Effect of sample collection site on semen parameters of healthy young volunteers.

The effect of sample collection site on semen parameters in ten men aged between 22 and 24 years was investigated. Sperm was collected at two sites: in a university hospital restroom for general use and in a one-person hospital room. Samples were collected from the same individual twice, with an interval of two weeks between collections. Semen parameters for the two sites were compared. Samples were collected after a minimum of three days and not longer than seven days of sexual abstinence. Sperm concentration did not differ significantly between the university hospital restroom location (86.8 +/- 25.4 x 10(6)/ml; mean +/- standard deviation) and the private hospital room (97.1 +/- 72.0 x 10(6)/ml). There was no difference in the total motile sperm count or daily sperm production between the collection sites. These results suggest that the collection site has little effect on semen parameters.

Individual variation in semen parameters of healthy young volunteers.

Individual variation in semen parameters was investigated in healthy young volunteers. Semen samples were collected approximately once a month over a one-year period for a total of 93 samples (5 to 10 samples per subject) from 12 volunteers in their twenties. Semen analysis was carried out according to the WHO Manual. The amount of variation in each semen variable was calculated for each subject by dividing the maximum value by the minimum value. The results showed that the semen volume varied by 1.9+/-0.8 fold (1.3 to 4.2 fold), the sperm concentration by 4.8+/-4.3 fold (1.5 to 17.2 fold), the percentage of sperm with forward progression by 2.8+/-1.4 fold (1.6 to 6.4 fold), the percentage of sperm with rapid linear progression by 3.4+/-2.6 fold (1.7 to 10.9 fold), the percentage of sperm with normal morphology by 1.9+/-0.4 fold (1.3 to 2.4 fold), and the percentage of live sperm by 1.5+/-0.4 fold (1.1 to 2.6 fold). A between-group comparison showed significant differences in all of the variables except the percentage of sperm with normal morphology. These results suggest multiple and considerable semen analyses are needed when evaluating semen parameters.

Gonadal function in patients with testicular germ cell tumors.

The gonadal function of 18 patients with testicular germ cell tumors was evaluated. Seminal parameters after orchiectomy were examined in 15 patients. Six of them were available for follow-up observation after 2 or 3 courses of adjuvant chemotherapy. Serum gonadal hormones before and after orchiectomy were evaluated in 7 patients (testosterone and PRL were not examined in one patient). Five of 15 (33.3%), 8 of 15 (53.3%), 13 of 15 (86.7%), 7 of 13 (53.8%), and 9 of 12 (75.0%) had abnormal values in seminal volume, sperm concentration, motility, morphology, and vitality, respectively. The sperm concentration gradually improved after chemotherapy following orchiectomy in 5 of 6 (83.3%) patients. In all the patients examined, serum levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) increased after orchiectomy. Serum levels of testosterone increased in 4 patients, but decreased in 2 after orchiectomy. These findings suggest that several factors, including preexisting intrinsic defect and disturbance of the hypothalamus-pituitary-gonadal axis, are involved in the deterioration of gonadal function in patients with testicular germ cell tumors.

Clinical study of testicular germ cell tumors.

A clinical statistical analysis on 65 patients with 68 testicular germ cell tumors was performed. Thirty-six testes (53.7%) had seminomas and the remainder non-seminomatous germ cell testicular tumors (NSGCTTs). Of the seminomas, 31 (88.6%) were in stage I and the others showed distant metastases at presentation. Of the 32 NSGCTTs, 22 (68.8%) were in stage I. The average ages of the patients with seminomas and NSGCTTs were 40.4 and 29.9 years, respectively. Thirty-nine patients (60.0%) had tumors on the right side, 23 (35.4%) on the left and 3 (4.6%) in both testes. Five patients had a past history of cryptorchidism. Chief complaints in 49 patients (73.1%) were a painless scrotal mass. The interval from clinical onset to presentation was longer in seminoma patients than in NSGCTT patients (10.9 months on average versus 3.4 months). Immunosuppressive acidic protein (IAP) was a useful diagnostic tumor marker as well as alpha-feto protein (AFP), beta-human chorionic gonadotropin (beta-hCG) and lactic dehydrogenase (LDH). We adopted a surveillance policy in more than half of the stage I patients and obtained acceptable results. In the remaining cases, therapies including combination chemotherapy, radiation and salvage operation were performed after orchiectomy. The three-year survival rate was 98.0, 100.0 and 26.7%, for stage I, II and III patients respectively.

Pericentric inversion of the Y chromosome of infertile male.

The authors report a case with pericentric inversion of the Y chromosome associated with asthenonecrozoospermia. The conventional karyotype was 46, X, inv (Y) (p11q11). Polymerase chain reaction (PCR) analysis revealed the deletion of DYZ3, DYS139, and RBM1. Three-color fluorescent in situ hybridization (FISH) analysis of the sperm chromosomes showed normal ratio between X- and Y-bearing sperm. In this case, the frequencies of aneuploidy of the sperm are not significantly higher compared with those from the normal volunteers. Cytogenetic analysis is recommended when the patients with pericentric inversion of the Y chromosome are attending an infertility clinic.

[A case of Down's syndrome associated with testicular seminoma].

Down's syndrome is an inherited disorder caused by trisomy of chromosome 21. In patients with Down's syndrome, an increased risk of leukemia has been observed. Recently, the coincidence of testicular cancer with this syndrome has been also emphasized. We present a case of Down's syndrome associated with testicular seminoma. This is the 19th case of Down's syndrome associated with testicular tumor in Japan.

Inhibitors on an elastase-like enzyme activity catalyzing Suc-Ala-Ala-Pro-Leu-pNA amidolysis in human seminal plasma.

The behavior of some proteinase inhibitors toward the Suc-Ala-Ala-Pro-Leu-pNA amidolytic enzyme activity in human seminal plasma (HSP) was tested. [(2S, 3R)-3-Amino-2-hydroxy-5-methyl-hexanoyl]L-valyl-L-valyl-L-aspartic acid (Amastatin) and 3-[1-[(2-(hydroxymethyl)- -pyrolidinyl)-2-methylpropyl]-carbamoyl] octanohydroxamic acid (Actinonin) showed strong inhibitory effects. No inhibition of this present enzyme activity was seen with anti-human serum (whole), anti-human leukocyte elastase, phenyl-methyl sulfonyl fluoride, Elastatinal, ethyeneglycol bis(beta-aminoethyl ethyl)N,N,N:N'-tetra acetic acid, and [L-3-trans-ethoxycarbonyl-oxirane-2-carbonyl]1-L-leucine(3-methylbutyl)a mido (E-64). No relation was observed between human pancreatic elastase antigen and the Suc-Ala-Ala-Pro-Leu-pNA amidolytic enzyme enzyme activity in HSP. Two peaks of Suc-Ala-Ala-Leu-Pro-pNA amidolytic enzyme activity were separated by Cellulofine GCL-2000 gel filtration and these activities were completely abolished by addition of Amastatin. Suc-Ala-Ala-Pro-Leu-pNA amidolytic enzyme activity in HSP is not an elastase-like metalloproteinase but is rather an acyl amidase-like leucine aminopeptidase.

Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: an initial clinical study.

BACKGROUND: To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods. METHODS: Fifteen patients with upper tract hematuria of unknown etiology were the subjects of the present study. Prior to ureteropyeloscopy, they underwent standard diagnostic methods, including cystourethroscopy, excretory urography and computed tomography scan. The upper tract (ureter, renal pelvis and calyces) was inspected systematically with a flexible ureteropyeloscope under epidural anesthesia. A biopsy specimen was obtained when neoplasm of a suspicious lesion was seen. Bleeding and hemangiomatous lesions were fulgurated at the time of ureteropyeloscopy. RESULTS: Unilateral gross hematuria was seen in 12 patients. Imaging studies revealed a filling defect in four patients, ureteral stenosis in one patient and nutcracker phenomenon in one patient. Urine cytology was positive in three patients and suspicious in four patients. Results of ureteropyeloscopy were papillary tumor in three patients, whitish encrustation in one patient, redness of the renal pelvis in one patient, bleeding from the renal calyx in two patients, hemangiomatous lesion in one patient, ureteral stenosis in two patients and no abnormalities in five patients. Biopsies were performed in five patients. The pathology results were transitional cell carcinoma in four patients and no abnormality in one patient. Although a ureteral stent catheter was placed in one patient, no serious complications were encountered during or after the procedures. CONCLUSIONS: Ureteropyeloscopy was useful and relatively safe. This endoscopic examination can differentiate insignificant lesions from significant lesions by visual inspection of the lesions, in addition, pathological diagnosis by biopsy specimen can also be performed if deemed necessary. Ureteropyeloscopy is recommended in the diagnosis of upper tract hematuria of unknown etiology.

XX-male syndrome bearing the sex-determining region Y.

The case of a 25-year-old man who presented for evaluation of infertility is described. The physical examination revealed testicular atrophy without gynecomastia. Repeated seminal analyses showed azoospermia, and serum hormonal levels suggested a state of a hypergonadotropic hypogonadism. Chromosomal analysis demonstrated 46XX. Polymerase chain reaction revealed the existence of a sex-determining region Y. The etiology of this rare sex reversal syndrome is discussed and cases reported in Japan are reviewed.

Bilateral emphysematous pyelonephritis with autosomal-dominant polycystic kidney disease successfully treated by conservative method.

Emphysematous pyelonephritis (EPN) is an uncommon and potentially life-threatening necrotizing inflammation of the renal parenchyma. EPN associated with autosomal dominant polycystic kidney disease (ADPCK) is extremely rare. We report such a case of bilateral EPN with ADPCK that was successfully treated with conservative methods. To our knowledge, our case is only the second to document bilateral EPN occurring with ADPCK and the first one to be treated successfully with conservative methods.

[Clinical studies on the quality of life in patients with ileal conduit].

Between August, 1985 and December. 1995 ileal conduit was performed in 36 cases of bladder cancer (30 males, 6 females). A survey based on a questionnaire was carried out on 15 patients to assess their quality of life (QOL) after the surgery. The questionnaire dealt with the working situation, appetite, sleep, defecation, bathing, travel, general health condition, satisfaction, sexual life and erection. Although only 64.0% of the patients returned to work, appetite, hours of sleep and bathing frequency showed only a slight decrease. We performed total cystectomy without using the nerve sparing method. After the operation, three patients could have an erection and enjoy sexual life. Because the ileal conduit resulted in few complications and only a slight reduction in QOL, it was considered an appropriate operation.

[A clinical study of superficial bladder cancer with grade 3 components].

A retrospective study was done on 33 patients treated for superficial bladder cancer, pTa and pT1, with grade 3 components between 1986 and 1995. All patients had undergone transurethral resection of the tumor (TUR-Bt), which was followed by total cystectomy in 7 patients. Three patients died of pulmonary diseases or heart attack and 6 patients subsequently died of bladder cancer. The 2-year and 5-year disease-specific survival rates of these patients were 83% and 75%, respectively, and the mean duration of follow-up was 50 months. Comparison of the disease-specific survival rates for several factors revealed that the configuration and size of the tumors were significantly predictable factors for prognosis. In well-selected patients with grade 3 superficial bladder cancer, bladder preservation seems to be possible by TUR with or without adjuvant therapies. Hence further studies on a larger series are needed to elucidate more feasible and reliable prognostic factors to avoid unnecessary cystectomy and improve the quality of life of the patients.

[Imaging studies of excretory urography and computed tomography scan for patients suffering from renal colic].

Renal colic mainly due to urolithiasis is one of the most common morbid conditions in urology and commonly seen in the urology emergency clinic. Imaging studies were performed to evaluate the upper urinary tract of 29 patients suffering from renal colic in the 2 years between November, 1994 and October, 1996. After intramuscular injection of the analgesic (pentazocine, 15 mg), all 29 patients were examined by excretory urography (IVP) at the time of the first visit. In some patients abdominal plain computed tomography (CT) scan was performed consecutively even when extravasation of the contrast medium was not seen. Spontaneous peripelvic extravasation was seen in 14 patients (11 males and 3 females) with urolithiasis; 7 of them were diagnosed by IVP, 5 by IVP plus CT scan and 2 with CT scan only. IVP imaging study followed by plain abdominal CT scan is useful even when the contrast medium is not extravasated on IVP in patients suffering from renal colic.

Acute testicular ischemia results in germ cell-specific apoptosis in the rat.

Testis torsion-induced aspermatogenesis is not necessarily due to permanent loss of blood flow nor to dysfunctional Leydig cells or Sertoli cells. This investigation was undertaken to gain further insight into the mechanism underlying torsion-induced germ cell loss. Male rats were subjected to 1-h or 2-h ischemia-inducing torsion, and testes were examined at either 1, 2, 4, 24, or 48 h after torsion, depending on the study. Testes were examined for evidence of 1) in situ apoptosis by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP)-biotin nick-end labeling (TUNEL) technique, 2) apoptosis by the DNA "laddering" technique, 3) leukocyte margination and diapedesis in testicular vessels by immunocytochemical and histological techniques, and 4) testicular lipid peroxidation by the thiobarbituric acid reactive substances assay. The first TUNEL evidence for torsion-induced apoptosis was at 4 h after repair of 1-h torsion. Induction of apoptosis was confirmed by the electrophoretic laddering of DNA fragments. It was hypothesized that apoptosis was induced by reactive oxygen species arising from reperfusing leukocytes. A significant increase in both leukocyte margination and diapedesis occurred 4 h after torsion repair as did a significant increase in intratesticular lipid peroxidation products. These events were contemporaneous with the first appearance of apoptosis and consistent with the hypothesis that post-torsion, germ cell-specific apoptosis is induced by reactive oxygen species.

Plasmacytoma of the testis.

Extramedullary plasmacytomas of the testes are extremely rare tumors, especially when occurring in the absence of precocious or concurrent diagnosis of multiple myeloma. This is a case report of an 83-year-old man with a solitary plasmacytoma of the left testis. Immunoperoxidase studies, performed on histologic specimens after radical orchiectomy, showed a monoclonal staining of intracellular immunoglobulin for IgG-lambda type. He has been well for more than 14 months with no evidence of local recurrence or multiple myeloma.

Lysosomal cysteine proteinases in rat epididymis.

To examine the precise localization of lysosomal cysteine proteinases, cathepsins B, H, and L in rat epididymal epithelial cells, immunohistochemistry and enzyme assay were applied to the epididymal tissue. Granular immunodeposits for cathepsins B and H were detected in epididymal epithelial cells, whereas faint or no immunoreactivity for cathepsin L was found. Moreover, immunoreactivity for cathepsin B appeared mainly in principal cells and was more intense in the head of the epididymis than in the tail, whereas that for cathepsin H appeared in both principal and clear cells and was more intense in the tail than the head. By enzyme assay, activities of cathepsins B and H showed a similar distribution to that of the immunoreactivity. The cathepsin L-specific activity was distributed evenly in each part of the epididymis and was also detected in epididymal fluids obtained from the body and tail parts. By immunoblotting, proforms of cathepsins B, H, and L were present in the seminal fluid. The results suggest that cathepsins B and H are involved in the intracellular degradation system of epididymal epithelial cells, and proforms of cathepsins B, H, and L may be secreted into the epididymal duct lumen.

Testicular injury: late results of semen analyses after uniorchiectomy.

Semen parameters from 4 patients with testicular injury after uniorchiectomy were investigated. Semen volume and sperm morphology were not affected after the operation, but sperm count and motility were severely diminished. Two of 4 cases showed azoospermia, and the other 2 cases showed low values in both sperm count and motility. After 150-300 days from the operation, 2 cases recovered to the normal range in sperm count while the other 2 remained in the abnormal range. In sperm motility, 3 cases recovered to the normal range but the rest remained abnormal. The results suggest that long-term follow-up in semen parameters is needed when unilateral orchiectomy is performed.

[Surgical exploration for renal cyst: two-case report].

A 59-year-old male was admitted to our clinic for further examination of the calcified renal cyst discovered incidentally on medical workup elsewhere. CT showed a left renal cyst associated with calcification. Ultrasound-guided puncture of the renal cyst was not successful because of thickness of the cystic wall. Renal angiography showed hypervascularity of the cystic wall. Association of renal cell carcinoma could not be ruled out, therefore the exploration was performed. Histological examination revealed benign renal cyst with calcification. A 27-year-old male presented with the chief complaint of left flank pain. Following examinations by US, CT and MRI, a renal cyst associated with renal cell carcinoma was highly suspected. Subsequent exploration revealed cluster of cysts with a yellowish lesion a few mm in diameter. Frozen section revealed no malignancy, and cystic fluid was not hemorrhagic. Therefore as many cystic walls as possible were removed without nephrectomy. Histological examination of the permanent specimen revealed renal cell carcinoma. Renal cyst associated with renal cell carcinoma was regarded as rare clinical entity, but such cases are reported in increasing number in recent years. We report such cases and review the pertinent literature in this paper.

Recombinant human interleukin-1 beta analogue as a regulator of hematopoiesis in patients receiving chemotherapy for urogenital cancers.

Ten patients with advanced urologic cancers who were scheduled to receive at least two courses of chemotherapy were enrolled in this trial. Fifty thousand units of recombinant human interleukin-1 (IL-1) beta analogue OCT-43 (Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan) was administered subcutaneously only once or twice when severe neutropenia (less than 500/microliters) continued for 2 consecutive days. In eight patients, OCT-43 was not injected in the first course of chemotherapy as a control, but was injected in the second course. The durations of leukocytopenia (less than 2000/microliters) and neutropenia (less than 1000/microliters) were significantly shortened in the second course compared with those in the first course in those eight patients. Recovery of neutrophil number from the lowest number was also significantly faster in the second course. Thus, OCT-43 was considered to have hematopoietic activities. However, single or double injection of OCT-43 did not affect the numbers of eosinophilic or basophilic granulocytes, monocytes, or platelets. Adverse effects associated with OCT-43 injections were high fever and chills, but they were controlled by indomethacin.

[Clinical study of renal cell carcinoma as incidental finding].

Reports on renal cell carcinoma (RCC) as an incidental finding have been increasing in recent years as the imaging modalities including ultrasonography (US) and computerized tomography (CT) scan have gained popularity in clinical medicine. Because effective treatment in RCC is only surgical removal of the involved kidney even at present, it is imperative for urologists to find and to diagnose the RCC in early stage. Whether RCC found incidentally is in early stage cancer is not determined at present. To determine if the RCC found incidentally is in early stage cancer and if the survival rate is better than that of the RCC found with symptoms, we undertook the following study. Between December 1972 and March 1990, 65 patients with RCC were registered at the Department of Urology, Teikyo University Hospital. Of 65 patients 20 with RCC as an incidental finding were subjected to this study. 34 patients with RCC found with symptoms including hematuria were subjected to control group. Causes of the diagnosis in 20 patients included workup for non-urological diseases in 11 patients (55.0%), workup for urological disease other than RCC in 5 patients (25.0%) and routine medical checkup in 4 patients (20.0%). First-line imaging modalities for the diagnosis was US in 9 patients (45.0%), DIP in 6 patients (30.0%) and CT in 5 patients (25.0%). Size of the tumor, pathological stage (pT) and grade in these 20 patients were tended to be smaller and lower, respectively, but these results were not significant as compared to those of the control group. Incidence of the remote metastasis, at the time of diagnosis, however, was significantly lesser than that of the control group (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)