Case of primary malignant melanoma of the female urethra at age 94 : a case report].

A 94-year-old woman visited a local urological clinic in January 2011 complaining of dysuria and vulvar discomfort that lasted for a month. Clinical examination showed a hematoma-like tumor at the external urethral meatus. She refused an operation. After 2 months, the tumor became hemorrhagic and she was referred to our hospital for operation. A black tumor of fingertip-size was seen at the external urethral meatus. Urinary sediment examination and urine cytology revealed malignant melanoma cells. The tumor showed T1WI high intensity, and T2WI low intensity by magnetic resonance imaging. Collectively, the patient was diagnosed with malignant melanoma. The tumor was extirpated. Pathological diagnosis showed malignant nodular melanoma. However, additional therapy was not performed due to her age and thereafter, the patient was followed up carefully. After 3 months, right inguinal LN swelled, and tumor recurred at the external urethral meatus. She died from multiple metastases 11 months from the initial consultation. We herein report this case of primary malignant melanoma of the female urethra in an elderly patient.

[Renal metastasis originating from colon cancer : a case report].

In 2008, a 65-year-old woman was referred to our department because of a right renal tumor detected by computed tomography (CT) that was associated with macroscopic hematuria. She underwent right hemicolectomy for ascending colon cancer in 2003, and right lower lobectomy for lung metastasis of colon cancer in 2004. CT, magnetic resonance imaging, fluorodeoxyglucose positron emission tomography computed tomography and bone scintigraphy did not indicate any other metastatic lesion except the right renal mass ; therefore, open right nephrectomy was performed. Results of the histopathologic examination demonstrated renal metastasis of colon cancer. Although administration of chemotherapy was continued, the patient died of multiple metastases 8 months after the right nephrectomy.

Apoptosis of bladder cancer by sodium butyrate and cisplatin.

The effects of sodium butyrate (SB), a histone deacetylase inhibitor, in combination with cisplatin (CDDP), for inhibition of cell growth and induction of apoptosis were investigated in bladder cancer cell lines in vitro. Bladder cancer cell lines T24, 253J, and UMUC3 were treated with different concentrations of CDDP or SB. Cell proliferation was studied by XTT assay. Cell-cycle analysis and induction of apoptosis were analyzed by laser scanning cytometry (LSC). Western blot analysis was used to determine expression of p21, p27, TRADD, FADD, caspase-2, and caspase-7. We observed that SB in combination with CDDP induced significant inhibition of cell growth in a dose-dependent manner through G1 arrest and apoptosis, as determined by LSC. When bladder cancer cell lines were treated with SB plus CDDP, Western blotting showed increased expression of p21 but not p27 in T24 cells, whereas both p21 and p27 increased in 253J and UMUC3 cells. All cell lines exhibited a moderate increase in TRADD and decrease in procaspase-2 but no significant change in FADD and procaspase-7. The results showed the synergistic anticancer effect of SB in combination with CDDP, their potential for treatment of bladder cancer, and their mechanism of action in terms of cell signal transduction and induction of apoptosis.

[Metachronous urothelial cancer in bilateral upper urinary tracts and bladder associated with hereditary nonpolyposis colorectal cancer].

A 40-year-old man had undergone right hemicolectomy and sigmoidectomy under the diagnosis of ascending and sigmoid colon cancer and right nephroureterectomy under the diagnosis of right ureteral cancer, in 1997 and in 2002, respectively. In 2007, He visited our hospital with a complaint of bloody stool and hematuria. Colon fiberscopy, ureteropelvicscopy and cystoscopy demonstrated colon cancer, left renal pelvis cancer and bladder cancer, respectively, as diagnosed by biopsies, followed by restative colectomy, left nephroureterectomy and cystectomy. The final histopathological examination showed well differentiated adenocarcinoma (pSM) in the colon, and urothelial carcinoma in the left renal pelvis (pT2) and the bladder (pT1). Since his uncle and elder brother had suffered from stomach cancer and colon cancer, respectively, he was diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC : Lynch syndrome). He has been well doing without recurrence for 3 years after the surgery.

[A case of primary urothelial carcinoma of the prostate responsive to MVAC intra-arterial chemotherapy: a case report].

A 70-year-old man visited a urological clinic on May 2008 complaining of dysuria and nocturia since 2 years prior. He was diagnosed as having gross benign prostatic hypertrophy, and was referred to a nearby hospital for transurethral resection of prostate (TURP). During TURP, a papillary tumor was found in the prostatic urethra on the left side and a biopsy was performed. A pathological examination revealed urothelial carcinoma G3. Cystoprostatectomy was planned, but the patient refused the procedure. Therefore, he underwent three courses of MVAC intra-arterial chemotherapy (methotrexate, vinblastin, doxorubicin, cisplatinum) at our hospital. After chemotherapy, no tumor was found in the prostatic urethra and a pathological report of repeat TUR showed no tumor. Currently, the patient is alive and there has been no evidence of recurrence for 1 year and 10 month.

Double short-time exposure to pirarubicin produces higher cytotoxicity against T24 bladder cancer cells.

This study was designed to determine the ideal manner (schedule and duration) of intravesical chemotherapy using pirarubicin (THP). At first, T-24 cancer cells were treated with 50, 100, 150, and 200 µg/ml THP for 10, 30 and 60 min. Following the first exposure, at various intervals (3, 6, 12, and 24 h), a second exposure to THP was performed under the same condition in vitro. The cell viability was measured by XTT assay. Further, the cells were scanned with a laser scanning cytometer (LSC) and DNA histograms were analyzed to evaluate the cell-cycle components. A single exposure of T-24 cells to THP resulted in significantly higher inhibition of cell growth for 30 min with 100 µg/ml and higher concentrations of THP; for example, the cell viability was reduced to 15, 2, and 0% by incubating cells with 100, 150, and 200 µg/ml of THP, respectively, whereas it was 49% with 50 µg/ml THP. Double exposure of T-24 cells to THP resulted in significantly higher inhibition of cell growth than single treatment at all intervals. LSC assay demonstrated a higher sub-G(1) peak after double treatment with THP when compared with that after a single treatment. Similar cytotoxic effects following double treatment with THP were observed on other bladder cancer cell lines (UMUC3, TCCSUP, 5637, and 253J cells) in vitro. In conclusion, the double short-term exposure to bladder cancer cells by THP has more remarkable cytotoxic effects than the single exposure in vitro.

A single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urological clean and clean-contaminated surgery.

A single dose of antimicrobial prophylaxis (AMP) was administered parenterally for the prevention of perioperative infection in a total of 788 patients undergoing urological surgery, including 380 endoscopic-instrumental, 328 clean, and 80 clean-contaminated operations performed at our institute between January 2007 and December 2009. Surgical site infections (SSIs), urinary tract infections (UTIs), and remote infections (RIs) were prospectively surveyed. The definition for a single dose of AMP allowed for the administration of an additional dose of an antimicrobial during surgery if the procedure was longer than 3 h, but not for the parenteral or oral administration at the end of the procedure in the recovery room, or at a later time over a period of more than 24 h. UTI was observed in 12 (3.2%) patients after endoscopic-instrumental operation, 1 (0.3%) after clean operation, and 1 (0.9%) after clean-contaminated operation. SSI was observed in 2 (0.6%) patients after clean operation but in none after clean-contaminated operations. RI was observed in 1 (0.3%) patient after endoscopic-instrumental operation, 3 (0.9%) after clean operation, and none after clean-contaminated operations. A single-dose regimen of AMP was effective and feasible for the prevention of perioperative infections, including SSIs, UTIs, and RIs, in endoscopic-instrumental, clean, and clean-contaminated urological surgical procedures.

[A case of lymphangioma of the intrascrotum in an adult].

We reported a rare case of intrascrotal lymphangioma in an adult. A 31-year-old man visited a urological clinic with a chief complaint of left scrotal swelling since a few days ago, and was pointed out to have a left intrascrotal cystic mass. The patient was sent to our hospital for further examination in 23 April 2008. The left scrotal mass was palpated elastic hard below the left testis and its surface was irregular. Light transillumination test showed positive. Ultrasonography revealed a cystic mass 7.0 x 4.4 x 4.5 cm with multiseptate accumulation at the lower pole of the left testis. Magnetic resonance imaging showed low intensity by T1WI and high intensity by T2WI, suggesting a protein-rich component. We suspected left intrascrotal lymphangioma and extirpated the scrotal mass under lumbar anesthesia. Pathological examination demonstrated lymphangioma. The patient had no evidence of recurrence after 1 year.

[A case of primary testicular malignant lymphoma associated with contralateral testicular recurrence after a nine-year interval: a case report].

A 69-year-old man visited our hospital in February 1996 with a chief complain of left scrotal swelling. The left scrotal content was hard by palpation and ultrasonography showed a hypo-echoic lesion. Left high orchiectomy was performed with suspicion of a testicular tumor. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the left testis, and then he underwent 5 courses of chemotherapy consisting of THP-COP (THP-adriamycin, cyclophosphamide, vincristin, predonisone). Following the treatment for five years, he had no evidence of recurrence. Nine years later, in October 2005, he noticed right scrotal swelling. He underwent right high orchiectmy with suspicion of a contralateral testicular malignant lymphoma. Pathological examination revealed DLBCL. He underwent chemotherapy (rituximab-THP-COP) and achieved complete remission again. He is doing well without recurrence of disease for three years after the last treatment.

[Results of microsurgical varicocelectomy in the adolescent].

PURPOSE: Microsurgical varicocelectomy procedures are known to have high rates of success and minimal incidence of postoperative hydrocele occurrences in adults. Herein, we report our initial experience with microsurgical inguinal and subinguinal techniques for the treatment of varicoceles in adolescent patients. PATIENTS AND METHODS: A total of 9 boys (averaged age 12.7 years each younger than 15 at the time of the operation) with a left varicocele underwent microsurgical inguinal or subinguinal repair, and were included in this study. RESULTS: The microsurgical varicocelectomy procedures including meticulous dissection required a mean 170.4 +/- 45.6 minutes (range, 105-240 minutes) and the testicular arteries were preserved in all patients. Catch-up growth was seen in one of two patients whose testicular volumes were determined by ultrasonography both pre and post operatively. None of the patients has developed a recurrent varicocele or postoperative hydrocele after a mean follow-up of 24.6 months. CONCLUSION: As with adults, microsurgical subinguinal and inguinal varicocelectomy procedures are safe and effective, and can be considered one of feasible treatment for varicoceles in adolescents.

[Clinical study of carcinoma of the penis].

We retrospectively analyzed the records of 21 patients with penile carcinoma treated between January 1993 and February 2007. According to TMN classification (UICC 2002), 9, 8, 2 and 2 patients belonged to stages I, II, III and IV, respectively. During the follow up period of 4 to 144 months (median 15 months), the overall 5-year survival rate was 75.8%. All three patients having N2 died within one year. Lymph node metastasis (p = 0.001) and organ metastasis (p = 0.007) were found to be unfavorable prognostic factors for patients with penile cancer.

[An adenocarcinoma arising from the urinary bladder 37 years after bladder augmentation using the ileum].

A 57-year-old man had undergone right nephrectomy at 10 years of age and bladder augmentation using the ileum at 20 years for treatment of urinary tract tuberculosis. He also had undergone intermittent catheterization after a traffic accident at 49 years of age. He presented at another hospital with a complaint of asymptomatic macroscopic hematuria. Cystoscopy revealed a lobulated tumor in the bladder. Transurethral resection of bladder tumor was performed, but complete resection was difficult. Histopathological examination of the specimen revealed a well differentiated adenocarcinoma. He was referred to our hospital for total cystectomy and percutaneous left nephrostomy. The tumor arose from the bladder wall near the anastomotic site between the bladder and the ileal segment. Histopathological examination revealed a well differentiated adenocarcinoma infiltrating into the muscle layer (pT2a). Postoperatively, he has been free of recurrence for one year. This is the 19th case of adenocarcinoma following bladder augmentation using the ileum reported in the Japanese literature.

[Influence of blood cells in urine samples on results of screening for urothelial carcinoma with NMP22 bladder chek].

We compared the sensitivity of Bladder Chek NMP22 with that of urine cytology in bladder cancer patients. Further, we evaluated the usefulness of Bladder Chek NMP22 in patients with benign diseases such as cystitis, urolithiasis, and benign prostate hyperplasia (BPH) and examined how blood cells in urine samples affect the results of Bladder Chek NMP22. Patients with macroscopic hematuria were excluded from this study. Of 77 bladder cancer patients, Bladder Chek NMP22 showed positive in 46.8%, while urine cytology in 33.8% (p = 0.16). Bladder Chek NMP22 and urine cytology showed positive in 31.8 and 0.0% in G1 (p = 0.004), 51.2 and 46.3% in G2 (p = 0.66) and 57.1 and 50% in G3 (p = 0.71); 44.4 and 88.9% in Tis (p = 0.052), 25.6 and 15.4% in Ta (p = 0.27), 72.2 and 33.3% in T1 (p = 0.02) and 81.8 and 54.5% in T2 or higher (p = 0.18), respectively. In bladder cancer patients with microscopic hematuria or pyuria, the positive rates of Bladder Chek NMP22 were 82.1 and 73.1%, respectively, whereas they were 26.5% (p < 0.001) and 33.3% (p = 0.002), respectively, in those without hematuria or pyuria. In 36 cystitis, 20 urolithiasis, and 19 BPH patients, the positive rates of Bladder Chek NMP22 were 58.3, 25.0 and 5.5%, respectively. Bladder Chek NMP22 showed higher sensitivity for detection of bladder cancer, especially in low-grade and low-stage cancers than urine cytology, but the result was likely affected by blood cells in urine samples. Thus, although Bladder Chek NMP22 may be less useful as the first device for screening of urothelial cancer in patients with hematuria or pyuria, it may show results of high quality when used in patients with negative urine cytology after excluding benign diseases.

[Testicular tumor detected in a male infertility patient with prior orchiopexy].

A 37-year-old man was referred to our hospital with the chief complaint of infertility. Semen analysis at another clinic had demonstrated severe oligozoospermia and he had a history of bilateral orchiopexy for undescended testes. Scrotal ultrasonography revealed a hypoechoic heterogeneous mass (1.5 cm in diameter) within the left testis. With a provisional diagnosis of testicular tumor, left high orchiectomy was performed. Pathological examination of the tumor revealed seminoma. At 12 months after surgery, there has been no evidence of recurrence. Clinicians should be aware of the link between male infertility and testicular cancer, particularly following orchiopexy.

[Case with renal pelvic carcinoma with giant hydronephrosis].

A 62-year-old man consulted us for further examination of left giant hydronephrosis which was accidentally found by abdominal ultrasonography. The patient chose observation instead of left nephrectomy. One year later, he re-visited us with a complaint of sudden abdominal pain. Computed tomography (CT) revealed left giant hydronephrosis containing high-density fluid which was suspected of hemorrhage in the renal pelvis. Percutaneous nephrostomy yielded discharge of 7000 ml of hemorrhagic fluid and urine cytology revealed class V. Systemic examination by CT and magnetic resonance imaging (MRI) showed renal pelvic tumors in the left kidney as well as multiple metastatic lesions in the lung, liver and bone. Pathological examination of the left renal pelvic tumors obtained by biopsy showed high-grade urothelial carcinoma. Although systemic and intra-arterial chemotherapy showed partial response in the metastatic lesions, he died of cancer 1 year and 3 months after the first diagnosis.

[Assessment of single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urologic surgery].

A single-dose ofantimicrobial prophylaxis (AMP) was administered parenterally for prevention of perioperative infection in a total of 206 urologic surgeries including 114 endoscopic-instrumental, 92 clean, and 20 clean-contaminated procedures between January and December, 2007, and surgical site infections (SSI), urinary tract infections (UTI), and remote infections (RI) were prospectively surveyed. The definition of a single-dose of AMP allowed the administration of a second dose of an antimicrobial during a surgical procedure that exceeded 3 hours but not parenteral or oral administration at the end of the procedure, in the recovery room, or at a later time over a period of more than 24 hours. UTI was observed in 3 cases (2.7%) after endoscopic-instrumental procedures and in 1 case (5%) after clean-contaminated procedures while no case was associated with UTI in clean procedures. SSI was seen in 1 case each after clean procedures (1.1%) and after clean-contaminated procedures (5%), and RI was seen in 2 cases (2.2%) after clean procedures. A single-dose regimen of AMP was effective for prevention ofperioperative infections including SSI, UTI, and RI in endoscopic-instrumental, clean, and clean-contaminated surgical procedures in urology.

[Idiopathic retroperitoneal fibrosis diagnosed by CT-guided needle biopsy: a case report].

A 72-year-old man was admitted to another hospital because of general fatigue and dyspnea secondary to renal insufficiency. Abdominal computed tomography (CT) and magnetic resonance imaging showed left atrophic kidney, right hydronephrosis, and an intra-pelvic mass of soft-tissue density located anterior to the sacrum, involving the right ureter at the level between the 5th lumber vertebra and the sacrum. He was referred to our hospital after percutaneous nephrostomy was constructed into right kidney. CT-guided needle biopsy revealed the idiopathic retroperitoneal fibrosis, leading us to give him steroid therapy. Three weeks later, radiographic findings showed a remarkable reduction of the mass and the improvement of the right ureteral stricture.

[Myolipoma arising from the renal capsule: a case report].

A 53-year-old female visited us with an asymptomatic renal mass, which was incidentally found on abdominal ultrasonography (US). US showed a heterogeneous renal mass measuring 5 cm in diameter. Computed tomorraphy and magnetic resonance imaging showed that the tumor was mixed with muscle and fat tissue, faintly enhanced, and located at the lower portion of the left kidney. Although renal angiomyolipoma (AML) was suspected from these findings, we could not rule out a malignant tumor. Therefore, she underwent a laparoscopic partial nephrectomy. Histopathological examination revealed the tumor composed of smooth muscle and mature adipose tissue without cytological atypia arising from the renal capsule. The tumor contained no AML-like blood vessels, and was negative for HMB-45 staining. The final diagnosis was myolipoma arising from the renal capsule. Myolipoma is a rare benign neoplasm in the soft tissue of retroperitoneum and abdominal cavity. Since it is difficult to distinguish myolipoma from other benign and malignant tumors with fat tissue only by imaging studies, a surgical approach should be considered.

[A case of adenomatoid tumor of the testis treated by testis-sparing surgery: a case report].

A 44-year-old man was referred to our hospital with a chief complaint of a painless left intrascrotal mass, palpable at the lower portion of the left testis. Serum levels of tumor markers, human choriogenic gonadotropin (hCG), hCG-beta, and alpha fetoprotein were within the normal limits. Ultrasonography revealed a hyperechoic mass 13 mm in diameter, which was demonstrated as a hypovascular tumor by Gadrinium-enhanced magnetic resonance imaging. Since the tumor was diagnosed as a benign tumor by frozen section examination intraoperatively, testis-sparing surgery was performed. Histological examination revealed adenomatoid tumor originating from the tunica alubuginea of testis. Adenomatoid tumor of the testis is a rare benign tumor, and the present case is the 36th one in the Japanese literature.

Diagnostic efficacy of free to total ratio of prostate-specific antigen and prostate-specific antigen velocity, singly and in combination, in detecting prostate cancer in patients with total serum prostate-specific antigen between 4 and 10 ng/ml.

To assess the diagnostic efficacy of prostate-specific antigen (PSA)-related parameters, using a total of 226 patients with gray zone PSA who underwent prostate biopsy, various cutoff points of free to total ratio of PSA (f/t PSA) and PSA velocity (PSAV) were evaluated. Higher cutoff points of f/t PSA resulted in high sensitivity and negative predictive value (NPV): at f/t PSA <15%, sensitivity was 82.0% (41/50) and NPV 84.7% (50/59), and at f/t PSA <20%, 96.0% (48/50) and 92.3% (24/26). Lowering cutoff points also resulted in higher sensitivity and NPV: at PSAV >or=0.75 ng/ml per year, sensitivity was 71.4% (15/21) and NPV 82.4% (28/34), and at PSAV >or=0.40 ng/ml per year, 95.2% (20/21) and 95.2% (20/21). Further, among the patients with both of these parameters available, both sensitivity and NPV achieved 100% (10/10 and 7/7) when the indication for biopsy was determined as f/t PSA <15% or PSAV >or=0.40 ng/ml per year. Our results showed that unnecessary prostate biopsies could be more effectively avoided among patients with "gray zone PSA" by combination of f/t PSA and PSAV than single usage of these indexes.