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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  Ectopic prostatic tissue in the bladder has rarely been reported and usually involves the midline in the form of vestigial remains of embryonic prostatic elements. To our knowledge there are only 32 reports on this lesion in the literature in English. Prostatic heterotopia may be endoscopically confused with malignancy in the urinary system. We report three cases of ectopic prostatic tissue at the retrotrigonal area and left ureteral orifice. The patients presented with gross or microscopic hematuria and all the lesions had a polypoid appearance. The histopathologic and immunohistochemical examination revealed the prostatic nature of the tissue. No recurrences were evidenced. The authors review the literature concerning this lesion which should be recognized by urologists and pathologists, who must be aware of its benign nature.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  Unusual causes of acute penis, such as the rupture of a superficial vein of the penis, can mimic fractured penis. The diagnosis in such cases is mostly after exploration. The author describes a case where a high index of clinical suspicion led to the diagnosis of the rupture of a superficial dorsal vein of the penis without exploration. The patient had a successful recovery with conservative management.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  We report two cases of acute urinary retention in women with an impacted pelvic mass. In both cases, all urinary symptoms resolved completely after the surgical removal of the mass.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  We report the first case of malignant retroperitoneal tumor arising in a multicystic dysplastic kidney of an 8-year-old girl with Schinzel-Giedion syndrome. Although conservative treatment has been regarded as the standard management for asymptomatic multicystic dysplastic kidney, prophylactic surgical removal should be considered for selected children with potential risk of malignancy.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Purpose: Vesicourethral anastomosis in laparoscopic prostatectomy is a very difficult procedure. Our purpose in this study was to evaluate a new method using extracorporeal bladder neck traction with nylon thread for vesicourethral anastomosis during laparoscopic radical prostatectomy.Materials and methods: A total of 10 patients underwent laparoscopic radical prostatectomy by this technique, and we evaluated anastomosis time, operative time, and postoperative status of vesicourethral anastomosis.Results: It was possible to shorten both anastomosis time and operative time by this procedure, and to obtain a hermetic anastomosis without higher risk of incontinence, stricture, or leakage.Conclusions: Extracorporeal bladder neck traction with nylon thread is a very useful procedure to carry out easier vesicourethral anastomosis, especially for a surgeon's initial experience in laparoscopic radical prostatectomy.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Electronic Resource

1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Aim: To investigate the prognostic and predictive relevance of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 in patients with transitional cell carcinoma (TCC) of the upper urinary tract.Methods: The expression of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 was examined by immunohistochemistry in 69 patients with TCC of the upper urinary tract. Correlation of p53, Ki-67, MMP-2 and MMP-9 over-expression with conventional pathological parameters and patient survival was examined.Results: p53 over-expression was significantly correlated with histological grade (P 〈 0.05), but not with pathological stage, vascular invasion, lymphatic invasion or lymph node metastasis. Ki-67 over-expression was significantly correlated with stage, grade, lymphatic invasion and vascular invasion (P 〈 0.05). In survival analyses, Ki-67 over-expression was a significant prognostic factor in the univariate analysis (P 〈 0.05), but it did not have a significant impact on survival in the multivariate analysis. Ki-67 labeling index was a significant prognostic factor in patients with a low p53 labeling index, but not in patients with a high p53 labeling index.Conclusion: Ki-67 over-expression is of prognostic value in TCC of the upper urinary tract, while p53, MMP-2 and MMP-9 are of limited value.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Background: We investigated the influence of physicians’ attitudes on the treatment of chronic prostatitis, and attempted to correlate demographic and professional characteristics with patterns of therapy regarding chronic prostatitis.Methods: Probability samples were drawn from the Korean Urological Association Registry of Physicians, and a random sample of 850 Korean urologists were asked to complete a questionnaire which explored practice characteristics, attitudes, and diagnostic and treatment strategies for the management of chronic prostatitis. The returned questionnaires were statistically analysed.Results: Of the 850 questionnaires sent, 302 were returned, and 275 of those were included in the final analysis (response rate 32.4%). Multivariate logistic regression analysis indicated that the type of hospital (P 〈 0.001) and belief that culture tests helped diagnose chronic prostatitis (P = 0.001) were the most determinant factors with respect to the routine performance or non-performance of culture tests. Most Korean urologists (96.4%) prescribed antibiotics for the primary treatment of chronic prostatitis. Even when primary antibiotic treatment was unsuccessful, urologists frequently prescribed a second course of antibiotics (57.8%). In the multivariate model used, the likelihood of prescribing antibiotics as a secondary treatment varied by the type of hospital, with 0.4-fold odds (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.21–0.87; P = 0.019) of the practice occurring in university hospitals, as opposed to primary clinics. According to the same model, the belief that culture tests help to diagnose chronic prostatitis was also an independent influencing factor (OR, 2.29; 95% CI, 1.39–3.77; P = 0.001), whereas the actual performance of culture tests had no statistical significance.Conclusion: Our findings suggest that the personal beliefs and professional characteristics of physicians may influence the diagnosis and treatment of chronic prostatitis in Korea.

Electronic Resource

1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Aim: Heterochromatin polymorphism is considered a variant of a normal karyotype but is more frequent in infertile men. The aim of this study was to evaluate the correlation between heterochromatic variants and male infertility and to discuss the possible mechanisms of how heterochromatic polymorphism might affect spermatogenesis.Methods: Cytogenetic analysis was undertaken in 210 infertile males who had been taken into assisted reproductive techniques and in 183 men with proven fertility. Additionally, C-banding was performed in men with heterochromatin polymorphism. Sperm fluorescence in situ hybridization (FISH) was applied in 54 men with normal karyotype presenting either normal or abnormal sperm parameters as well as in 8 men with heterochromatin polymorphism. The outcomes of assisted reproductive techniques were compared between infertile men with normal karyotype and men with heterochromatin polymorphism.Results: The incidence of heterochromatin polymorphism was higher in infertile men. The most frequent chromosome involved in heterochromatin polymorphism was chromosome 9. Sperm FISH analysis revealed an increased rate of aneuploidy in men with heterochromatin polymorphism. Laboratory and clinical outcomes in assisted reproductive techniques were compromised in men with heterochromatin polymorphism.Conclusions: An increased rate of heterochromatin polymorphism in infertile males seems to be more than an incidental finding, and must not be considered as a normal variant. Polymorphic heterochromatin may have deleterious effects on the genetic constitution of spermatozoa. More attention must be directed to infertile men with heterochromatin polymorphism.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Aim: We used self-completed questionnaires to obtain a longitudinal assessment of urinary continence and urinary, bowel, and sexual domain-related quality of life (QOL) in Japanese patients undergoing radical perineal prostatectomy (RPP).Methods: A total of 41 Japanese patients with a median age of 69 years who underwent RPP between February 2002 and February 2004 were included in the study. We measured QOL by the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and assessed urinary continence on the basis of three different definitions of continence. The International Prostate Symptom Score (I-PSS) was also included to evaluate lower urinary tract symptoms (LUTS).Results: When urinary continence was defined as none, one, or two protective pads per day, 100%, 73%, 94%, 97%, or 100% of the patients were continent before, and 1, 3, 6, and 12 months after, RPP, respectively. When it was defined as total control or occasional dribbling, the corresponding values were 97%, 70%, 84%, 94%, and 97%. Urinary function returned to the preoperative baseline level by 6 months postoperatively and scores for urinary bother had significantly surpassed the baseline by 12 months (P = 0.043). The I-PSS was significantly improved (P = 0.014), with a mean 4.7-unit decrease. Sexual function worsened significantly after surgery, and its recovery was less favorable. No significant change was observed in scores for bowel function or bowel bother.Conclusions: The majority of patients who undergo RPP rapidly regain urinary continence and QOL within 3–6 months. RPP has a favorable impact on LUTS.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  We report the case of a 47-year-old male patient who suffered from a malignant phyllodes tumor of the prostate with invasion to the rectum and urinary bladder. The local recurrence at the left scrotum was identified 6 years after radical cystoprostatectomy. Another 2 years after radical orchiectomy showed no evidence of secondary local recurrence or distant metastasis. Histopathologically, both primary and recurrent tumors showed an admixture of stromal and glandular components. However, while extensive squamous metaplasia was identified in the primary tumor, the recurrent tumor had only focal and mild squamous metaplasia. No dependable prognostic factor has been found to date. Here, we describe the morphological features and immunohistochemical presentations of malignant phyllodes tumor of the prostate and review the literature.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  Proteus syndrome is a very rare and complex disorder with malformations and overgrowth of multiple tissues. This disorder was designated Proteus syndrome by Wiedemann et al. to denote its variable clinical expression. Our patient presented with macrodactyly, cerebriform appearance and a huge abdominal mass. A biopsy under laparotomy was performed, and histopathological examination revealed myelolipoma. Tumor resection was performed. To our knowledge, no case of Proteus syndrome presenting a myelolipoma in the retroperitoneal cavity has been reported before.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  An extremely rare case of a primary carcinoid tumor arising in a mature retroperitoneal teratoma is reported. A 53-year-old woman was admitted for further examination of an incidental retroperitoneal mass with calcification. Computed tomography scans demonstrated a tumor with fat, soft tissue and bone densities on the left renal hilum. Surgical excision of the tumor was performed with a preoperative diagnosis of retroperitoneal teratoma. The pathological diagnosis was mature teratoma, including all three germ layers. A carcinoid tumor was evident among teratoid tissues and it was thought to be a teratoma with malignant transformation. The patient did not have a carcinoid syndrome and had an uneventful recovery. She has been followed for 31 months with no recurrence. Carcinoid tumors rarely occur in teratomas of the ovary and the testis and, to our knowledge, this is the first case of carcinoid arising in a retroperitoneal mature teratoma.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Electronic Resource

1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Aim:  Hemorrhagic cystitis (HC) is a limiting side-effect of chemotherapy with ifosfamide (IFS). In the study presented here, we investigated the use of dexamethasone in combination with mesna for the prevention of IFS-induced HC.Methods:  Male Wistar rats (150–200 g; 6 rats per group) were treated with saline or mesna 5 min (i.p.) before and 2 and 6 h after (v.o.) administration of IFS. One, two or three doses of mesna were replaced with dexamethasone alone or with dexamethasone plus mesna. Cystitis was evaluated 24 h after its induction by the changes in bladder wet weight and by macroscopic and microscopic analysis.Results:  The replacement of the last dose or the last two doses of mesna with dexamethasone reduced the increase in bladder wet weight induced by IFS by 84.79% and 89.13%, respectively. In addition, it almost abolished the macroscopic and microscopic alterations induced by IFS. Moreover, the addition of dexamethasone to the last two doses of mesna was more efficient than three doses of mesna alone when evaluated microscopically.Conclusion:  Dexamethasone in combination with mesna was efficient in blocking IFS-induced HC. However, the replacement of last two doses of mesna with saline or all of the mesna doses with dexamethasone did not prevent HC.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract Acute scrotum is a common clinical problem and establishing its etiology can be difficult, often necessitating scrotal exploration. We report here a very rare case of acute scrotum: torsion of the epididymis. Only one such case has been reported previously in the literature.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract We report a case of aldosterone-producing microadenoma that was correctly diagnosed and thus treated less invasively by laparoscopic adrenalectomy. A 58-year-old woman presented with palpitation and muscular weakness. She exhibited hypertension, hypokalemia and increased aldosterone excretion with suppressed renin activity. Therefore, primary aldosteronism was suggested. Although adrenal scintigram and computed tomography findings in the adrenal glands were normal, adrenal venous sampling tests indicated an overproduction of aldosterone in the right adrenal gland. We diagnosed an aldosterone-producing microadenoma in the right adrenal gland and performed an adrenalectomy. The patient became normotensive postoperatively and histopathological examination demonstrated a microadenoma, 5 mm in diameter.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

We report the case of a bilateral, relatively huge, multilocular spermatocele diagnosed at sonography with surgical and pathological correlation. A 45-year-old man presented with bilateral, large inguinoscrotal masses. He had had the masses since his adolescence and their size gradually increased in the past 5 years. Scrotal ultrasonographic examination showed cystic fluid masses that were 65 × 45 × 50 mm in size on the right and 55 × 45 × 40 mm in size on the left side in multilocular spaces. The cystic masses were excised via bilateral inguinoscrotal incision staying near the body of the epididymis. The patient had fathered three children with no fertility problem.

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1442-2042

Blackwell Publishing Journal Backfiles 1879-2005

Medicine

Abstract  A 59-year-old man presented with a 2-month history of left flank pain and a possibility of gross hematuria. Left renal cell carcinoma stage II was diagnosed and radical left nephrectomy was performed. Twenty-two months postoperatively, lung metastases were demonstrated and 6 × 106 units of α-interferon (IFN-α) were administered for 9 months, only to keep the sizes of the metastases unchanged. Thirty-four months after the operation, liver metastases and bone metastasis in the left sacroiliac joint were revealed. The combination cytokine therapy was performed with 1.4 × 106 U of interleukin-2 (IL-2) and 3 × 106 U of IFN-α for 16 weeks, and the left sacroiliac joint metastasis was treated with radiation therapy of 4 Gy per day for 7 days. Six months after the 16 weeks of immunotherapy, computed tomography and bone scintigraphy revealed that the metastases of the lung, liver and bone substantially disappeared and this complete response is still kept after 16 months.

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