There is still controversy surrounding the indications for performing either a retrograde ureteral stent or percutaneous nephrostomy to manage malignant extrinsic ureteral obstruction (MEUO). We retrospectively analyzed 53 patients who underwent a decompression of MEUO using retrograde ureteral stent. Ureteral stent failure occurred in 18 of 53 patients (34%). Multivariate analysis showed that gastrointestinal cancer as the primary disease, poor preoperative performance status and severe preoperative hydronephrosis were independent predictors of stent failure. Based on the present data, we propose an algorithm for the management of MEUO.

Effects of testosterone on the autonomic receptor-mediated function of the male rabbit urinary bladder and proximal urethra were examined. The alteration of alpha 1-, alpha 2-, beta-adrenergic receptor and muscarinic cholinergic receptor densities in the urinary bladder and proximal urethra were determined by radioligand binding techniques after castration. The density of alpha 1-adrenergic receptor in the proximal urethra decreased gradually after castration. This change was significant 8 weeks after castration. The alpha 2-adrenergic receptor density in the proximal urethra slightly increased after castration, but it was not statistically significant. The beta-adrenergic receptor density in the bladder dome did not change after castration. The density of muscarinic cholinergic receptor in the bladder dome significantly decreased in animals 2 weeks after castration. Additionally, the density of autonomic receptors and the response of muscle strips to autonomic drugs were compared in three age-matched experimental groups: control group, castrated group and castrated and testosterone supplemented group. When the autonomic receptor densities in the castrated group were compared to those of the control, the changes similar to the result in the previous experiment were noted. Testosterone supplementation restored the densities of alpha 1-adrenergic and muscarinic cholinergic receptors in castrated group to control levels. The responses of muscle strips to autonomic drugs closely paralleled the receptor densities. Castration decreased the alpha 1-adrenergic and the muscarinic cholinergic receptor function, however, testosterone restored those function. These findings indicate that testosterone affects the autonomic receptor-mediated function in the smooth muscle of lower urinary tract.

A 71-year-old man was first diagnosed with primary transitional cell carcinoma of the prostate with a skip lesion on the distal urethra. The patient received three courses of intra-arterial chemotherapy of cisplatin (CDDP) and pirarubicin (THP-ADM) followed by a radical prostatectomy. Histopathologic examination of the prostatectomy specimen revealed adenocarcinoma invasion along the prostatic duct extending to the peripheral acini, which was diagnosed as ductal adenocarcinoma. The clinical and histopathologic features of this case are entirely different from usual adenocarcinomas of the prostate. This rare histopathologic feature should be recognized as 'ductal carcinoma of the prostate', to distinguish it from papillary adenocarcinoma or adenocarcinoma with endometrioid features. The patient has had no sign of recurrence 14 months after the operation. CDDP-based chemotherapy followed by radical prostatectomy may be one of the promising therapeutic modalities for this rare entity.

Objectives Cervical myelopathy (CM) and lumbar canal stenosis (LCS) are common degenerative spinal diseases among the elderly, and the major associated complaints include lower urinary tract symptoms (LUTS). The aim of this study was to investigate subjective and objective urological parameters of patients undergoing decompression surgery for CM and LCS. Methods We retrospectively reviewed patients who underwent evaluation by the International Prostate Symptom Score (IPSS) and uroflowmetry before decompression surgery for CM and LCS. Patients with comorbidities that can affect LUTS were excluded. Postoperative changes were evaluated in patients followed up within 1 month. Results Among referrals to urological consultations for LUTS, 231 patients were evaluated preoperatively. Moderate‐severe urinary symptoms (IPSS ≥ 8) were present in 59.8% of 92 CM patients and 64.0% of 139 LCS patients. Poor voiding patterns defined as maximum urinary flow rate <12 mL/s or postvoid residual volume >100 mL were identified in 26.1% of CM and 25.2% of LCS. While IPSS did not associate with disease severity, poor voiders presented with worse Japanese Orthopedic Association scores. Moreover, poor voiders suffered for a longer period of time from orthopedic symptoms due to LCS. In followed‐up patients (CM, n = 32; LCS, n = 47), total IPSS, storage subscores, and voiding subscores were significantly improved after surgery, as was voiding time from uroflowmetry. Conclusions This study demonstrated high prevalence of lower urinary tract dysfunction of CM and LCS as well as short‐term effectiveness of decompression surgery. These results would encourage urologists to consider an orthopedic consultation when lower urinary tract dysfunction is identified in patients with degenerative spinal diseases.