Masako Kawakami

Prostate-specific antigen, Gleason sum and clinical T stage for predicting the need for radionuclide bone scan for prostate cancer patients in Japan.

Abstract

Importance of Transition Zone Prostate Biopsies in Patients with Gray-Zone PSA Levels Undergoing the Ultrasound-Guided Systematic Ten-Biopsy Regimen for the First Time

Introduction: We analyzed the efficacy of routine transition zone biopsies for patients undergoing ultrasound-guided systematic prostate biopsies for the first time because of an elevated serum prostate-specific antigen (PSA) level. Patients and Methods: Using the systematic ten-biopsy regime, four additional transition zone biopsies were performed in 236 consecutive patients, because they showed an elevated PSA level (range 4.0– 9.9 ng/ml). Results: The overall prostate cancer detection rate was 21.2% (50/236). In 24 patients (48.0%), cancers were detected only in the peripheral zone, in 4 (8.0%) only in the transition zone, and in 22 (44.0%) in both zones. No distinguishing characteristics could be determined for the cancers detected in the transition zone only. Conclusions: Although the cancer detection rate for the transition zone was significantly lower than for the peripheral zone, it was higher than that reported in most other studies which may have included biopsy specimens from patients with advanced prostate cancers. The usefulness of transition zone biopsies for the detection of early-stage prostate cancer, especially in patients with a PSA gray zone, can, therefore, not be denied.

Tobacco use and occupational exposure to carcinogens, but not N-acetyltransferase 2 genotypes are major risk factors for bladder cancer in the Japanese

Abstract Our study investigated the risks of genotypes of N-acetyltransferase 2 (NAT2), tobacco use and/or occupational exposure to carcinogens in patients with bladder cancer and in age- and sex-matched controls in Japanese. NAT2 genotypes were categorized into two groups, homozygous mutant (slow acetylator genotype) and homozygous and heterozygous wild type (fast acetylator genotype). The percentage of NAT2 slow acetylator types was 6.7% in the bladder cancer patients, close to the value for controls (6.1%). There was no association between NAT2 slow acetylator genotype and the risk of bladder cancer. This association was also insignificant when subjects were restricted to those who used tobacco or those occupationally exposed to carcinogens. In contrast, tobacco use in combination with exposure to carcinogens was a significant risk factor, as based on the odds ratio and chi-square test. The combination of both factors should be an additive risk factor for bladder cancer. In this study, we demonstrated that the environmental factors of smoking habit and occupational exposure for carcinogenicity are much more important than genetic factors in bladder cancer.

Successful treatment of arterial priapism with radiologic selective transcatheter embolization of the internal pudendal artery

We report our successful treatment of arterial priapism by means of radiologic selective transcatheter embolization of the internal pudendal artery using an absorbable gelatin sponge (Spongel).

Leiomyosarcoma of the urinary bladder in a patient with bilateral retinoblastoma.

Abstract:  We report a case of bladder leiomyosarcoma in a 27‐year‐old woman who had previously been treated with surgery and radiation for bilateral retinoblastoma. The patient was admitted to hospital with discomfort on micturition. Cystoscopy revealed a bladder tumor covered by normal urothelium. Transurethral resection of the bladder tumor was performed, and the histopathological diagnosis was leiomyosarcoma. Partial cystectomy was performed. The leiomyosarcoma of the bladder did not invade the muscle layer. However, bladder tumors recurred at new intravesical locations repeatedly. After transurethral resection of the bladder tumor had been performed twice, total cystectomy and creation of an ileal conduit were performed.

Rupture of urachal diverticulum in radiation cystitis and neurogenic bladder dysfunction after radical hysterectomy

Abstract  We experienced a rare case of the rupture of the urachal diverticulum in radiation cystitis and neurogenic bladder after radical hysterectomy. A 61‐year‐old woman presented with severe lower abdominal pain and urinary retention. Abdominal computed tomography revealed that the urachal remnant contained a large volume of urine that leaked to subcutaneous tissue. We excised the urachal diverticulum and bladder together and created a continent urinary diversion using transverse colon. Nine months after the operation, the patient could manage clean intermittent self‐catheterization 6 times a day through her umbilical stoma without any urinary complications.

A clinical and pathological study of radical prostatectomy for prostate cancer

BACKGROUND Thirty-one patients with prostate cancer underwent radical prostatectomy and simultaneous pelvic lymphadenectomy at Matsumoto National Hospital between 1988 and 1994. Prognostic factors are discussed from their clincopathological findings. METHODS The patients ranged from 54 to 80-year-old, with an average age of 69.9 years. The median follow-up period was 44 months. The diagnosis was confirmed by needle biopsy or transurethral resection of the prostate. All the patients received short-term endocrine therapy preoperatively, and only noncuratively resected patients underwent adjuvant therapy postoperatively. At initial diagnosis, the tumor grades were well, moderately, and poorly differentiated adenocarcinoma in 9, 12, and 10 patients, respectively. The clinical stage was defined as A2, B, C, D1, and D2 in 12, 4, 6, 3, and 6 patients, respectively. RESULTS A difference of tumor grade was found between the initial diagnosis and the final diagnosis based on the resected prostate in 8 patients (26%), with 7 of them (88%) showing an increase in grade in the final diagnosis. Also revealed was that 11 of the 25 patients (44%) in stage A2, B, C, or D1 had been understaged preoperatively. The five-year actuarial survival rates were 100%, 92%, and 51% for patients with well, moderately, and poorly differentiated adenocarcinoma, respectively, with a significant difference noted between well and poorly differentiated adenocarcinoma (p = 0.03). Recurrence only developed in patients with pathological stage D tumors. However, the presence or absence of lymph node metastasis did not affect the crude 5-year survival rate. Several stage D patients were successfully treated by radical prostatectomy and adjuvant therapy, achieving long survival. CONCLUSION These results indicate that patients in clinical stage C have tumors which exhibit differing biological behavior. These patients should be analyzed and classified more precisely so that the most appropriate therapy can be chosen.

A Free Smooth Muscle Graft for a Continent Urinary Conduit in Dogs

We constructed a continent, catheterizable urinary conduit using a smooth muscle graft in dogs. One end of an isolated vascularized ileal segment was anastomosed to the bladder dome, and the other end was opened in the abdominal wall. The ileal conduit was tightly encircled with a free seromuscular flap of the ileum in 6 dogs and with a similar flap of colon in 6 other dogs. All smooth muscle grafts were alive 6 months after the operation. Pressure study showed that all but one ileal conduit had a pressure of more than 30 cm of water. Two dogs with a free ileal graft leaked urine when the bladder pressure increased, whereas all dogs with a colonic graft never leaked urine from the stoma. This smooth muscle graft will be available to reinforce the continent action of a plicated or narrowed intestinal tube for a urinary reservoir.