Hiromasa Yaguchi

Spinal substance P immunoreactivity is enhanced by acute chemical stimulation of the rat prostate.

OBJECTIVES To investigate the role substance P (SP) plays in prostatic inflammation, we evaluated SP immunoreactivity within the spinal cord after irritation of the prostate. Because alpha-adrenergic blockade attenuates nociceptor-induced pain, the effects of an alpha-adrenergic blocker on SP immunoreactivity were also evaluated. SP is considered a mediator of nociception in the spinal cord. Immunoreactivity of SP is enhanced after acute chemical stimulation of somata. METHODS Rats received chemical irritation of the prostate with or without pretreatment with tamsulosin. They were killed after 1 hour, and immunohistochemical staining for SP was performed. SP immunoreactive areas were quantified in the dorsal spinal cord of the L5 to S2 segments. RESULTS Chemical irritation of the prostate increased SP immunoreactive areas in the L6 to S2 segments. Enhancement was observed in the whole dorsal spinal cord regions. This enhancement was significantly attenuated by tamsulosin in the L6 and S1 segments. CONCLUSIONS SP probably plays a significant role in mediating nociceptive processing from the prostate. Tamsulosin can attenuate nociception-induced SP upregulation within the spinal cord.

Acute Hemorrhagic Cystitis Caused by Adenovirus after Kidney Transplantation

We report on 10 kidney transplant patients with acute hemorrhagic cystitis caused by adenovirus, accompanied by the deterioration of kidney function. They developed macrohematuria with urgency, frequency and micturition pain for more than 7 days within 1 year after transplantation. Adenovirus type 11 was isolated from the urine of 6 patients, and complement-fixing antibody became positive in 9 patients. Hematuria and irritative voiding symptoms disappeared without any specific treatment; however, serum creatinine rapidly increased. The histological findings of the biopsy specimens indicated that renal impairment was attributed to acute rejection in some cases and virus-associated nephropathy in other cases. Acute hemorrhagic cystitis caused by adenovirus is an interesting complication after kidney transplantation, especially with regard to kidney impairment and treatment.

Schwannoma of the penis

A schwannoma located in the penile shaft in a 74-year-old patient is described. A review of the schwannoma of the penis is presented and the importance of the S-100 protein stain is stressed.

Skene's duct cyst in adult women: Report of two cases

Skenes duct cysts in the adult are uncommon lesions. Complete urologic examinations are necessary because these lesions simulate other clinically important lesions. Herein we report two cases of Skenes duct cyst in adult women. In these cades we could make differential diagnosis by physical, radiological and endoscopic examinations.

Down's syndrome associated with seminoma in undescended testis.

In patients with Downs syndrome, the coincidence of testicular cancer with the syndrome has recently been emphasized. We present a case of Downs syndrome associated with seminoma in undescended testis and discuss the relationship between testicular cancer and Downs syndrome.

The effect of triathlon on urinary excretion of enzymes and proteins.

In order to investigate the effect of triathlon and renal function of normal subjects, we evaluated the excretion of urinary enzymes and proteins before and after triathlon. From 6 subjects samples were obtained 24 hours after the first urine collection. We performed quantification of urinary total protein, β2-microglobulin (β2-M), N-acetyl-β-D-glucosaminidase activity (NAG), and concentration of urinary creatinine from each participant. There was a significant increase in urinary total protein excretion immediately after triathlon (p<0.01). The urinary β2-M and NAG excretions after triathlon were higher than the initial values. Post-exercise proteinuria in one subject persisted until the next morning, whereas the increased excretion of urinary β2-M and NAG returned to the pre-exercise level at least 24 hours after triathlon. It appears to be reasonable to presume that glomerular damage may persist in some subjects who do heavy exercise.

OSTEOSARCOMA OF THE BLADDER SUCCESSFULLY TREATED WITH PARTIAL CYSTECTOMY

A 55-year-old man presented in May 1995 with hematuria, dysuria and urinary frequency 3 weeks in duration. Physical examination was unremarkable and blood chemistry studies were normal. Serum calcium was 8.9 mg./dl. (normal 8.5 to 10). Excretory urography demonstrated a calcification in the bladder (fig. 1, A). A large calcified bladder tumor was evident on cystoscopy. The specimen from transurethral biopsy of the tumor revealed osteosarcoma. Computerized tomography of the pelvis showed a large calcified mass arising from the right posterior wall without clear evidence of invasion (fig. 1, B). Other localization studies, including chest x-ray and bone scan, were unremarkable. Because the patient declined radical cystectomy, partial cystectomy was performed in June. Gross examination of the surgical specimen revealed a firm 5 3 5 3 6 cm. mass with calcification (fig. 2, A). The edge and boundaries of the tumor were well demarcated. Microscopic examination revealed malignant osteoblasts with a moderate number of mitotic figures, and stroma associated with osteoid and atypical woven bone formation (fig. 2, B). No transitional cell carcinoma or carcinosarcoma elements were evident. Bone elements were randomly deposited throughout the tumor with adhesion of cytologically malignant cells. There were no areas of necrosis. The tumor had invaded the subepithelial connective tissue but not the muscle layer. The margin of resection was free of tumor, and no adjuvant therapy was performed. The patient was well and with no evidence of tumor recurrence at 36-month followup.

Penile block via subpubic space for children who underwent superficial operation of the penis

Penile nerve block via the subpubic space was performed to relief the postoperative pain of children who underwent superficial surgery of the penis. Thirty-one male children were subdivided into two groups. After dorsal split procedure had been carried out under general anesthesia, 16 patients underwent subpubic penile nerve block (group 1), while 15 patients had no additional anesthetic procedure (group 2). Time to the first postoperative pain in group 1 was statistically longer than that in group 2 (p < 0.05). Most patients in group 1 did not require postoperative analgesics during the first 24 h after surgery. This technique appeared to be effective in relieving the postoperative pain of children who underwent superficial operation of the penis.

Mixed Prostatic Carcinoma Containing Malignant Squamous Element

Two cases of mixed prostatic carcinoma are reported. A 67-year-old man with mixed urothelial and squamous cell carcinoma died 10 months after diagnosis despite hormonal therapy and pelvic irradiation. A 70-year-old man with adenosquamous carcinoma responded well to such treatment.

Retroperitoneal Schwannoma Extending into the Intravertebral Foramen

A 35-year-old Japanese man first visited the hospital for episodes of numbness in the right medial femoral region and loss of muscular strength in the right thigh. A CT scan of the abdomen showed a 10 × 9-cm well-circumscribed in homogeneous multilayered mass, in contact with the lumbar vertebrae. MRI demonstrated a hypodense and hyperdense mixed mass. Tumor extension into the L2/L3 intravertebral foramen was shown. To avoid spinal cord damage, we chose enucleation of the tumor in the intravertebral foramen. A follow-up CT after 1 year showed no evidence of a recurrent mass. In conclusion, we advocate the nerve-sparing operation in cases like that of our patient.