記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

ObjectivesTo determine the effect of preoperative chemotherapy on survival in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.
MethodsWe retrospectively analyzed 55 consecutive patients who received radical nephroureterectomy with or without preoperative chemotherapy for upper urinary tract urothelial carcinoma clinically involving regional lymph nodes at a single institution between January 1991 and December 2013.
ResultsMedian follow up was 18 months (range 2-193). Of 55 patients, 24 (43.6%) received preoperative chemotherapy (study group) and 31 (56.4%) underwent primary surgery (control group). Preoperative chemotherapy consisted of two to four cycles (median 3) of cisplatin-containing regimens. The fraction of patients with lower pathological T stage and N stage than clinical T stage and N stage was higher in the study group (29.2% and 54.2%) compared with the control group (3.2% and 16.1%; P = 0.013 and 0.010, respectively). The 5-year overall survival rate was significantly higher in the study group than in the control group (44.0% vs 12.9%, log-rank, P = 0.003). In multivariate analysis incorporating age at diagnosis, Eastern Cooperative Oncology Group Performance Status, clinical N stage and the number of removed lymph nodes, preoperative chemotherapy was a predictor of better overall survival (P = 0.047, HR 0.47, 95% CI 0.22-0.99).
ConclusionsPreoperative chemotherapy might provide better survival outcomes in patients with upper urinary tract urothelial carcinoma clinically involving regional lymph nodes.

DOI： 10.1111/iju.13010

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

ObjectivesTo characterize patients experiencing late recurrence after primary radical surgery for renal cell carcinoma and to approach the mechanism of late recurrence.
MethodsWe retrospectively analyzed 657 consecutive patients who underwent radical surgery for pathologically confirmed stage III renal cell carcinoma in a single institution between January 1981 and December 2008. Early or late recurrence was defined as a recurrence occurring before or after 60 months after primary surgery.
ResultsOf 657 patients, 96 (14.6%) experienced early recurrence, and 41 (6.2%) developed late recurrence. Patients with late recurrence had smaller diameter of primary tumor (median 5 cm vs 8 cm, P < 0.001), lower pathological stage (P < 0.001) and lower nuclear grade (P = 0.004) at primary surgery than those with early recurrence. On multivariate analysis, vascular invasion (including microscopic and gross invasion) was the predictor of late recurrence (P < 0.01, HR 3.79). Overall survival and disease-specific survival after recurrence were longer in patients with late recurrence (median 64 and 76 months, respectively) than in those with early recurrence (34.5 and 35 months, respectively; P = 0.008 and 0.002).
ConclusionsThese results suggest that micrometastasis at the time of surgery associated with vascular invasion at primary tumor site and their relatively lower malignant potential could lead to late recurrence. Further studies are warranted for better understanding and managing late recurrence of renal cell carcinoma.

DOI： 10.1111/iju.12996

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD  

Curcumin is an antioxidant agent with both radiosensitizing and radioprotective properties. The aim of the present study was to evaluate the effect of curcumin supplementation on oxidative status of patients with prostate cancer who undergo radiotherapy. Forty patients treated with radiotherapy for prostate cancer were randomized to the curcumin (CG, n = 20) or placebo group (PG, n = 20). They received curcumin (total 3 g/day) or placebo during external-beam radiation therapy of up to 74 Gy. Plasma total antioxidant capacity (TAC) and activity of superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) were measured at baseline and 3 mo after radiotherapy completion. Analysis of covariance was used to compare the variables between groups following the intervention. Serum PSA levels and MRI/MRS images were investigated. In CG, TAC significantly increased (P < 0.001) and the activity of SOD decreased (P = 0.018) after radiotherapy compared with those at baseline. In CG, however, the activity of SOD had a significant reduction (P = 0.026) and TAC had a significant increase (P = 0.014) compared with those in PG. PSA levels were reduced to below 0.2 ng/ml in both groups, 3 mo after treatment, however, no significant differences were observed between the 2 groups regarding treatment outcomes.

DOI： 10.1080/01635581.2016.1115527

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

IgG4-related autoimmune pancreatitis is frequently accompanied by relevant lesions in the genitourinary tract and retroperitoneal organs, which cause various clinical problems, ranging from non-specific back pain or bladder outlet obstruction to renal failure. The diagnosis of IgG4-related retroperitoneal fibrosis requires a multidisciplinary approach, including serological tests, histological examination, imaging analysis, and susceptibility to steroid therapy. Radiological examinations are helpful to diagnose this condition, but surgical resection is occasionally unavoidable to exclude malignancy, particularly for patients with isolated retroperitoneal involvement. Steroid therapy is the treatment of choice for this condition, the same as for other manifestations of IgG4-related disease. For patients with severe ureteral obstruction, additional ureteral stenting needs to be considered prior to steroid therapy to preserve the renal function. Some papers have suggested that IgG4-related disease can affect male reproductive organs including the prostate and testis. IgG4-related prostatitis usually causes lower urinary tract symptoms, such as dysuria and pollakisuria. Patients sometimes state that corticosteroids given for IgG4-related disease at other sites relieve their lower urinary tract symptoms, which leads us to suspect prostatic involvement in this condition. Because of the limited number of publications available, further studies are warranted to better characterize IgG4-related disease in male reproductive organs. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

DOI： 10.3748/wjg.v20.i44.16550

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記述言語：英語   出版者・発行元：CIG MEDIA GROUP, LP  

Diabetes mellitus and prostate cancer are 2 of the most important public health concerns, especially in the elderly population. Although diabetes has been recognized as a potent risk factor for many types of cancers, there is a large amount of evidence that shows that it has a protective role against prostate cancer. The underlying cause of this protective role is not fully understood, however, some mechanisms have been proposed in this area. In the present study we have reviewed these mechanisms and some new mechanisms are also proposed.

DOI： 10.1016/j.clgc.2014.01.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Objectives: To clarify the effect of the time from the presentation of symptoms to medical consultation (time to consultation) on oncological outcomes in men with testicular cancer and to examine whether the recent improvement of delays in consultation has led to better outcomes.
Methods: We reviewed 175 consecutive patients registered for testicular cancer (124 men with seminoma and 51 men with nonseminoma) at a single institution between 1991 and 2010.
Results: Men with the time to consultation of >6 months (n = 56) had a poorer overall survival than those with the time to consultation of <= 6 months (log-rank test, P = 0.028), despite similar disease stage between them (P = 0.897) and less prevalent nonseminoma in the former (P = 0.032). Although the negative effect of consultation delay on overall survival was significant only in nonseminoma histology (log-rank test, P = 0.004), the time to consultation of >6 months was an independent risk factor associated with poorer overall survival (hazard ratio [HR] = 18.0, 95% confidence interval [CI]: 1.78 182, P = 0.014), in addition to nonseminoma histology (HR = 17.4, 95% Cl: 1.38-219, P = 0.027) and stage II or higher disease (HR = 12.9, 95% CI: 1.36-123, P = 0.026) in all the patients. The time to consultation was positively correlated with the primary tumor size (P < 0.001). The time to consultation was shorter and the primary tumor size was seemingly smaller in patients registered between 2001 and 2010 (n = 104) than in those registered between 1991 and 2000 (median 74 d vs. 109 d, P = 0.042 and 5.8 +/- 2.6 cm vs. 6.7 +/- 3.3 cm, P = 0.068, respectively), although disease stage and overall survival were not different between the 2 periods (P = 0.233 and log-rank test, P = 0.719, respectively).
Conclusions: The time to consultation and primary tumor size showed a strong positive correlation in men with testicular cancer. Delays in consultation had a negative effect on their survival, particularly in those with nonseminoma. The time to consultation significantly shortened and the primary tumor size was reduced with a borderline significance in men registered between 2001 and 2010 compared with those between 1991 and 2000, although stage migration or survival improvement in recent years was not observed. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.urolonc.2013.05.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BENTHAM SCIENCE PUBL LTD  

Androgen and androgen receptor (AR) play a critical role in the development of prostate cancer. Androgen deprivation therapy (ADT) has become the therapeutic mainstay for patients with metastatic prostate cancer. ADT can reduce the serum testosterone level from the normal range between 500 and 600 ng/dl to the castrate level. Following surgical castration, the serum testosterone level decreases to less than 20 ng/dL (0.69 nmol/L) in about three quarters of the patients. Although insufficient suppressions of the serum testosterone level following ADT have not been well recognized to date, the failure in achieving the castrate level of testosterone may have an adverse impact on survival in men with prostate cancer. Although circulating testosterone levels following castration do not necessarily reflect the amount of intraprostatic testosterone or dihydrotestosterone, testosterone during ADT mainly derives from intratumorally synthesized precursors and adrenal androgens. The advent of new agents represented by abiraterone acetate and enzalutamide, which target adrenal or intraprostatic androgen biosynthesis and AR signaling, respectively, has retrieved interest in testosterone levels during ADT. We critically reviewed androgen metabolism and its significance in prostate cancer biology and treatment to promote their better understanding and management of men with prostate cancer.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objectives To clarify the prevalence of lower urinary tract symptoms and overactive bladder in patients with chronic methyl mercury poisoning. Methods A total of 151 patients (61 men and 90 women; mean age 72.1 years) with Niigata Minamata disease were enrolled. An age- and sex-matched group of 150 participants was used as control. Patients reported their International Prostate Symptom Score and overactive bladder symptom score. Results In men, the total, storage and voiding International Prostate Symptom Score scores were higher in the Niigata Minamata disease group than in the control group (10.6 +/- 7.8 vs 5.0 +/- 5.0, 4.5 +/- 3.3 vs 2.4 +/- 2.4 and 6.1 +/- 5.1 vs 2.7 +/- 3.1, respectively, P<0.001 in all). In women, these scores were also higher in the Niigata Minamata disease group than in the control group (8.9 +/- 7.3 vs 4.0 +/- 4.0, 4.4 +/- 3.2 vs 2.8 +/- 2.4 and 4.5 +/- 5.0 vs 1.3 +/- 2.0, respectively, P<0.001 in all). The prevalence of overactive bladder was more frequent in the Niigata Minamata disease group compared with that in the control group (51.7% vs 26.7%, P<0.001). In both men and women, the overactive bladder symptom score was higher in the Niigata Minamata disease group than in the control group (4.1 +/- 3.0 vs 2.4 +/- 2.9, P=0.002 and 4.6 +/- 3.6 vs 2.7 +/- 2.9, P<0.001, respectively). The International Prostate Symptom Score and overactive bladder symptom score in the Niigata Minamata disease group were highest in patients aged 60-69 years (P<0.001 in both), whereas these increased in an age-dependent manner in the control group. Conclusions Lower urinary tract symptoms and overactive bladder are severe and highly prevalent conditions among patients with methyl mercury poisoning. The higher prevalence of lower urinary tract symptoms among patients aged 60-69 years might be related to the fact that they were exposed to methyl mercury during their childhood/development.

DOI： 10.1111/iju.12001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Surveillance after orchiectomy has recently been a management option in patients with stage I seminoma, while it remains controversial in those with stage I nonseminoma, and the risk factor associated with relapse is still a matter of concern in both entities. This study was performed to explore pathological risk factors for post-orchiectomy relapse in patients with stage I seminoma and nonseminoma, and to assess oncological outcomes in those managed with surveillance. Methods: In this single institution study, 118 and 40 consecutive patients with stage I seminoma and nonseminoma were reviewed, respectively. Of the 118 patients with stage I seminoma, 56 and one received adjuvant radiotherapy and chemotherapy, respectively, and 61 were managed with surveillance. Of the 40 men with stage I nonseminoma, 4 underwent adjuvant chemotherapy and 36 were managed with surveillance. Results: No patient had cause-specific death during the mean observation period of 104 and 99 months in men with seminoma and nonseminoma, respectively. In men with stage I seminoma, 1 (1.7%) receiving radiotherapy and 4 (6.6%) men managed with surveillance had disease relapse
the 10-year relapse-free survival (RFS) rate was 93.4% in men managed with surveillance, and their RFS was not different from that in patients receiving adjuvant radiotherapy (logrank P=0.15). Patients with tunica albuginea involvement showed a poorer RFS than those without (10-year RFS rate 80.0% vs. 94.1%), although the difference was of borderline significance (P=0.09). In men with stage I nonseminoma, 9 (22.5%) patients experienced relapse. Patients with lymphovascular invasion seemingly had a poorer RFS than those without
40.0% and 18.7% of the patients with and without lymphovascular invasion had disease relapse, respectively, although the difference was not significant (logrank P=0.17). Conclusion: In both men with stage I seminoma and nonseminoma, surveillance after orchiectomy is a feasible option. However, disease extension through tunica albuginea might be a factor associated with disease relapse in patients with organ-confined seminoma, and those with stage I nonseminoma showing lymphovascular invasion may possibly be at high risk for disease relapse. © 2013 Kobayashi et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1746-1596-8-57

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Intratumoral synthesis of dihydrotestosterone(DHT) from precursors cannot completely explain the castration resistance of prostate cancer. We showed that DHT was intratumorally synthesized from the inactive androgen metabolites 5 alpha-androstane-3 alpha/beta, 17 beta-diol(3 alpha/beta-diol) in prostate cancer cells via different pathways in a concentration-dependent manner. Additionally, long-term culture in androgen-deprived media increased transcriptomic expression of 17 beta-hydroxysteroid dehydrogenase type 6(HSD17B6), a key enzyme of oxidative 3 alpha-HSD that catalyzes the conversion of 3 alpha-diol to DHT in prostate cancer cells. Correspondingly, the score for HSD17B6 in tissues of 42 prostate cancer patients undergoing androgen deprivation therapy(ADT) was about 2-fold higher than that in tissues of 100 untreated individuals. In men receiving ADT, patients showing biochemical progression had a higher HSD17B6 score than those without progression. These results suggested that 3 alpha/beta-diol also represent potential precursors of DHT, and the back conversion of DHT from androgen derivatives can be a promising target for combination hormone therapy.

DOI： 10.1038/srep01528

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The hand-assisted technique enables the rapid extraction of the graft, shortening the warm ischemia time (WIT), and the retroperitoneoscopic approach is potentially associated with a less incidence of postoperative ileus in donor nephrectomy for living kidney transplantation. The aim of this study was to assess the efficacy and safety of retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device (GelPort), which is a wound sealing device that permits the access of the hand to the surgical field, free trocar site choice within it, and rapid conversion to open surgery if necessary, while preserving the pneumoperitoneum/pneumoretroperitoneum.
Methods: Seventy-five consecutive donors receiving this procedure were retrospectively studied. A 2-cm skin incision was made at the midpoint between the tip of the 12th rib and superior border of the iliac bone in the midaxillary line, through which retroperitoneal space was made. Preperitoneal wound with a 6 - 7-cm pararectal incision in the upper abdominal region was connected to the retroperitoneal space. A GelPort was put inside the pararectal surgical wound. The principle was pure retroperitoneoscopic surgery; hand-assist was applied for retraction of the kidney in the renal vessel control and graft extraction.
Results: The mean operation time including waiting time for recipient preparation was 242.2 +/- 37.0 (range: 214.0-409.0) min, and the mean amount of blood loss was 164.3 +/- 146.6 (range: 10.0-1020.0) ml. The mean WIT was 2.8 +/- 1.0 (range: 1.0-6.0) min. The shortage of renal vessels or ureter was observed in none of the grafts. No donor experienced blood transfusion, open conversion, or injury of other organs. Blood loss was greater in patients with body mass index (BMI) of 25 kg/m(2) or higher than in those with BMI of <25 kg/m(2) (218.4 +/- 98.8 vs. 154.8 +/- 152.1 ml, P=0.031). No donor had postoperative ileus or reported wound pain leading to decreased activity of daily life or wound cosmetic problem.
Conclusions: Retroperitoneoscopic hand-assisted donor nephrectomy with the mentioned approach was suggested to be a feasible option without compromising safety, although further improvement in surgical techniques is warranted.

DOI： 10.1186/1471-2490-13-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVE To elucidate the mechanism of the androgen deprivation therapy (ADT)-related decrease in lean body mass (LBM).
MATERIALS AND METHODS The LBM and blood samples were studied before and after 6 months of ADT in 72 patients with localized prostate cancer. The LBM was assessed using a foot-to-foot bioelectrical impedance analyzer.
RESULTS Before ADT, the LBM correlated with none of the serum sex steroid levels; however, it correlated closely with serum 5 alpha-androstane-3 alpha, 17 beta-diol glucuronide (Spearman's rank correlation coefficient = 0.409, P = .001) and insulin-like growth factor-1 (IGF-I, Spearman's rank correlation coefficient = 0.329, P = .005). After ADT, the LBM decreased by 0.9% (P = .036), and the serum testosterone and dihydrotestosterone had decreased by 96.8% and 94.3%, respectively (P < .001 for both), and the IGF-I had increased by 11.6% (from 19.9 to 22.2 nmol/L, P = .001). The serum 1,25-dihydroxyvitamin D3 [1,25(OH)2D] levels decreased after ADT by 9.8% (from 66.2 to 59.7 pg/mL, P = .008), and the post-treatment LBM correlated inversely with 1,25(OH) 2D (Spearman's rank correlation coefficient = -0.343, P = .003). The post-treatment LBM was dissociated with 5 alpha-androstane-3 alpha, 17 beta-diol glucuronide and IGF-I. The pretreatment and post-treatment LBMs both correlated inversely with serum sex hormone-binding globulin (P = .024 and P = .016, respectively).
CONCLUSION The deficiency in androgen levels was suggested to be a link to the ADT-related decrease in LBM; the androgen metabolite 5 alpha-androstane-3 alpha, 17 beta-diol glucuronide has a potential value for assessing the LBM in untreated men. IGF-I also promotes muscle building and is positively regulated during ADT. Sex hormone-binding globulin possibly accelerates the ADT-related decrease in LBM. Although the mechanism for the decrease in 1,25(OH) 2D and its inverse correlation with LBM during ADT is unclear, 1,25(OH) 2D might be a biomarker reflecting the ADT-related decrease in LBM. UROLOGY 81: 376-380, 2013. (C) 2013 Elsevier Inc.

DOI： 10.1016/j.urology.2012.10.050

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Objective:To evaluate the potential of the RENAL nephrometry score and the PADUA classification in the prediction of perioperative outcomes represented by intraoperative conversion to nephrectomy in patients with renal tumors for which nephron-sparing surgery (NSS) was attempted. Methods: Recent 100 open NSSs attempted for cT1 renal tumors at a single institution were studied retrospectively. Results: With the RENAL, the operation time and ischemia time were longer in the high complexity group (p = 0.01 and p = 0.03, respectively), and blood loss was seemingly greater in this group (394 vs. 220 and 167 ml, p = 0.09). Conversion to nephrectomy was more frequent in the high complexity (4 procedures, 33.3%) than in the low (0%) and moderate (1 procedures, 1.5%) groups (p < 0.01). Regarding the PADUA, the operation time, blood loss and ischemia time increased according to the complexity (p = 0.04, p = 0.02, and p = 0.02, respectively). Conversion to nephrectomy was more frequent in the high complexity (4 procedures, 22.2%) than in the low (0%) and moderate (1 procedure, 1.8%) groups (p < 0.01). In patients with achieved NSS, postoperative estimated glomerular filtration rate was more impaired in the high complexity group in the PADUA (p = 0.02), although not significant in the RENAL (p = 0.11). Conclusions: Both the RENAL and PADUA are useful in the prediction of conversion to nephrectomy in addition to NSS-associated perioperative outcomes. (C) 2013 S. Karger AG, Basel

DOI： 10.1159/000353086

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記述言語：英語  

Naftopidil, which to a certain extent shows an affinity to α1D-adrenoceptor subtype in addition to a high affinity to α1A-adrenoceptor, has been used for the treatment of benign prostatic obstruction and benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS). The aim of the present review is to systematically refer to the published studies on this unique agent for BPH. Based on a randomized prazosin-controlled study and another double-blind placebo-controlled study, which verified the dose-dependent effects of naftopidil, the Japanese Ministry of Health, Labor and Welfare approved naftopidil for treating men with BPH in 1996. Several tamsulosin-controlled studies have suggested treatment effects of naftopidil similar to those of tamsulosin and potentially higher efficacy for alleviating storage symptoms by naftopidil. Although well-designed, randomized studies are warranted to confirm the long-term outcomes and effector/target of naftopidil, the α1A-antagonist naftopidil, which also blocks α1D-adrenoceptor, improves voiding symptoms, and may also be useful for the management of men with storage symptoms represented by nocturia, retrieving their quality of life impaired by BPH-associated LUTS. © 2012, SAGE Publications. All rights reserved.

DOI： 10.1177/1756287212461681

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: Luteinizing hormone (LH) during androgen-deprivation therapy (ADT) with gonadotropin-releasing hormone analogues (GnRHa) has been thought to be biologically inactive, and the regulation of LH during ADT with GnRHa is thus unknown. Insulin-like growth factor-1 (IGF-1) is involved in the regulation of cell proliferation and differentiation, and IGF-1 production in the liver is dependent on growth hormone (GH) secretion from the anterior pituitary. Despite the presence of IGF-1 receptors in the gonadotroph, associations between the GH/IGF-1 and pituitary-gonadal axes, e.g., whether IGF-1 elicits the LH secretion, remain unclear.
Methods: Seventy-one patients with localized prostate cancer, who received ADT with GnRHa, were prospectively studied based on their blood samples before treatment and after ADT for 6 months. We employed highly sensitive assays for measurement of serum testosterone (electrochemiluminescence immunoassay), GH/IGF-1 (radioimmunoassay), adrenocorticotropic hormone (ACTH: immunoradiometric assay), LH (chemiluminescent immunoassay), and dehydroepiandrosterone sulfate (DHEA-S: chemiluminescent enzyme immunoassay).
Results: No correlation was noted between the pretreatment LH and IGF-1 levels; after ADT, the serum LH level was closely correlated with the IGF-1 concentration [Spearman's correlation coefficient (rs) = 0.370, P = 0.001]. The serum levels of androgens and gonadotropins reduced following ADT (P < 0.001 in all). The serum IGF-1 level increased (22 +/- 6 nmol/L) compared with that at the baseline (19 +/- 5 nmol/L) (P < 0.001), but no change was observed in the serum GH concentration between before and after ADT (1.4 +/- 2.3 vs. 0.9 +/- 0.9 mu g/L, respectively, P = 0.691). The serum testosterone level was not correlated with the LH level either before or after ADT. The testosterone and DHEA-S levels after ADT were correlated with ACTH concentration (rs = 0.367, P = 0.002 and rs = 0.354, P = 0.002, respectively). We did not identify any correlations between the serum IGF-1 concentration and Gleason score, PSA value, or androgen levels.
Conclusions: During ADT with GnRHa, IGF-1 possibly promotes LH production, although its role is unclear. Associations among pituitary-gonadal, pituitary-adrenal, and GH/IGF-1 axes represented by IGF-1-mediated LH secretion and ACTH-mediated androgen synthesis are of interest, since both prostate epithelium proliferation and male anabolic activity are involved in these 3 axes. Assessment of oncologic outcomes is warranted for their significance in patients with prostate cancer. (C) 2012 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.urolonc.2010.11.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

BACKGROUND Interleukin-6 produced in adipose tissue plays a role in lipid metabolism, and also interacts with sex steroids. This study was performed to elucidate the mechanism of lipid metabolism disorder during androgen deprivation therapy (ADT) in terms of the association of interleukin-6 with sex steroids. METHODS Seventy-two patients with localized prostate cancer were prospectively studied based on their body-composition and blood samples before and after ADT for 6 months. RESULTS Before ADT, serum interleukin-6 levels were inversely correlated with serum total-testosterone (rs?=?-0.305, P?=?0.009) and dihydrotestosterone (rs?=?-0.380, P?=?0.006) concentrations, but not correlated with adrenal androgen or estradiol levels. Pretreatment interleukin-6 levels were positively correlated with %body fat (rs?=?0.349, P?=?0.003) and %visceral fat (rs?=?0.384, P?=?0.001). After ADT, %body fat increased (P?<?0.001) and lean body mass decreased (P?=?0.036). After ADT, in contrast to the pretreatment relationship, interleukin-6 levels were positively correlated with total-testosterone concentrations (rs?=?0.343, P?=?0.003), and were positively correlated also with levels of androstenedione (rs?=?0.351, P?=?0.002) and estoradiol (rs?=?0.335, P?=?0.004). Interleukin-6 levels were equivalent between before and after ADT (2.02 vs. 2.16?pg/ml, P?=?0.205), but the positive correlation between interleukin-6 levels and %body or %visceral fat noted before ADT disappeared after ADT. CONCLUSIONS Posttreatment interleukin-6 levels had a strong positive correlation with total-testosterone, androstenedione, and estradiol levels, suggesting that a regulation loop may emerge between these sex steroids and interleukin-6 during ADT. The altered association between interleukin-6 and sex steroids is possibly involved in ADT-related lipid metabolism disorder with unchanged interleukin-6 levels despite increased %body fat. Prostate 72:12071213, 2012. (C) 2011 Wiley Periodicals, Inc.

DOI： 10.1002/pros.22471

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：CHURCHILL LIVINGSTONE  

Objective: This study was performed to elucidate the mechanism of high bone turnover during androgen deprivation therapy (ADT) in terms of osteogenic endocrine activity by testosterone, adrenal androgens, and insulin-like growth factor-1 (IGF-I), and to identify markers reflecting the bone mineral density (BMD) during ADT.
Design: BMD and samples of blood and urine were studied before and after 6 months of ADT in 70 patients with localized prostate cancer.
Results: Before ADT, serum free-testosterone, dehydroepiandrosterone sulfate (DHEA-S), androstenedione, and IGF-I levels were correlated with BMD (rs = 0.344, p = 0.004; rs = 0.264, p = 0.027; rs = 0.329, p = 0.005; rs = 0.300, p = 0.012, respectively). The serum IGF-I level was independently correlated with the pretreatment BMD (Multivariate p = 0.001). These relationships disappeared after ADT (p = 0.519, 0.316, 0.116, and 0.597, respectively). After ADT, serum levels of free-testosterone decreased (7.9 to 0.2 pg/mL), and DHEA-S and androstenedione were also reduced (3.6 to 2.3 mu mol/L and 5.6 to 2.9 nmol/L, respectively) (p<0.001 in all). In contrast, IGF-I levels were elevated after ADT by 11.6% (19.9 to 22.3 nmol/L, p<0.001). Delta-values of IGF-I (post- minus pretreatment levels, mean: +2.2, ranged between -7.1 and +15.3) were inversely correlated with the pretreatment (rs = -0.333 p = 0.005) and post-treatment (rs = -0.408, p = 0.001) BMD. After ADT, the serum IGF-I level was closely correlated with the serum level of the bone formation marker bone-specific alkaline phosphatase (BAP) (rs = 0.328, p = 0.006), and delta-IGF-I and delta-BAP showed a close positive correlation.(rs = 0.388, p = 0.001). The post-treatment BMD was correlated only with the urine deoxypyridinoline (DPD) concentration (rs = -0.302, p = 0.024) among the bone formation/resorption markers including serum/urine N-telopeptide.
Conclusions: Serum IGF-I levels increased during ADT in men with a low BMD. Coupled with reduced androgen levels, elevated IGF-I levels, which were positively correlated with BAP during ADT, possibly explain the mechanism of ADT-related high bone turnover. The increase of IGF-I is more prominent in men whose BMD is already low at the baseline, and urine DPD might be a marker that reflects BMD during ADT. (C) 2012 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ghir.2012.04.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BIOMED CENTRAL LTD  

Background: The prediction of pathological outcomes prior to surgery remains a challenging problem for the appropriate surgical indication of prostate cancer. This study was performed to identify preoperative values predictive of pathological and oncological outcomes based on standardized extended prostate biopsies with core histological results diagrammed/mapped in patients receiving radical prostatectomy for prostate cancer clinically diagnosed as localized or locally advanced disease.
Methods: In 124 patients with clinically localized or locally advanced prostate cancer (cT1c-cT3a) without prior treatment, pathological outcomes on the surgical specimen including seminal vesicle involvement (SVI), positive surgical margin (PSM), and perineural invasion (PNI) were studied in comparison with clinical parameters based on the results of 14-core prostate biopsies comprising sextant, laterally-directed sextant, and bilateral transition zone (TZ) sampling.
Results: Concerning the association of pathological outcomes with oncological outcomes, patients with PSM and PNI on surgical specimens had poorer biochemical-progression-free survival than those without PSM (logrank p = 0.002) and PNI (p = 0.003); it was also poorer concerning SVI, although the difference was not significant (p = 0.120). Concerning the impact of clinical parameters on these pathological outcomes, positive TZ and multiple positive biopsy cores in the prostatic middle were independent values predictive of SVI with multivariate analyses (p = 0.020 and p = 0.025, respectively); both positive TZ and multiple positive prostatic middle biopsies were associated with larger tumor volume (p<0.001 in both). The percentage of positive biopsy cores (%positive cores) and biopsy Gleason score were independent values predictive of PSM (p=0.001) and PNI (p=0.001), respectively. Multiple positive cores in the prostatic base were associated with proximal/bladder-side PSM (p<0.001), and also linked to poorer biochemical-progression-free survival (p=0.004). Clinical T stage had no association with these pathological outcomes.
Conclusions: %positive cores and Gleason score in extended biopsies were independent values predictive of PSM and PNI in prostate cancer clinically diagnosed as localized or locally advanced disease, respectively, which were associated with poorer oncological outcomes. When diagramming biopsy-core results, extended biopsy may provide additional information for predicting oncological and pathological outcomes including SVI in patients clinically diagnosed as having localized or locally advanced disease.

DOI： 10.1186/1746-1596-7-68

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記述言語：英語   出版者・発行元：HINDAWI PUBLISHING CORPORATION  

Prostate cancer and the androgen deprivation therapy (ADT) thereof are involved in diabetes in terms of diabetes-associated carcinogenesis and ADT-related metabolic disorder, respectively. The aim of this study is to systematically review relevant literature. About 218,000 men are estimated to be newly diagnosed with prostate cancer every year in the United States. Approximately 10% of them are still found with metastasis, and in addition to them, about 30% of patients with nonmetastatic prostate cancer recently experience ADT. Population-based studies have shown that dissimilar to other malignancies, type 2 diabetes is associated with a lower incidence of prostate cancer, whereas recent large cohort studies have reported the association of diabetes with advanced high-grade prostate cancer. Although the reason for the lower prevalence of prostate cancer among diabetic men remains unknown, the lower serum testosterone and PSA levels in them can account for the increased risk of advanced disease at diagnosis. Meanwhile, insulin resistance already appears in 25-60% of the patients 3 months after the introduction of ADT, and long-term ADT leads to a higher incidence of diabetes (reported hazard ratio of 1.28-1.44). Although the possible relevance of cytokines such as II-6 and TNF-alpha to ADT-related diabetes has been suggested, its mechanism is poorly understood.

DOI： 10.1155/2012/801610

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

Objective: In 2005, the University of California, San Francisco developed the Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score as a new risk stratification tool. The UCSF-CAPRA, which ranges from 0 to 10 points, consists of five clinical variables, prostate-specific antigen, Gleason score, T stage, percent of positive biopsies and age. The aim of this study was to validate the UCSF-CAPRA score for Japanese prostate cancer patients receiving radical prostatectomy using the contemporary Gleason grading.
Methods: From 1999 to 2010, 211 men who underwent radical prostatectomy were used for validation. Biochemical progression-free survival was calculated using the Kaplan-Meier method and the UCSF-CAPRA and D'Amico risk categories were compared using the log-rank method. The concordance index (c-index) for the UCSF-CAPRA and D'Amico risk classification was calculated.
Results: Using the UCSF-CAPRA score, 85 (40.3%), 106 (50.2%) and 20 (9.5%) subjects were stratified as 0-2 points (low risk), 3-5 points (intermediate risk) and 6-10 points (high risk). Using the D'Amico risk criteria, 66 (31.3%), 89 (42.2%) and 56 (26.5%) were stratified as low-, intermediate- and high-risk groups, respectively. The Kaplan-Meier analysis showed that the UCSF-CAPRA divided the patients significantly into each risk category. There was no significant difference between low and intermediate in the D'Amico risk classification. The c-index of the UCSF-CAPRA and D'Amico classification was 0.755 and 0.713, respectively.
Conclusion: The UCSF-CAPRA is an acceptable risk category tool comparable to that of the D'Amico risk classification for Japanese prostate cancer patients receiving radical prostatectomy in the contemporary Gleason grading era.

DOI： 10.1093/jjco/hyr136

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT, INC  

Purpose: To assess long-term oncologic outcomes in patients with renal pelvic cancer who are receiving nephrectomy plus endoscopy-assisted intussusception ureterectomy. There has been no large study reporting long-term oncologic outcomes of this approach in comparison with those of conventional nephroureterectomy plus bladder cuff removal.
Patients and Methods: We reviewed 181 consecutive patients with renal pelvic cancer who underwent open nephroureterectomy with complete bladder cuff removal (cuff removal group, n = 33), nephroureterectomy with incomplete cuff removal (orifice-remaining group, n = 39), and nephrectomy with intussusception ureterectomy (intussusception group, n = 109).
Results: Patients in the intussusception group had larger tumor size, higher histologic grade, and more advanced pathologic stage (P = 0.005, 0.021, and 0.030, respectively), while the incidence of coexistent bladder/ureteral cancer was lower in this group (P < 0.001). The mean operative time was shorter in the intussusception group than in the cuff removal and orifice-remaining groups (201.2 +/- 33.1 and 221.5 +/- 47.2 min, respectively, P < 0.001). The 5-year extraurinary tract recurrence-free survival rate in the intussusception and cuff removal groups was 74.8% and 71.4%, respectively (log-rank P = 0.766), and it was lower in the orifice-remaining group compared with that in the intussusception group (P = 0.031). The 5-year urinary tract recurrence-free survival rate in the intussusception, cuff removal, and orifice-remaining groups was 76.6%, 65.0%, and 65.0%, respectively (intussusception vs cuff removal: P = 0.089). With both univariate and multivariate analyses, intussusception ureterectomy had no significant impact on urinary tract recurrence (multivariate P = 0.553, hazard ratio = 0.784).
Conclusions: Nephrectomy plus endoscopy-assisted intussusception ureterectomy is an oncologically safe alternative for renal pelvic cancer patients, which is possibly associated with less patient morbidity.

DOI： 10.1089/end.2010.0336

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objectives:
The aim of the current study was to establish the predictive accuracy of the Kattan postoperative nomogram for non-metastatic renal cell carcinoma (RCC) in a Japanese population.
Methods:
A total of 211 patients with stage T1-3N0M0 clear cell RCC who underwent radical nephrectomy or nephron-sparing surgery between 1991 and 2004 were included in this analysis. Median follow up was 81 months (range: 4-208). Univariate and multivariate analyses were performed, and the influence of age, sex, clinical presentation, T stage, histological tumor size, grade, and microvascular invasion on disease recurrence-free survival (RFS) was determined. For each patient, the prognostic score for 5-year RFS was calculated using the Kattan nomogram. The discriminating ability of this model was assessed by the concordance index, and bootstrapping was used to evaluate confidence intervals.
Results:
The 5-year RFS rate for all patients calculated using the Kaplan-Meier method was 80.6%. In multivariate analysis, the statistically significant prognostic factors for 5-year RFS were high-grade tumors (P = 0.019) and symptomatic disease (P = 0.017). The concordance index for RFS predicted by the Kattan nomogram was 0.735 (95% confidence interval: 0.734-0.736). There was a slight discrepancy between the RFS predicted by the Kattan nomogram and the likelihood of being recurrence-free at 5 years according to the Cox analysis in the current patient population.
Conclusion:
These findings suggest the necessity of constructing a more useful nomogram for predicting the prognosis of Japanese patients with non-metastatic RCC.

DOI： 10.1111/j.1442-2042.2010.02693.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives. To examine the feature of men who benefit from dose escalation of naftopidil for lower urinary tract symptoms (LUTSs). Methods. Based on the IPSS, men reporting LUTS were prospectively studied using 50mg/day of naftopidil for the first 4 weeks
satisfied patients continued its 50mg/day (n=11), and those reporting unsatisfactory improvement received its 75mg/day (n=35) for the next 4 weeks. Results. The 75mg group showed improvement in the total IPSS and QOL score in a dose-dependent manner (at 4 weeks: P&lt
.001, at 4 weeks versus 8 weeks: P&lt
.05). In the 50mg group, both scores reduced at 4 weeks, thereafter unchanged. The baseline slow stream score alone was higher in the 75mg group (P=.013). The rate of change in the QOL score during the initial 4 weeks (ΔQOL) and Δnocturia was smaller in the 75mg group (P&lt
.05). Conclusions. Men with high slow stream score and unsatisfactory improvement in nocturia may benefit from dose escalation of naftopidil. Copyright © 2011 Takaki Mizusawa et al.

DOI： 10.1155/2011/804583

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Purpose: We elucidated the regulatory mechanism of adrenal androgen synthesis and examined the influence of pituitary-adrenal axis activity on prostate specific antigen during androgen deprivation therapy.
Materials and Methods: A total of 72 patients with localized prostate cancer were prospectively studied based on blood samples before and after androgen deprivation therapy for 6 months. Serum pituitary hormones, androgens and prostate specific antigen were measured using highly sensitive assays. Results: After androgen deprivation therapy serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, dehydroepiandrosterone sulfate, androstenedione and prostate specific antigen decreased compared with those at the baseline (all values p <0.001). No difference was noted between serum levels before and after androgen deprivation therapy in growth hormone (p = 0.098) and adrenocorticotropic hormone (p <0.101). Each serum level of luteinizing hormone, follicle-stimulating hormone and growth hormone after androgen deprivation therapy was not correlated with the serum levels of androgens or prostate specific antigen. The serum adrenocorticotropic hormone level after androgen deprivation therapy was correlated with the serum levels of testosterone (p = 0.002), dehydroepiandrosterone sulfate (p = 0.002), androstenedione (p = 0.006) and prostate specific antigen (p <0.001). Serum dehydroepiandrosterone sulfate and androstenedione levels were also correlated with serum prostate specific antigen (p <0.001 and p = 0.002, respectively).
Conclusions: In patients treated with androgen deprivation therapy the pituitary-adrenal axis mediated by adrenocorticotropic hormone has a central role in the regulation of androgen synthesis. Serum adrenocorticotropic hormone and adrenal androgen concentrations were correlated with the posttreatment prostate specific antigen. Adrenocorticotropic hormone mediated androgen synthesis is a potential target for advanced androgen deprivation therapy.

DOI： 10.1016/j.juro.2010.06.115

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.canlet.2010.05.015

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

BACKGROUND. Although androgen deprivation therapy (ADT) has a marked impact on the androgen milieu in vivo and outcomes of prostate cancer (PCa), it remains unclear which parameters reflect the androgen milieu during ADT or whether the milieu is associated with PCa aggressiveness.
METHODS. Seventy-two patients with localized PCa were prospectively studied based on their blood samples before and after ADT for 6 months. Serum androgens and related values were measured.
RESULTS. Before ADT, there was no correlation between the serum prostate-specific antigen (PSA) and androgen levels. After ADT, the serum PSA levels were correlated with each level of serum testosterone, dihydrotestosterone, and rostenedione, dehydroepiandrosterone-sulfate (DHEA-S), and 3alpha-diol C (P < 0.010 in all). Before ADT, patients with Gleason score of >= 8 were likely to have lower serum testosterone levels than those with Gleason score of <= 6 (P = 0.058). After ADT, conversely, the testosterone levels in patients with Gleason score of >= 8 appeared to be higher than in those with Gleason score of <= 6 (P = 0.060). The serum DHEA-S level was correlated with Gleason score before and after ADT (P = 0.050 and P = 0.040, respectively).
CONCLUSIONS. The serum PSA levels well reflect the androgen milieu in localized PCa patients receiving ADT, which can be explained by the Saturation Model and disease control. The androgen milieu in men with high Gleason score PCa is probably less affected by conventional ADT than that in men with low score cancer, which was suggested to be associated with adrenal androgen levels. Prostate 70: 1395-1401, 2010. (C) 2010 Wiley-Liss, Inc.

DOI： 10.1002/pros.21174

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objectives: To evaluate the efficacy of clean intermittent catheterization for urinary incontinence in myelodysplastic children.
Methods: The cohort comprised of 38 children (19 boys and 19 girls, aged between 10 months to 16 years) with neurogenic bladder secondary to myelodysplasia. Group A included 16 children who had dilated upper urinary tract or vesicoureteral reflux when clean intermittent catheterization was introduced. The remaining 22 children with normal upper urinary tract were enrolled to group B. In the present study, we defined socially acceptable continence as having completely dry or slight stress incontinence that patients can manage with several small pads.
Results: Of the 16 group A patients, 9 obtained socially acceptable continence by conservative management. Of the 22 group B patients, 11 reported socially acceptable continence by conservative management. Vesical compliance was significantly higher in cases who reported socially acceptable continence than in those with incontinence persistent regarding all participants (10 +/- 7.2 vs 6.8 +/- 6.2 mL/cmH(2)O, P = 0.0347) and group A (9.1 +/- 6.7 vs 3.7 +/- 1.4 mL/cmH(2)O, P = 0.0350). Leak point pressure was significantly higher in patients who obtained socially acceptable continence than in those having persistent incontinence regarding all participants (50 +/- 17.2 vs 25 +/- 6.6 mL/cmH(2)O, P = 0.0003), group A (51 +/- 21.4 vs 26 +/- 7.2 mL/cmH(2)O, P = 0.0348) and also, group B (49 +/- 12.8 vs 23.7 +/- 6.3 mL/cmH(2)O, P = 0.0043).
Conclusion: In our series, socially acceptable continence was obtained in only 20 patients (52%) by conservative management. The present study suggests that the limitation of conservative treatment seems to be apparent when they have urethral closure deficiency and/or intractable poor vesical compliance.

DOI： 10.1111/j.1757-5672.2010.00070.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: The kinetics and reproducibility of serum prostate-specific antigen (PSA) following extended multisite biopsies are unknown. The aim of this study was to examine the kinetics of hematogenous leakage of PSA molecules by comparing the postintervention PSA manner among extended biopsies, transurethral resection of the prostate (TURP) and biopsy plus TURP.
Methods: Total and free PSA values were examined before and sequentially after intervention (at 1 hour, 24 hours, 2 days, 14 days, and 28 days), in patients who underwent 14-core prostate biopsy (Biopsy, n = 53), TURP (TURP, n = 21), or prostate biopsy plus TURP (Biopsy+TURP, n = 18).
Results: Ten patients in the Biopsy group were histologically diagnosed as having prostate cancer, and all other patients were diagnosed with non-malignant disorders. One hour after intervention, the increase in total PSA in the Biopsy group (mean 19.58 +/- 24.78-fold) and Biopsy+TURP group (mean 14.00 +/- 10.52-fold) was higher than that of the TURP group (mean 6.189 +/- 7.567-fold) (P = 0.0207 and 0.0119, respectively). The increase in total PSA in the Biopsy+TURP group was not different from that of the Biopsy group. The increase in free PSA in the Biopsy group (mean 36.52 +/- 21.18-fold or more) was greater than that of the TURP group (mean 15.57 +/- 18.17-fold) (P = 0.0002 or less). Both total and free PSA values in the Biopsy group recovered to the initial levels 28 days after intervention (P = 0.380 and P = 0.0873, respectively). The course of both total and free PSA values in the Biopsy group was not different between prostate cancer and non-malignant disorders.
Conclusions: Extended multisite biopsies caused marked elevation of both total and free PSA compared with ordinary sextant protocol or TURP, and they reduced to the preoperative levels in about 4 weeks. The postintervention increase of PSA and its manner of recovery were comparable between the Biopsy and Biopsy+TURP groups, suggesting that the hematogenous leakage of PSA by biopsies occurs in an early phase just after biopsy and rapidly reduces also in the early phase. (c) 2010 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.urolonc.2008.10.014

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

We experienced a case of parathyroid hormone-related peptide (PTHrP)-producing pheochromocytoma, which was found in a 12-year-old boy with hypercalcemia. The leading symptom was abdominal pain, and severe hypertension and tachycardia were noticed at the initial visit. His medical and familial histories were unremarkable. Laboratory examinations showed hypercalcemia (3.3 mmol/L of serum-calcium). Computed tomography showed a heterogeneous mass measuring 5.0 cm in the right adrenal gland, which had abnormal uptake with 123-I metaiodobenzylguanidine scintigraphy. Serum/urine catecholamines were highly elevated, and serum PTHrP also increased (1.4 pmol/L). The patient underwent laparoscopic right adrenalectomy. The tumor was histologically diagnosed as typical pheochromocytoma and the expression of PTHrP was confirmed with immunohistochemistry. The serum PTHrP level was normalized after surgery. He was free of disease postoperatively for 12 months. There has been no described pediatric patient with PTHrP-producing pheochromocytoma. We showed evidence that the present tumor is a complex neoplasm involving various neuroendocrine activities with the dual-lineage differentiation.

DOI： 10.1111/j.1442-2042.2010.02555.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVES To elucidate the mechanism of blood hemoglobin loss in patients with prostate cancer during androgen deprivation therapy (ADT), and to examine the activity of the growth hormone (GH)/insulin-like growth factor-1 (IGF-1) axis during ADT, which plays an important role in hematopoiesis.
METHODS A total of 83 patients with localized prostate cancer, who received ADT, were prospectively studied on the basis of their blood samples at the baseline and after ADT for 6 months.
RESULTS Before ADT, the IGF-1 level was correlated with the red blood cell (RBC) count (Spearman's rank correlation coefficient analysis [rs] = 0.315, P = .011), hemoglobin (rs = 0.278, P = .018), and mean corpuscular volume (rs = 0.266, P = .020), but such relationships disappeared after ADT. After ADT, the serum IGF-1 level increased compared with that at the baseline (21 +/- 6 vs 18 +/- 5 nmol/L, respectively, P <.001), but no change was observed in the serum GH level (P = .691). There was no difference between erythropoietin and interleukin-6 concentrations before and after ADT (P = .852 and P = .208, respectively). The hemoglobin concentration and RBC count declined after ADT compared with those before treatment (P <.001 for each). Although the mean corpuscular volume declined after ADT (P = .002), the mean cell hemoglobin was comparable between before and after ADT (P = .676).
CONCLUSIONS Despite the unaffected GH, erythropoietin, and interleukin-6 levels, the serum IGF-1 concentration was elevated by ADT. Even with the increased IGF-1 level, the RBC count and hemoglobin concentration declined after ADT. IGF-1 in the bone marrow erythroid progenitor cells might be functionally inactivated during ADT. UROLOGY 75: 1441-1445, 2010. (c) 2010 Elsevier Inc.

DOI： 10.1016/j.urology.2009.11.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Nonocclusive mesenteric ischemia (NOMI) is an infrequent and fatal disorder. We describe a 54-year-old man who developed NOMI during the peritransplant period following ABO-incompatible living-donor kidney transplantation, but who was successfully treated with his renal graft function unimpaired. Abdominal pain appeared on the sixth postoperative day (POD), and emergency surgery was performed on POD 8. Discontinuous segmental necrosis extended throughout the small intestine, and the necrotic segments were entirely removed. He thereafter had ischemia of the ascending colon, which was treated with colectomy, and prostaglandin E1 delivered through the related artery prevented advanced necrosis. Temporary colostomy was closed 20 months after surgery. He maintains excellent graft function at present without secondary disorder. There has been no ABO-incompatible kidney transplant recipient complicated with NOMI. However, patients with end-stage renal disease are at the highest risk for this lethal condition, and physicians and urologists should correctly recognize its diagnostics and therapeutics.

DOI： 10.1007/s10157-009-0232-0

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/TP.0b013e3181c89307

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

BACKGROUND. Although androgen deprivation therapy (ADT) has been associated with bone loss in patients with prostate cancer, its mechanism remains unclear. The growth hormone (GH)/insulin-like growth factor-1 (IGF)-1/parathyroid hormone (PTH) axis plays a critical role in bone synthesis, but its activity during ADT is also unknown.
METHODS. Seventy-one patients with localized prostate cancer, who received ADT, were prospectively studied based on their bone mineral density (BMD) and blood and urine samples at the baseline and after ADT for 6 months.
RESULTS. The IGF-1 level was correlated with BMD before ADT (rs = 0.325, P = 0.007), but such a relationship disappeared after ADT (P = 0.565). Following ADT, the serum IGF-1 level increased compared with that at the baseline (22 +/- 6 nmol/L vs. 19 +/- 5 nmol/L, respectively, P < 0.001). The serum PTH level was reduced after ADT (41 +/- 33 ng/L) compared with the baseline (55 +/- 44 ng/L) (P < 0.001), but no change was observed in the serum GH level (P = 0.691). Bone resorption markers such as blood N-telopeptide (NTx), urinary NTx, calcium, and inorganic phosphorus levels increased after ADT (P < 0.001 in all). The ratio of the IGF-1 level after ADT/before ADT was associated with the ratio of the value after ADT/before ADT of alkaline phosphatase (rs = 0.266, P = 0.025) and calcium (rs = 0.242, P = 0.042).
CONCLUSION. Despite the unaffected GH and upregulated bone resorption, the serum IGF-1 level was elevated by ADT. The IGF-1 level was correlated with BMD before ADT, but the relationship was disrupted after ADT. IGF-1 or its receptor in the bone may be functionally inactivated during ADT. Prostate 70: 155-161, 2070. (C) 2009 Wiley-Liss, Inc.

DOI： 10.1002/pros.21047

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：NATURE PUBLISHING GROUP  

Health-related quality-of-life (HRQOL) after a radical prostatectomy (RP) or external beam radiation therapy (EBRT) has not been studied in conjunction with oncological outcomes in relation to disease risk stratification. Moreover, the long-term outcomes of these treatment approaches have not been studied. We retrospectively analyzed oncological outcomes between consecutive patients receiving RP (n = 86) and EBRT (n = 76) for localized prostate cancer. HRQOL and functional outcomes could be assessed in 62 RP (79%) and 54 EBRT (79%) patients over a 3-year follow-up period (median: 41 months) using the Medical Outcomes Study Short Form-36 (SF-36) and the University of California Los Angeles Prostate Cancer Index (UCLA PCI). The 5-year biochemical progression-free survival did not differ between the RP and EBRT groups for low-risk (74.6% vs. 75.0%, P = 0.931) and intermediate-risk (61.3% vs. 71.1%, P = 0.691) patients. For high-risk patients, progression-free survival was lower in the RP group (45.1%) than in the EBRT group (79.7%) (P = 0.002). The general HRQOL was comparable between the two groups. Regarding functional outcomes, the RP group reported lower scores on urinary function and less urinary bother and sexual bother than the EBRT group (P < 0.001, P < 0.05 and P < 0.001, respectively). With risk stratification, the low-and intermediate-risk patients in the RP group reported poorer urinary function than patients in the EBRT group (P < 0.001 for each). The sexual function of the high-risk patients in the EBRT group was better than that of the same risk RP patients (P < 0.001). Biochemical recurrence was not associated with the UCLA PCI score in either group. In conclusion, low-to intermediate-risk patients treated with an RP may report relatively decreased urinary function during long-term follow-up. The patient's HRQOL after treatment did not depend on biochemical recurrence.

DOI： 10.1038/aja.2009.10

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The tumor de novo in the residual kidney after surgery for nonfamilial bilateral renal cell carcinoma (RCC) is problematic. We reviewed 5 patients who experienced such a situation. Three patients had had metachronous bilateral RCC, treated with radical nephrectomy in one kidney and nephron-sparing surgery (NSS) in the other. Two patients had had synchronous disease
one patient had received radical nephrectomy and NSS, and the other bilateral NSS. The 5 patients had another solid mass/de novo tumor in the residual kidney 16-88 (mean 46.8) months after surgery. For the tumor de novo in earlier years (1992-1999), one patient underwent surgery and hemodialysis, and the other selected a conservative observation. In recent years (2000-2007), one patient was conservatively observed
the remaining 2 received computerized-tomography-guided radiofrequency ablation, and the local tumors were well controlled postoperatively for 20 and 12 months with their renal function unimpaired. Ablative techniques can potentially strike a balance between oncological and nephrological outcomes in patients with sporadic multiple RCC, successful management of which was difficult previously. © 2009 Noboru Hara et al.

DOI： 10.1155/2009/135143

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.eururo.2007.12.035

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objective: To determine the optimum schedule for perioperative antimicrobial prophylaxis (AMP) for bladder cancer patients submitted to radical cystectomy with ileal conduit urinary diversion.
Methods: We studied 77 consecutive bladder cancer patients who underwent radical cystectomy with ileal conduit. The 1-day group (n = 33) received pre-, intra- and postoperative administrations of 2 g of piperacillin on the operation day alone; the 3-day group (n = 44) received antibiotics for 3 days or more (same schedule as the 1-day group on the operation day and every 12 h thereafter). The study was designed and postoperative complications including surgical-site infection (SSI) were defined according to the modified Centers for Disease Control and Prevention criteria.
Results: No significant differences were found between the 1-day group and 3-day group in terms of total SSI (18.1% vs 20.5%), superficial incisional SSI (12.1% vs 13.6%), deep incisional SSI (12.1% vs 13.6%), space SSI (12.1% vs 11.4%), postoperative ileus (18.2% vs 11.4%), febrile urinary tract infections (15.2% vs 15.9%) or pneumonia (3.0% vs 4.3%), respectively. In both groups, disease stage and patients' underlying conditions such as diabetes did not have an influence on the incidence of postoperative complications.
Conclusion: One-day AMP had equivalent efficacy to that of the standard prophylaxis protocol for preventing septic complications following radical cystectomy with ileal conduit. This finding supports the hypothesis that delivery of antibiotics on the operation day is critical in this setting.

DOI： 10.1111/j.1442-2042.2008.02050.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

Background: Solitary fibrous tumor (SFT) is an infrequent but distinct neoplasm, which generally arises from submesothelial connective tissue in the pleura. SFT is rarely recognized in extrathoracic sites, and histologically identical conditions have also been reported in the retroperitoneum, although their pathophysiology has not been extensively investigated.
Methods: We present four cases of primary SFT in the retroperitoneum, and review 37 similar cases in the previous literature.
Results: About 40% of patients were asymptomatic, and 19.2% and 15.4% presented with an abdominal mass and urinary symptoms, respectively. The tumor size ranged between 2 and 26 (mean 9.1) cm. Sixty-three percent of tumors showed nonspecific development with haphazard distribution of bland short spindle or polygonal cells with or without collagenous bundles and stromal hyalinization. In 22.0%, hemangiopericytomatous appearance was seen. About 15% of cases showed histologically malignant characteristics. The tumor cells were immunoreactive for vimentin in all cases, CD34 in 91% and Bcl-2 in 86%. All tumors were excised, and in 85.4% of cases, tumors did not recur postoperatively for 6 to 48 months. No significant difference was found between the recurrence rate of histologically benign and malignant cases. Cases positive for both CD34 and Bcl-2 had no recurrence.
Conclusions: The identification of SFT in the retroporitoneum is of importance because histopathological indicators of malignancy are not necessarily associated with clinical malignant potential in many cases of retroperitoneal SFT. Retroperitoneal SFT showing typical pathological features with expression of CD34 and Bcl-2 is associated with a favorable outcome following excision. (C) 2008 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.urolonc.2007.03.024

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

We present the case of a young lady who developed renal cell carcinomas (RCC) in the allograft and bilateral native kidneys metachronously within one year. She received a living donor kidney transplantation from her father. A solid tumor of 4 cm in diameter was uncovered first in the allograft kidney 103 months after transplantation, and was treated with graftectomy. Six months after graftectomy, a right renal tumor measuring 3.5 cm and left renal tumors emerged in the native kidneys. She underwent laparoscopic right and left radical nephrectomy in separate sessions. The pathological diagnosis in the allograft and right renal tumors was clear cell RCC with eosinophilic cytoplasm and that in the left kidney was clear cell carcinoma. Fluorescence in situ hybridization and human leukocyte antigen typing showed that each tumor was most probably primary disease. She was free of disease 18 months postoperatively. This is the first report on RCC arising both in the allograft and bilateral native kidneys.

DOI： 10.1111/j.1442-2042.2007.01941.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT INST ANTICANCER RESEARCH  

Background: In renal cell carcinoma (RCC), glycosphingolipids monosialosyl globopentaosylceramide (MSGb5) and GalNAc disialosyl lactotetraosylceramide (GalNAcDSLc4) were shown to be predictors of metastasis. Here we extended the research using a larger cohort of patients with a longer follow-up period, and reevaluate their relationship to malignant potential, metastasis and prognosis in patients with RCC. Patients and Methods: MSGb5 and GalNAcDSLc4 were examined in 114 primary RCCs by immunohistochemical method on ctyostat sections. Results: GalNAcDSLc4 was detected in 13.2% of RCCs and was associated with a significantly higher incidence of metastasis at the time of primary visit (60.0% vs. 31.3%, p=0.0419) as well as de novo metastasis during follow-up (33.3% vs. 14.7%), and a shorter survival (p=0.0399). MSGb5 was detected in 51.8% of tumors and was not related to clinocopathological characteristics or survival. Conclusion: RCC patients with tumors positive for GalNAcDSLc4 are at higher risk of metastasis at the time of diagnosis and during follow-up.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE INC  

OBJECTIVES Novel prognostic indexes clinically applicable for patients with Stage IV prostate cancer are needed because prostate-specific antigen (PSA) tests occasionally fail to reflect the prognostic outcome. We investigated various clinicopathologic parameters in men with Stage IV prostate cancer and evaluated the utility of the PSA/prostatic acid phosphatase (PAP) ratio as a prognostic index.
METHODS We reviewed 241 patients with Stage IV prostate cancer, who were treated in Niigata Cancer Center Hospital from 1992 to 2004. Survival Curves were generated using the Kaplan-Meier method. Univariate and multivariate analyses of survival associations, including age, performance status, clinical presentation, disease localization, pathologic findings, and serologic markers, were conducted using the log-rank test and Cox proportional hazard models.
RESULTS The 5-year overall survival rate using the Kaplan-Meier method for all 241 patients was 43.0%. No significant difference was found in the Survival rates according to PSA level. However, the 5-year survival rate was significantly lower in patients with a PSA/PAP ratio of less than 3.0 (P = 0.0022): 24.2% and 48.0% in those with a PSA/PAP ratio of less than 3.0 and 3.0 or greater, respectively. On multivariate analysis using the proportional hazards model, the statistically significant prognostic factors of overall survival were alkaline phosphatase (P = 0.0413), lactate dehydrogenase (P = 0.0409), and the PSA/PAP ratio (P = 0.0113).
CONCLUSIONS The PSA/PAP ratio is a valuable prognostic indicator in men with Stage IV prostate cancer. Although our study found that other laboratory tests also had a prognostic influence, the PSA/PAP ratio was an essential index implicated in the physiopathology of prostate cancer.

DOI： 10.1016/j.urology.2007.05.019

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Objectives: We evaluated prostate-specific antigen (PSA) density of the prostatic volume (PSAD) estimated using transrectal ultrasonography (TRUS; TRUS-based PSAD), magnetic resonance imaging (MRI; MRI-based PSAD), and PSA density of the transition zone (TZ) volume (PSATZD) estimated using MRI (MRI-based PSATZD) in the diagnosis of prostate cancer (PCa).
Methods: One hundred and twenty patients, who were suspected to have PCa based on PSA, ranged between 4.1 and 20.0 ng/mL were enrolled in this study.
Results: The prostatic volume estimated using TRUS was smaller than the volume estimated using MRI by 11.4% in the patients with PSA levels ranging 4.1-20.0 ng/mL, 7.2% in those 4.1-10.0 ng/mL, and 15.7% in those 10.1-20.0 ng/mL, respectively. PSA levels were correlated with the prostatic volume estimated using TRUS and MRI, and TZ volume estimated using MRI in the patients without PCa; however, the level was not correlated with them in the patients with PCa. The area under the receiver operating characteristic curve of MRI-based PSAD was higher than that of TRUS-based PSAD; however, there was no statistical difference. Stepwise logistic regression analysis for the prediction of PCa by using PSA-related parameters confirmed that MRI-based PSATZD was the most significant predictor in patients with PSA levels in the range of 4.1-20.0 ng/mL (P < 0.001), the range of 4.1-10.0 ng/mL (P=0.002), and the range of 10.1-20.0 ng/mL (P < 0.001), respectively.
Conclusions: The prostatic volume estimated using TRUS was smaller than the volume estimated using MRI. MRI-based PSATZD is the most significant predictor in the four parameters.

DOI： 10.1111/j.1442-2042.2007.01686.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Idiopathic retroperitoneal fibrosis (IRPF) is an inflammatory fibrosclerosing condition, leading to renal failure by obstruction of the ureters. Idiopathic chronic pancreatitis associated with marked inflammatory infiltrates has recently been referred to as autoimmune pancreatitis (AIP), and infiltrating plasmacytes carrying immunoglobulin-gamma type 4 (IgG4) are relevant to its pathogenesis. The case is described herein of IRPF associated with subclinical pancreatitis that was most probably AIP in a 70-year-old man. Biopsy specimens of the retroperitoneal pseudotumor revealed a marked lymphoplasmacytic infiltration with dense fibrosis. Infiltrating plasma cells were immunoreactive for anti-IgG4 antibodies. Subsequent systemic examinations showed an extremely elevated serum IgG4 level and pancreatitis concordant with AIP. Following oral steroid administration, the serum IgG4 level normalized, although the appearance of the pseudotumor did not alter. Some AIP cases have been associated with idiopathic fibrosclerosing disorders including IRPF, but histological evidence of IgG4-related IRPF has rarely been provided.

DOI： 10.1111/j.1442-2042.2006.01568.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT INST ANTICANCER RESEARCH  

Background: Genetic alterations of p14(ARF) contribute to dysfunction of p53 pathways by disruption of MDM2-mediated inhibition of p53. P14(ARF) was investigated by focusing on the homozygous deletion (HD) in the INK4a/ARF locus and hypermethylation of the p14ARF promoter in renal cell cancer (RCC). Materials and Methods: Using 6 RCC cell lines, RT-PCR and Western blotting was performed for p14(ARF) DNA from 34 RCCs was analyzed for HD in the INK4a/ARF locus, promoter hypermethylation and p53 gene mutation. Results: HD was confirmed in 4 out of 6 cell lines and in 8 out of 34 (23.5%) RCC specimens, which correlated with the presence of metastasis, high tumor grade and had a tendency to more advanced stage (I vs. II-IV). No hypermethylation of the p14(ARF) promoter or p53 mutation was detected among the RCC specimens. Conclusion: These results indicate that the deletion in the INK4a/ARF locus might contribute to tumor progression in RCC at least partly by functional inactivation of wild-type p53.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Aim: To investigate the outcomes for Asian populations with locally advanced/clinical stage III prostate cancer (PCa) treated with currently prevailing modalities. Methods: We reviewed the record of 209 patients with clinical stage III PCa, who were treated at Niigata Cancer Center Hospital between 1992 and 2003. Treatment options included hormone therapy-combined radical prostatectomy (RP+HT), hormone therapy-combined external beam irradiation (EBRT+HT) and primary hormone therapy (PHT). Results: The 5- and 10-year overall survival rates were 80.3% and 46.1% in all cohorts, respectively. The survival rates were 87.3% and 66.5% in the RP+HT group, 94.9% and 70.0% in the EBRT+HT group and 66.1% and 17.2% in the PHT group, respectively. A significant survival advantage was found in the EBRT+HT group compared with that in the PHT group (P < 0.0001). Also, the RP+HT group had better survival than the PHT group (P= 0.0107). The 5- and 10-year disease-specific survival rates for all cases were 92.5% and 80.0%, respectively. They were 93.8% and 71.4% in the RP+HT group, 96.6% and 93.6% in the EBRT+HT group and 88.6% and 62.3% in the PHT group, respectively. A survival advantage was found in the EBRT+HT group compared with the PHT group (P= 0.029). No significant difference was found in disease-specific survival between the EBRT+HT and RP+HT groups or between the RP+HT and PHT groups. Conclusion: Although our findings indicate that radiotherapy plus HT has a survival advantage in this stage of PCa, we recommend therapies that take into account the patients' social and medical conditions for Asian men with clinical stage III PCa.

DOI： 10.1111/j.1745-7262.2006.00175.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Gastrointestinal stromal tumor (GIST) is the most frequent non-epithelial neoplasm in the gastrointestinal tract. GIST has received much attention both for its clinical significance and biological nature, while the retroperitoneal condition identical to GIST has been rarely described. Presented herein is a case of GIST arising from the retroperitoneum in a 67-year-old man. The solid tumor measuring 4 cm was uncovered in the retroperitoneum, between the abdominal aorta and inferior vena cava, on computed tomography. The patient underwent surgical excision of the tumor. Histological examination showed proliferating spindle cells in the clearly demarcated tumor; immunoreactivity for Kit and CD34 in tumor cells confirmed the diagnosis of GIST. The histological origin of GIST is suggested to be gastrointestinal pacemaker cells, because they share specific immunoreactivity for CD117/Kit, which is also relevant to pathogenesis of GIST. The present case was a rare primary GIST in the retroperitoneum with typical immunopathological features.

DOI： 10.1111/j.1442-2042.2006.01545.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Aim: To assess the efficacy and limitation of free/total prostate-specific antigen ratio (f/tPSA) at a single institution in Japan, focusing on the avoidance of pointless prostate biopsies. Methods: In total, 631 men between 44 and 93 years old (mean 69.8 years) with elevated PSA underwent power-Doppler ultrasoundgraphy-guided transrectal 10-core prostate biopsies at Niigata Cancer Center Hospital, and their histological features were investigated with total PSA (tPSA) and f/tPSA. Results: PCa was detected in 126 of 134 patients (94.3%) with tPSA of 26 ng/mL or higher. The detection rate was 59.4% for tPSA of 21-25 ng/mL, followed by 39.2% for 16-20 ng/mL, 30.0% for 11-15 ng/mL, 20.0% for 4.1-10 ng/mL and 7.6% for <= 4.0 ng/mL. f/tPSA of the PCa group was significantly lower than that of non-malignamt disorders in any tPSA ranges (mean 0.122 vs. 0.160, P < 0.001). Receiver-operating characteristics analyses showed that f/tPSA (AUC: 0.664) performed more valuably than tPSA (AUC: 0.559) in patients with tPSA between 3.0-10 ng/mL (P < 0.01). Although f/tPSA of 0.250 for the cut-off value might miss 1.8% PCa patients, it potentially spares 9.2% of unnecessary biopsies. Conclusion: f/tPSA is more valuable compared with tPSA alone for the prediction of the occurrence of PCa. We recommend 0.250 as the cut-off value for f/tPSA in PCa screening for Asian men having so-called grey-zone tPSA.

DOI： 10.1111/j.1745-7262.2006.00155.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MARY ANN LIEBERT INC  

Purpose: To improve the therapeutic efficacy of extracorporeal shockwave lithotripsy (SWL) for ureteral stones by attempting semilateral/rotated approaches. There has been no study that shows the advantage of rotated positions.
Patients and Methods: Two hundred forty-eight (group 1) and 156 (group 1R) patients with proximal-ureteral stones were treated by the Dornier Lithotriptor U15/50 in the supine and rotated-supine position, respectively. When residual calculi remained in the middle-distal ureter, group 1 subjects underwent subsequent sessions in the ordinary prone position, and Group 1R patients were treated in the rotated-prone position. Sixty-two (group 2) and 60 (group 2R) patients with primary middle-ureteral stones were treated in the prone and rotated-prone position, respectively, while 110 (group 3) and 98 (group 3R) patients with distal-ureteral stones were treated in the prone and rotated-prone position, respectively.
Results: Although the stone-free rate was not different in group 1 (94.8%) and 1R (97.4%), the number of sessions required for Group 1R patients to be stonefree (mean 1.49) was less than for Group 1 patients (mean 1.74; p = 0.023). Group 1R patients tolerated a higher shockwave intensity than group 1 patients for sessions in the proximal ureter (p = 0.042). The stone-free rate for Groups 1 and 1R for booster sessions in the middle-distal ureter was 85.4% and 100%, respectively (p = 0.059). The stone-free rate for groups 211 (95.0%) and 3R (98.0%) was higher than that for groups 2 (83.9%) and 3 (89.1%) (p = 0.046; p = 0.011).
Conclusion: These effortless modifications bring about a superior outcome when treating ureteral calculi with SWL.

DOI： 10.1089/end.2006.20.170

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

We previously reported a case of bilateral ureteral stenosis accompanied by systemic lupus erythematosus, which was successfully managed by total ureteral reconstruction using a segment of the ileum. Herein, we describe an unusual complication in the same patient, which we experienced 5 years after the ileal-ureteral substitution. Left-sided back pain repeated together with transient obstruction of the ileal ureter interposed between the right and left renal pelvis. Consequently, exploratory laparotomy revealed that left colic vessels oppressed and caused obstruction, and the obstructed ileal ureter was released by reconstitution of these vessels instead of re-anastomosis of the ileal ureter. Left hydronephrosis and related back pain disappeared postoperatively. The number of patients with an indication of ileal-ureteral substitution is increasing for various disorders, and thus, the present report gives additional suggestions for the follow up of patients with ileal ureter.

DOI： 10.1111/j.1442-2042.2006.01232.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：TAYLOR & FRANCIS AS  

Objectives. SMemb/non-muscle myosin heavy chain B (SMemb/NMMHC-B) is most abundantly expressed in proliferating smooth muscle cells and correlates with phenotypic changes from a contractive to a proliferative type. The stromal cells of the prostate play a crucial role in the regulation of prostatic growth and function. The aim of this study was to investigate the effects of the multifunctional cytokine transforming growth factor-beta 1 (TGF-beta 1) on SMemb/NMMHC-B mRNA expression and stromal cell growth. The expression of the SM2 isoform of smooth muscle myosin heavy chain (SMMHC) mRNA was also examined. Material and methods. Primary cultures of prostate stromal cells were established by means of an explant method from eight normal prostates. The effects of TGF-beta 1 on stromal cell growth were determined by means of a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide conversion assay. SMemb/NMMHC-B and SM2 mRNA expression were analyzed quantitatively by means of real-time polymerase chain reaction. Results. In the absence of TGF-beta 1, cells expressed alpha-smooth muscle actin and vimentin. After TGF-beta 1 treatment, the expression of alpha-smooth muscle actin increased and cells also expressed desmin. TGF-beta 1 at concentrations of 1.0, 5.0 and 10 ng/ml suppressed cell growth by 72%, 62% and 56%, respectively, downregulated SMemb/NMMHC-B mRNA expression by 71%, 52% and 38%, respectively and upregulated SM2 mRNA expression 2.1-, 3.0- and 5.3-fold, respectively. Conclusions. These results demonstrate that TGF-beta 1 modulates the smooth muscle cell phenotype from a proliferative to a contractile type and that the inhibitory effects of TGF-beta 1 on stromal cell growth correlate with downregulation of the SMemb/NMMHC-B gene.

DOI： 10.1080/00365590500192918

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Mixed epithelial and stromal tumor of the kidney (MESTK) is a rare kidney neoplasm that almost exclusively occurs in perimenopausal women, and long-term estrogen replacement is relevant to its pathogenesis. Herein is described an atypical case of MESTK uncovered in a 12-year-old premenarcheal girl without a history of prior estrogen use. On surgical specimen it was found that the well-circumscribed tumor measuring 14 cm arose from the lower pole of the right kidney, showing solid and fibrous-cystic areas. Microscopically, it was composed both of epithelial structures similar to renal tubules and stroma comprising non-specific spindle cells. Some intratumoral tubules showed affinities to distal-nephron-specific lectins, and those immunoreactive for proximal-tubule-specific CD15 were also present. In addition, primitive ductal structures were reactive both for CD15 and lectins, but immature epithelial elements typical of nephroblastoma were absent. Spindle cells were positive for actin, desmin and vimentin, and expressed progesterone and estrogen receptors. The tumor was comparable with MESTK, although some epithelia were associated with the immunophenotype of proximal tubules. The patient was free of disease postoperatively for 40 months. In the present case, remnants of the primitive periductal mesenchyme might be promoted to neoplastic cells by a sex-steroid surge during puberty.

DOI： 10.1111/j.1440-1827.2005.01888.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING  

Angiomyofibroblastoma (AMFB) and cellular angiofibroma (CA) are angiomyxoid tumors which infrequently arise in the female vulvovagina and each has been proposed to be a distinct clinicopathological entity. The former in male genitalia is exceedingly rare and has been described as its male analog or under the name of male AMFB-like tumor, while the latter in men has not been reported. We describe an angiomyxoid tumor which appeared in the inguinal region of 72-year-old man. The present case had a histopathological characteristic and immunophenotype intermediate between AMFB and CA. Male genital angiomyxoid tumors share many immunopathological features with their female counterparts, suggesting that they are male homologs rather than analogs. Immature mesenchymal cells with a potential of the multilineage differentiation might be promoted toward neoplastic myoblasts, fibroblasts and adipocytes, resulting in genital angiomyxoid tumors showing a broad spectrum in the immunopathological phenotype.

DOI： 10.1111/j.1442-2042.2005.01148.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

We describe an unusual complication caused by urethral catheterization which, to our knowledge, has not yet been reported. A 16 Fr urethral balloon catheter was unintentionally placed into the left ureter through the ureteral orifice in a 51-year-old woman following retropubic suspension surgery for stress urinary incontinence. After retrograde urography from the urethral catheter and removal of the catheter, reoperation was performed and a double pig-tail ureteral stent was placed in the left ureter with subsequent proper replacement of a urethral catheter. The patient had uneventful postoperative recovery. Although the presented accident was an unexpected complication which might be associated with anatomical changes resulting from colposuspension, we should have confirmed the catheter position intraoperatively.

DOI： 10.1111/j.1442-2042.2005.01011.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

BACKGROUND. The aim of this study was to visualize early stage prostate cancer (Cap) in a clinical setting. In previous studies, the results of magnetic resonance imaging (MRI) for screening Cap have rarely been confirmed by well-designed multisite prostate biopsy.
METHODS. The prostate glands of 90 men with elevated prostate-specific antigen (PSA) were imaged by dynamic contrast-enhanced MRI (DCE-MRI) before transrectal ultrasound-guided 14-cores prostate biopsy. Each core was divided into three subcore fractions (total of 42 fractions) to generate a histological localization diagram, which was compared with localization-visualized DCE-MRI.
RESULTS. The detection rate of Cap in 57 patients with PSA < 10.0 ng/ml was 36.8% as determined by the initial biopsy. DCE-MRI uncovered 92.9% of the clinically significant Caps and its specificity was 96.2% for the first biopsy session. One case with positive DCE-MRI and a negative primary biopsy was positive with additional biopsies. All of 26 DCE-MRI positive cases had significant Cap, and two of eight patients with histological Cap and negative or equivocal imaging had significant cancer. In total, 9 of 20 cases with DCE-MRI stage T2 underwent radical prostatectomy. All of them had organ-confined disease, although 33-77% (mean 63%) of them were expected to be rated T3 or higher by Partin's table.
CONCLUSIONS. DCE-MRI can identify early stage Cap with high sensitivity and specificity, and can predict the histological grade to some extent. DCE-MRI prior to biopsy should be applied to younger patients with surgical indications. Otherwise, we recommend the definitive diagnosis of Cap by utilizing DCE-MRI alone. (C) 2004 Wiley-Liss, Inc.

DOI： 10.1002/pros.20124

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

Median raphe cyst (MRC) is a benign lesion occurring predominantly in the ventral surface of the penises of young men and is an embryological developmental anomaly of the male genitalia. Serous borderline tumors (SBT) are found most frequently in the female ovary and only several cases with SBT of the male genitalia have been reported. We describe a case of MRC with features of SBT, which appeared in the scrotum of a 9-year-old boy after orchiopexy and was associated with surgery for cryptorchidism. The cyst arose on the right testicular tunica and consisted of cystic components with intracystic papillae lined by stratified epithelial cells, some of which showed mild cytological atypia and sporadic mitosis. These epithelial cells expressed CA 125, CA 19-9, carcinoembryonic antigen, estrogen receptor and progesterone receptor. Although no cases of MRC with characteristics of SBT in association with the rete testis has been described, the current report gives additional information for follow-up of cryptorchidism.

DOI： 10.1111/j.1442-2042.2004.00965.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

BACKGROUND. Exclusion of prostatitis in screening for prostate cancer (Cap) is a matter of concern in the prostate-specific antigen (PSA) era. Yet, the identification of acute bacterial prostatitis (ABP), intentionally utilizing PSA in patients with pyrexia has been scarcely reported.
METHODS. In total, 39 men, who presented at our department with a fever higher than 38.3degreesC, were randomly selected. We investigated the fraction of patients who had serum PSA levels higher than 4.0 ng/ml and categorized them according to an initial diagnosis of pyelonephritis, ABP, other urogenital infections, and fever of unknown origin (FUO).
RESULTS. Six of nine cases initially diagnosed as pyelonephritis, presented with elevated PSA levels between 9.5 and 75.1 ng/ml. All six cases of clinically diagnosed prostatitis had PSA elevated between 4.1 and 13.6 ng/ml. In 8 of 18 FUO cases, PSA was elevated between 5.1 and 77.0 ng/ml. PSA levels significantly correlated with age (P < 0.005). All 20 patients with elevated PSA received antibiotics, and serum PSA was significantly reduced in all cases (P < 0.001) together with the alleviation of fever and normalization of CRP.
CONCLUSIONS. PSA is a prompt and steady diagnostic tool for identifying ABP that might be missed or misdiagnosed. We recommend the measurement of PSA in cases not only with urologic infection but also puzzling pyrexia. (C) 2004 Wiley-Liss, Inc.

DOI： 10.1002/pros.20077

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

An 18-year-old female, who had undergone antireflux surgery for bilateral vesicoureteral reflux 5 years ago, was admitted to our department with complaints of fever and left-sided back pain. Bilateral renal stones and pyelonephritis were diagnosed after roentgenography, ultrasonography and urinalysis. Pyelonephritis was successfully treated with antibiotics and the left renal stone was completely disintegrated with extracorporeal shock wave lithotripsy. Spectrophotometric analysis revealed that the stone was composed of pure ammonium urate (AU). The patient had not experienced any episodes of urinary tract infection from the antireflux surgery until the present event, but had lost 20 kg in body weight during the last year due to a low-caloric diet and laxative abuse. AU urinary stones have been infrequently reported in Japan, and they are supposed to be associated with a low-caloric diet, laxative abuse, and anorexia nervosa.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BLACKWELL PUBLISHING ASIA  

There are few published reports of low-grade renal epithelial tumor originating from the distal nephron. However, it should not be disregarded clinically, because the actual number of patients with such tumors may be higher than expected. We investigated the immunohistochemical profile of a histologically distinct subtype of such a tumor in detail, in addition to the clinical course and imaging studies. The present study demonstrated that both glandular and spindle cell components of this tumor have a persistent characteristic of an epithelial tumor arising from the distal tubule or collecting duct. This tumor is a benign complex neoplasm that can be treated successfully with radical surgery. Beta-catenin and E-cadherin are suggested to play a crucial role in tumorigenesis and the biphasic arrangement of this neoplasm, concerning the expression of epithelial membrane antigen and carbohydrate antigen 19-9. We suggest that the term 'distal nephron epithelioma' is appropriate for classifying such rare but clinicopathologically distinct tumors.

DOI： 10.1111/j.1442-2042.2004.00754.x

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Seventeen patients were given lower dose and intermittent oral administration of estramustine phosphate (6 mg/kg/day) and etoposide (30 mg/m 2/day) for 7 days. Then administration was discontinued for 7 days. This administration cycle was repeated. Therapy was continued until evidence of disease progression or unacceptable toxicity occurred. Fifteen of the 17 patients were finally evaluated for PSA response. Overall, the pretreatment PSA levels were lowered at least 50% from baseline in 7 (47%) of the 15 patients. The median survival was 65 weeks. Five of the 17 patients complained of anorexia or nausea during the treatment, but none of them showed over grade 2 anorexia, none requiring transfusion or hospitalization. None of the patients showed edema, deep venous thrombosis, thrombocytopenia, anemia or myocardial infarction. Because of its rare and mild adverse effects, this intermittent administration of oral estramustine and oral etoposide may be a useful and secure regimen for hormone refractory prostate cancer.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT INST ANTICANCER RESEARCH  

Background: Nitric oxide (NO) has been suggested to have polar roles in carcinogenesis with both antitumor and tumor promoting activity, and the status of NO synthase (NOS) in renal cell carcinoma (RCC) has not yet been completely elucidated. Materials and Methods: We investigated the expression and induction of inducible NOS (iNOS) in RCC specimens and cell lines, respectively. Results: Although the expression of iNOS was not observed in primary lesions or in metastatic sites, it was found in 6 cases of 11 tumor thrombi. The cause-specific survival rate of patients with iNOS-positive tumor thrombi was lower than that of patients with iNOS-negative tumor thrombi, showing borderline significance. iNOS-mRNA and protein were expressed in A498 and A 704 RCC cells under hypoxic conditions. Conclusion: iNOS is suggested to be a significant molecule for RCC to acquire not only hypoxic adaptation but also the ability to invade into veins and form tumor thrombi.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

Caspases exist as zymogens, and are activated by various extracellular stimuli, leading to apoptosis. One such stimulus is Fas/CD95, a member of the tumor necrosis factor receptor family, providing one means of cytotoxic T lymphocyte (CTL)-mediated cell lysis. Clinical evidence has shown that administration of cytokine leads to regression in selected patients with renal cell carcinomas (RCCs). Interferon-gamma (IFN-gamma) indicates its contribution to anti-tumor activity of immune cells. IFN-gamma elicits its effect through the transcription factor signal transducer and activator of transcription-1 (STAT-1), and through interferon regulatory factor-1 (IRF-1), one of the target genes of STAT-1. Our previous study demonstrated an increase in the susceptibility of ACHN cells, established from RCC, to Fas-mediated apoptosis by IFN-gamma, and the inhibition of this effect by the caspase-3 and -7 inhibitor, DEVD-CHO. We demonstrated the following phenomena in IFN-gamma-treated ACHN cells: 1) enhanced transcription of caspase-1, 3 and 7 m RNAs without any change in cleavage of their substrates; 2) increased cleavage DEVD (specific for caspase-3 and 7), but not YVAD (for caspase-1) or DMQD (for caspase-3), after anti-Fas/CD95 MAb treatment; 3) activation of the STAT-1 and IRF-1 pathway; and 4) partial abrogation of the IFN-gamma-induced increase in Fas-mediated apoptosis by antisense IRF-1 oligodeoxynucleotide. These results suggest that IRF-1 plays a pivotal role in the IFN-gamma-mediated-enhancement of Fas/CD95-mediated apoptosis, through regulation of DEVD-CHO-sensitive caspases, most likely caspase-7. (C) 2003 Wiley-Liss, Inc.

DOI： 10.1002/ijc.10956

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-LISS  

XIAP directly inhibits executor caspases, making it the most downstream antiapoptotic molecule. Here, we examined the expression and function of XIAP in normal urothelium and TCC. We also examined the therapeutic effect of xiap AS PODN on the cell cycle and apoptosis of multidrug-resistant T24 bladder cancer cells. XIAP was moderately expressed in normal transitional epithelium with prominent expression on the superficial layer cells. Seventy-nine of 108 (73.15%) tumor samples were positive for XIAP protein, but XIAP positivity was not correlated with tumor stage or grade. Moreover, 4 bladder cancer cell lines (SCaBER, HT 1376, T24 and RT4) expressed similar levels of XIAP. xiap AS PODN dose-dependently reduced the XIAP protein level and induced apoptosis, leading to decreased cell viability by 87%. Combined administration with doxorubicin resulted in marked cytotoxicity due to escalation of apoptosis. Overexpression of XIAP in T24 cells resulted in a modest but statistically significant (p < 0.01) survival advantage compared to parental cells. Thus, XIAP expression may be critical for maintaining the viability and drug resistance of TCC, and endogenous XIAP levels are sufficient to protect cells from apoptosis. Our results suggest that XIAP may play an important role early in human TCC carcinogenesis. xiap AS may be a candidate for use as a cancer therapy for overcoming drug resistance in highly malignant TCC. (C) 2002 Wiley-Liss, Inc.

DOI： 10.1002/ijc.10776

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Urological Association  

We report a case of retroperitoneal gas gangrene, which was caused by cecal diverticulitis with perforation. A-57-year-old male was admitted to the Sado General Hospital with the chief complaint of right lateral abdominal pain. Roentogenogram and Computelized Tomography (CT) showed gas accumulation in the retroperitoneal space behind the ascending colon. Based on the clinical, labolatory, and instrumental examination findings gas gangrene was diagnosed. Since urolithiasis or urinary tract infection was suspected to be the cause of the lesion at that time. the patient was transferred to our department immediately. CT scan done on day 3 at our inpatient department provided data suspicious for the cecal perforation into retroperitoneal space due to appendicitis or diverticulitis. We performed an acute drainage of the abscess and intensive care including continuous hemodiafiltration (CHDF), oxygen under high pressure (OHP), and chemotherapy with antibiotics was carried out. However. in spite of the above mentioned measures, the patient's condition deteriorated and he died due to progression of gangrene and multiple organ failure in 23 days. The autopsy revealed that the cause of perforation was cecal diverticulitis. Retroperitoneal gas gangrene is an uncommon entity and has been rarely reported. It is supposed that laparotomy with diagnostic and therapeutic purpose should have been performed in this case.

DOI： 10.5980/jpnjurol1989.93.758

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：KARGER  

Background/Aim: Caveolin, which is a major constructive component of the caveolar membranes, plays a key role in transcytosis of molecules into cells and regulation of several signal transductions. Caveolin has three isoforms, and recent studies suggest that in some malignant tumors an alteration of caveolin-1 expression correlates with oncogenetic changes. Caveolins have been reported to be negative regulators of inducible nitric oxide synthase (iNOS) which can provoke an antitumor response via infiltrating immune cells. The aim of this study was to examine the expressions of caveolin-1 and caveolin-3 (which is a caveolin-1 homologue localized predominantly in muscle tissue) in testicular cancer. Methods: We evaluated the expressions of caveolin-1, caveolin-3, and iNOS in 16 seminoma and 10 non-seminoma testicular cancer specimens as well as normal testicular tissue, using a streptavidin-biotin bridge technique on cryostat sections. The expression of caveolin-3 was confirmed by slot-blot analysis. Tumor-infiltrating immune cells were also studied immunohistochemically, and the correlation between the number of immune cells and caveolin-3 concentrations was calculated. Results: Immunohistochemistry revealed that caveolin-3, but not caveolin-1, was frequently expressed in seminomas (12 positive out of 16 specimens) without positive staining in their normal counterparts or in nonseminomatous germ cell tumors, except for muscle components in the teratoma. iNOS was not expressed in any tissues examined. Samples with high levels of caveolin-3 tended to have higher degrees of tumor-infiltrating immune cells, although this finding was not statistically significant. Conclusion: This is the first report demonstrating the involvement of caveolin-3 in germ cell tumors. Copyright (C) 2002 S. Karger AG, Basel.

DOI： 10.1159/000064363

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：英語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.101.330_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：新潟大学  

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記述言語：日本語   出版者・発行元：新潟大学  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：新潟大学  

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記述言語：日本語   出版者・発行元：新潟大学  

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記述言語：日本語   出版者・発行元：新潟大学  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：英語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.96.250_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：英語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.92.299_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：英語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.92.253_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.91.249_2

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

DOI： 10.5980/jpnjurol.91.419_4

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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記述言語：日本語   出版者・発行元：一般社団法人 日本泌尿器科学会  

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