Possible role of hyposensitivity of C-fiber afferents at the proximal urethra in the development of urge urinary incontinence in patients with detrusor overactivity.

OBJECTIVE: The aim of the present study was to investigate associations between urethral sensation and urge urinary incontinence (UUI) in patients with and without detrusor overactivity (DO). METHODS: The medical records of 80 consecutive patients who underwent filling cystometry and urethral current perception threshold (CPT) tests were examined retrospectively. Following the exclusion of 4 patients not eligible for analysis, patients were classified into neurogenic DO, idiopathic DO, or DO-negative groups based on neurological and cystometric findings (n = 30, 12, and 34, respectively). Eleven DO-negative patients were defined as normal controls on cystometrograms (CMG) using the following exclusion criteria: bladder compliance <12.5 mL/cmH2 O, volume >275 mL at first filling sensation, and comorbidities possibly affecting lower urinary tract function. Thus, 53 patients were finally included in the study. Proximal urethral CPT was evaluated with intraurethral square-wave stimulation at 3 Hz to activate C-fiber afferents. RESULTS: Median CPT was higher in neurogenic and idiopathic DO than in the normal CMG group (11.3 and 9.0 vs. 2.8 mA, respectively; P < .05), as well as in patients with UUI (n = 19) compared with non-UUI patients (n = 34; 12.5 vs. 5.4 mA, respectively; P < .05). The proportion of UUI patients was significantly greater in the DO-positive groups than in the normal CMG group (P < .05). CPTs were not associated with bladder capacity at the first filling sensation (r = 0.11). CONCLUSION: Hyposensitive C-fibers of the proximal urethra may contribute to the development of urodynamic DO as well as UUI in patients complaining of lower urinary tract symptoms.

Stone clearance after extracorporeal shockwave lithotripsy in patients with solitary pure calcium oxalate stones smaller than 1.0 cm in the proximal ureter, with special reference to monohydrate and dihydrate content.

OBJECTIVE: The aim of this study was to assess stone-free rates following extracorporeal shockwave lithotripsy (ESWL) of pure calcium oxalate (CaOx) stones in the proximal ureter. MATERIAL AND METHODS: The investigators retrospectively examined 53 patients with 5-10 mm pure CaOx stones in the proximal ureter from the medical archives of 593 consecutive patients treated with ESWL. The compositions of calcium oxalate monohydrate (COM) and dihydrate (COD) in a given stone were determined by infrared spectrometry. Stone size, attenuation number and stone-to-skin distance (SSD) were measured using plain radiography and computed tomography (CT). ESWL success was evaluated by stone-free status after the first single session. RESULTS: On average, calculi were 8.0 × 5.3 mm in size, with an SSD of 11.0 cm. The mean CT attenuation value was 740.1 HU. Attenuation numbers correlated significantly with stone diameter (r = 0.49), but had no correlation with the stone content of COM or COD. A negative correlation was observed between COM and COD content (r = -0.925). With regard to patients' physical characteristics and COM and COD content, no differences were found between study subgroups with stone-free and residual status (n = 38 and 15, respectively). There were also no differences in clinical features between patient subgroups with COM- or COD-predominant stones (n = 22 and 31, respectively). CONCLUSION: The findings indicated that the differences in COM and COD content of CaOx stones had no impact on stone clearance after ESWL and that a favorable stone-free rate of the stones treated with ESWL may be achieved independently of CaOx hydration.

The enhancer of zeste homolog 2 (EZH2), a potential therapeutic target, is regulated by miR-101 in renal cancer cells.

We investigated a prognostic significance and the mechanism of aberrant nuclear expression of EZH2, a histone methyltransferase, in human renal cell carcinoma (RCC). We found nuclear EZH2 in 48 of 100 RCCs and it was significantly correlated with worse survival in RCC patients. We detected a decreased expression of miR-101 in 15 of 54 RCCs. We found that re-expression of miR-101 resulted in EZH2 depletion and decreased renal cancer cell proliferation. Our results show nuclear EZH2 as a prognostic marker of worse survival in human RCC, and identify miR-101 as a negative regulator of EZH2 expression and renal cancer cell proliferation.

Re-expression of miR-199a suppresses renal cancer cell proliferation and survival by targeting GSK-3ß.

Recently, we have identified GSK-3 as a new therapeutic target in renal cell cancer (RCC). miR-199a could potentially downregulate GSK-3ß expression. Here, we found a decreased miR-199a expression in 59% (32 of 54) of RCCs and it was correlated with higher tumor stage (p < 0.05) and nuclear overexpression of GSK-3ß (p < 0.05). We show that re-expression of miR-199a downregulates GSK-3ß and suppresses cancer cell growth. Our results demonstrate low miR-199a expression as a feature of advanced RCCs, identify miR-199a as a negative regulator of GSK-3ß, and suggest re-expression of pre-miR-199a as a new potential treatment of RCC.

[Successful treatment of a case of advanced adult Wilms' tumor with pre-surgical chemotherapy, irradiation and radical nephrectomy].

A 37-year-old male was referred with a huge renal mass and multiple lung lesions. Abdominal and chest computed tomographic scan revealed a 11×15×17. 5 cm right renal tumor and multiple lung metastases. Neither tumor was enhanced, and no lymph adenopathy was detected. Percutaneous needle core biopsy was performed and the tumors were diagnosed as Wilms' tumor histologically supported by immunohistological positive staining to WT-1 and CD56. Since lung metastases were detected and the renal tumor reached the abdominal aorta on the left side, presurgical systemic chemotherapy (ifosphamide＋ carboplatin＋etoposide ; ICEx 4 courses) was performed. The renal tumor and the lung metastases were markedly decreased in size and subjected to a radical nephrectomy. Histological examination confirmed the diagnosis of Wilms' tumor without anaplastic change categorized as mesenchymal type. As an adjuvant therapy, irradiation to renal bed (40 Gy/20 fr) and bilateral lung (12 Gy/8 fr) were performed. Six months after the end of the therapy, no evidence of recurrence was detected.

[Examination of prostate biopsy among Japanese with less than 4.0 ng/ml prostate specific antigen--usefulness of free/total PSA ratio].

The low specificity of the prostate specific antigen (PSA) test is considered to be a problem when PSA measurement alone is performed to detect cancer. Therefore, we examined a method to decrease the number of unnecessary biopsies while maintaining the power of the test by using PSA, PSA free/total ratio (PSAf/t), and digital rectal examination (DRE). The subjects were 232 patients with PSA levels of 4.0 ng/ml or less who underwent biopsy for prostate cancer. An endorectal ultrasound perineal biopsy was conducted, and the average biopsy core number was 21. Cancer was detected in 37 of the 232 subjects. Receiver operating characteristic curves of PSA and PSAf/t were subsequently determined. Although the area under the curve (AUC) was 0.56 for PSA alone, the AUC increased to 0.75 when the factor of positive data in DRE was taken into account. Although the AUC was 0.62 for PSAf/t alone, when the factor of positive data in DRE was added as for PSA, the AUC increased to 0.79. In addition, as a result of examining the combination of PSA, PSAf/t and DRE, the condition of the biopsy for prostate cancer in the cases with PSA of 4.0 ng/ml was determined as follows: PSA should be 3.1 ng/ml or more and PSAf/t 27% or less, or the result of DRE should be positive. Based on these criteria, the sensitivity, specificity and detection rate of cancer increased to 0.919, 0.436 and 23.2%, respectively. We consider that this approach will be useful.

A case of labial adhesion due to lichen sclerosus et atrophicus.

A 67-year-old Japanese woman first visited to the hospital in regard to episodes of a 6 months history of difficulty on urination. Her perineum was mild whitish, and labia majorae were all adhered with only a pinhole-sized opening. A labial incision was performed under a spinal anesthesia. Pathological finding of the skin biopsy specimen was lichen sclerosus et atrophicus (LSA). In view of that LSA occasionally develops into squamous cell carcinoma, urologists should be care of LSA in labial adhesion case.

Posterior retroperitoneoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors.

BACKGROUND AND PURPOSE: Laparoscopic partial nephrectomy remains surgically challenging because of the potential for excessive blood loss, infection, and the development of urinary fistulas. In addition, posterior retroperitoneoscopic partial nephrectomy is not popular because of the limited space for surgical manipulation. We evaluated the usefulness of a microwave tissue coagulator in posterior retroperitoneoscopic partial nephrectomy for small posterior renal tumor. PATIENTS AND METHODS: Posterior retroperitoneoscopic partial nephrectomy was performed without renal pedicle clamping using a microwave tissue coagulator in six patients with small posterior renal tumors. RESULTS: The mean operative time was 136 minutes (range 78-180 minutes), and the blood loss was <20 mL. No serious operative complications occurred, and there was no significant deterioration of renal function. CONCLUSION: Posterior retroperitoneoscopic partial nephrectomy using a microwave tissue coagulator can be a safe and less invasive method for the treatment of small posterior renal tumors.

Retroperitoneal schwannoma extending into the intravertebral foramen.

A 35-year-old Japanese man first visited the hospital for episodes of numbness in the right medial femoral region and loss of muscular strength in the right thigh. A CT scan of the abdomen showed a 10 x 9-cm well-circumscribed in homogeneous multilayered mass, in contact with the lumbar vertebrae. MRI demonstrated a hypodense and hyperdense mixed mass. Tumor extension into the L(2)/L(3) intravertebral foramen was shown. To avoid spinal cord damage, we chose enucleation of the tumor in the intravertebral foramen. A follow-up CT after 1 year showed no evidence of a recurrent mass. In conclusion, we advocate the nerve-sparing operation in cases like that of our patient.